Dissertations / Theses: 'Acute psychiatry'

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Williams, Jenny, and n/a. "Ethics in acute psychiatry : a case study." University of Canberra. Professional & Community Education, 1996. http://erl.canberra.edu.au./public/adt-AUC20061110.143655.

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This workplace study examined the every day ethical dilemmas of a multidisciplinary team in one acute psychiatric setting and the social factors affecting their moral domain of practice. The research design was a case study involving both qualitative and quantitative data. The context that shaped the team's process of ethical dilemma identification was conceptualised for the purpose of this research within a systems theory framework of interrelated factors at a societal, organisational and clinical level with ethics theory pervading the entire scene. The findings indicated that dilemmas arose in situations concerning patient care, team strain, and limited resources with the most common dilemma across disciplines arising from lack of community resources. Further findings suggested that clinicians were aware of various forces shaping practice but these ideas were not well connected conceptually. Staff felt wary of identifying ethical dilemmas because they were unsure of the process and sensed a reticence in the unit's social processes around negotiation and problem solving. Important social factors that were perceived to affect their abilities around ethical dilemma identification included rational economics, professional socialisation, medical-legal monopoly with a concomitant use of the ethic of justice, and managerial strategies. The concept of transference and countertransference issues within the staffing group was explored. These results are useful for the team to understand the nature of their own particular dilemmas and what factors constrain and enhance their abilities to identify dilemmas. Other health care settings may find that replication of the research results in a similar way may raise awareness of their moral situation. Generalisability at a theoretical level contributes to the current research agenda in applied ethics about the effect of context in the ethical domain of clinical practice.

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Michael, Benedict. "Detection and diagnosis of acute viral encephalitis." Thesis, University of Liverpool, 2014. http://livrepository.liverpool.ac.uk/2003409/.

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Introduction Acute viral encephalitis is a severe form of brain inflammation due to sporadic infection, typically with herpes simplex virus, or epidemic/pandemic infections. Epidemiological data are particularly important for pandemic viruses. Although new reporting approaches are often considered, no real-time clinical data collection tool has been developed. These data are dependent on diagnosis of individual cases. However, the aspects of management that result in delays and missed diagnoses are not clear and it is not known if interventions can improve sample collection and diagnosis. Whilst the importance of cytokines and associated mediators is increasingly recognised, signatures associated with specific aetiologies have not been established. Also, it is not known whether these mediators correlate with clinical severity and outcome, or their impact on blood-brain barrier permeability. Methods I undertook a national surveillance study through neurology networks, and investigated alternative notification approaches. I undertook a multicentre cross-sectional study of clinical investigation, studied viral load and assessed the impact of a lumbar puncture pack. I used bead array to assess mediator profiles and assessed the albumin ratio and viral load, in samples from a Health Protection Agency study. I examined profiles with respect to aetiology, disease severity and outcome and compared this with histopathology tissue and a blood-brain barrier model. Results In the context of a pandemic influenza virus, existing mechanisms identified limited cases, and a smartphone application was developed to collect real-time data. Delays in lumbar puncture and sub-optimal sample collection were identified, in association with a lower viral load. A lumbar puncture pack improved sample collection. Mediator profiles differed between those with an infectious versus immune-mediated aetiology, and those of unknown aetiology best reflected infectious; particularly myeloperoxidase, in part relating to neutrophils in cerebrospinal fluid and parenchyma. The interleukin1 antagonists, IL1RA and IL10, were associated with coma and outcome; and IL10 with reduced blood-brain barrier permeability. Adhesion molecules may counteract this, in both clinical samples and the model. Conclusions Current limitations of detection may be augmented with novel real-time technologies. Diagnosis is limited by delayed and sub-optimal sample collection, which can be improved with a simple pack. Mediators profiles may assist in the distinction of infectious from immune-mediated encephalitis, and cytokines that act against IL1 correlated with clinical severity and outcome. This may be more closely associated with outcome than viral load, although this may reflect sample timing. These findings should direct future research to develop approaches for improved diagnostics and adjunctive therapies.

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Forsey, Mary. "Brief group therapy for psychosis in acute care." Thesis, University of Liverpool, 2013. http://livrepository.liverpool.ac.uk/13073/.

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Introduction Individual cognitive behaviour therapy for psychosis (CBTp) is a recommended treatment in the acute phase and beyond. However, less is known about the effectiveness of group CBTp in acute care. This mixed methods study explored the implementation and effectiveness of brief group CBTp with inpatients. Methods This prospective trial compared inpatients who received either a four week group CBTp program or treatment as usual (TAU). Participants (n=113 at baseline) completed self-report measures of distress, confidence and symptoms of psychosis at baseline, post-intervention and one month follow up. CBTp group participants also completed a brief open-ended satisfaction questionnaire. Results Participants who received CBTp showed significantly reduced distress at follow up compared to TAU and significantly increased confidence across the study and follow up period. Qualitative analysis of the satisfaction data revealed positive feedback with a number of specific themes. Conclusion The study demonstrates that brief group CBTp with inpatients can improve confidence and reduce distress in the longer term. Participants report that the groups are acceptable and helpful.

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Lees, Rosalind A. "Describing cognitive and mood assessments in acute stroke." Thesis, University of Glasgow, 2016. http://theses.gla.ac.uk/7128/.

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Background Stroke is the foremost medical condition responsible for acquired disability and dependency. The initial psychological and physical deficits should arguably be identified early to allow interventions to be put in place if potential long-term sequelae are to be minimised. Physical impairments within stroke cohorts have been extensively researched and reported. We have access to numerous scales that describe general physical functioning during daily activities and its effects on independence and quality of life. Deficits in movement are easily identified and attributes of physical movements can be associated with such obvious measurement terms as strength, speed, co-ordination and task completion. As these attributes can be graded, it is simple to compare patients over time, within stroke cohorts and against the general population: controlled studies are straightforward, even if natural biological variation demands large samples. However, though physical impacts on a patient may be easily observed and measured, corresponding deficits in cognition and mood are less easily detected and quantified. Psychological problems are common within stroke populations, and exert both short and long term effects throughout all stages of rehabilitation. Despite our awareness of the potentially critical effects of psychological factors on patient outcome, there is a dearth of high quality research in this area. Although many cognitive and mood assessments are available, including some that were developed specifically for use in stroke, these are neither regularly administered nor have been convincingly shown to be accurate and reliable in identifying specific deficits. Thus, it is understandable that research available to us that describes prevalence and effects of cognitive and mood problems post-stroke is sparse in comparison to our knowledge of physical deficits. Methodology In order to begin to understand the effects that cognition and mood have on patient outcome post-stroke, a way of identifying prominent issues is required. Knowing that their effects can have both short and long term impact, reliable screening beginning early after stroke onset could offer opportunities to improve patient outcome through early implementation of interventions. Before an appropriate screening tool can be selected, evidence is required to support its feasibility and accuracy within acute stroke cohorts. In this thesis, I investigate cognitive and mood-screening assessments in stroke, across a series of linked projects. I carried out a review of the current research and I surveyed stroke units to identify which cognitive and mood assessments are commonly implemented. I collated and offer synthesis of the published data on accuracy of cognitive assessment instruments. I used these results to inform a diagnostic test accuracy study, examining selected measures that are commonly used in UK practice to screen for cognitive and mood problems. Based on these results, I designed (and was awarded grant funding for) a clinical study to assess test properties of cognitive and mood screening instruments in a rehabilitation setting and to describe potential obstacles affecting patient assessment. Findings There is heterogeneity in the choice of cognitive and mood tests employed across research and clinical practice. There was some overlap in assessment choice within these domains but no clear consensus on a preferred assessment tool. This is in part explained by the substantial number of tests available, it is telling that the most popular assessments accounted for only a fraction of the tool assessments employed. My literature based work also points to a relative lack of published science employing a cognitive or mood assessment tool. My review of diagnostic test accuracy found that properties of cognitive tools commonly used in practice and research (Folstein’s Mini Mental State Examination: MMSE, the Montreal Cognitive Assessment: MoCA, the Addenbrookes’ Cognitive Examination Revised: ACE-R and the Cambridge Cognitive Examination revised: R-CAMCOG) were susceptible to changing populations and purpose of assessment, with test properties differing when screening tools are used in acute and chronic stage of stroke. Depending on the cut-offs that are used to define “screen positive” cases, these tools would have varying ability to identify multi=domain cognitive impairment or dementia. Generally when applying standard (i.e. the traditional cut-off described for test use in an unselected population) cut-offs, sensitivity was good but specificity was low. Specificity could be improved when the cut-offs were altered while maintaining reasonable sensitivity and this suggests that screen positive thresholds may need to be altered to suit a stroke population The need for lowering our standard cut-offs suggests that there may be factors present in typical acute stroke patients which affect assessment accuracy compared to the populations and purpose for which these scales have been developed. Using the MOCA in the acute setting of my clinical study, confirmed that stroke cohorts require altered cut-offs to improve accuracy in cognitive impairment detection. A stroke cognitive assessment that can be derived from a standard neurological examination *the Cog4) has been described. Cross sectional comparison of MoCA and Cog 4 suggest that Cog4 has questionable validity and stroke specific cognitive measures are required since scores derived from other types of measures are not necessarily testing the most appropriate domains for stroke deficits. A lack of published data on cognitive and mood screening in the first days post-stroke suggested that describing the feasibility of assessing stroke patients in an acute setting would be a useful topic for research. My subsequent clinical study incorporated verbal and non-verbal assessments for mood and the MOCA. As well as usual test accuracy outcomes I considered feasibility issues such as proportion of patients suitable for initial approach, acceptance of assessment, prevalence of common stroke related impairments that mandate assistance or cause difficulty in completing assessments, or that preclude assessment altogether. A moderate proportion of patients who were approached declined to take part and several others required external assistance to complete the assessments. Shorter, less cognitively demanding assessments required less assistance and appeared to offer higher accuracy for predicting mood problems at follow-up. These results suggest that delaying cognitive and mood assessments until later during the post-stroke period may reduce the interference from acute stroke deficits. The final piece of work generated from my PhD studies, and that is ongoing, continues the theme of feasibility of cognitive and mood assessments. Cognitive and mood assessments are performed in stroke rehabilitation centres. The rehabilitation setting was chosen, as it will include varying patterns of physical and cognitive impairment. By comparing brief assessments and more lengthy measures of cognition, I hope to identify the most appropriate testing scheme that minimises patient burden. As part of this work I will describe the impact of stroke deficits on assessment and quantification of the patient’s psychological capabilities. Conclusions In conclusion, these studies have demonstrated a lack of guidance and of protocols for cognitive and mood assessment post-stroke. The evident heterogeneity in choices of assessment in research and usual practice indicated a need for evidence based accuracy studies. In conducting these I found that usual measures are susceptible to the population, timing, and cut-off used to define test positive cases, together indicating undesirable sources of variation. Transient stroke-related problems may lead to overestimation of persistent impairments. Although acute screening of cognition and mood would be possible, such screening may not be widely acceptable to patients and would require a high level of assistance from health professionals. Acute screening should only be performed if there are potential benefits that could impact on the patient from identification of cognitive or mood problems at this early stage. With the transient changes in cognition and mood that the majority of stroke survivors experience, screening is best left until later in the patient journey. However, there may still be potential feasibility issues of administration and assessment completion during later stages. Therefore, I suggest that studies that investigate what assessments are feasibly administered to stroke patients in later stages are required. This will inform future trial recruitment for complete data requirements as well as provide clearer picture of stroke survivors’ affected cognitive domains and or mood problems.

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McCormick, Michael Thomas. "Hyperglycaemia, insulin and acute ischaemic stroke." Thesis, University of Glasgow, 2008. http://theses.gla.ac.uk/280/.

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Background: Hyperglycaemia is common in acute stroke and is associated with a poor outcome. Underlying aetiology and mechanism of action is poorly understood. Management remains uncertain. Methods: We undertook a randomised placebo controlled trial to assess the effect of GKI (Glucose-Potassium-Insulin) versus placebo on lesion volume progression and cerebral lactate levels using magnetic resonance imaging (MRI) and spectroscopy (MRS). An observational study of the capillary blood glucose within 48 hours of stroke onset was performed to define the temporal profile of glucose, with a subset followed prospectively to determine the prevalence of abnormal glucose metabolism in patients with stress hyperglycaemia. The association between insular cortex involvement and hyperglycaemia was determined by analysing MRI data sets from two randomised trials. Stroke unit practice for the management of glucose was assessed in a review of the stroke unit trialists’ collaboration data set. Results: • GKI infusion failed to attenuate infarct growth in patients with moderate hyperglycaemia within 24 hours of acute ischaemic stroke. A trend towards attenuation of increased lactate concentration was evident in the GKI treatment arm. Exploratory analyses raised the possibility that GKI may be harmful in patients with persistent arterial occlusion. • Over the 48hour monitoring period 75% of patients developed Hyperglycaemia. Stroke severity was not predictive of admission hyperglycaemia whereas glycosylated haemoglobin was (OR 2.97; 95%CI 1.84-4.78; p<0.001). 50% of patients screened were found to have abnormal glucose metabolism at follow-up. • Insular cortex involvment on MRI was not predictive of admission hyperglycaemia. • Testing for blood glucose concentration in stroke units was infrequent. Of the minority of units that had a protocol in place, the threshold for intervention with insulin was >10mmol/l. Conclusion: We found no evidence that GKI infusion attenuated infarct growth in patients with mild hyperglycaemia following acute ischaemic stroke. In post-hoc analysis the possibility that GKI infusion may be harmful in patients with total occlusion suggests an effect dependent on recanalisation status. A non-significant trend towards attenuation of increased lactate concentration was evident. Stroke severity was not found to be a predictor of post stroke hyperglycaemia. Underlying dysglycaemia was common in non-diabetic patients manifesting hyperglycaemia within 48hours of stroke ictus. Screening of high risk patients with oral glucose tolerance testing is justified and provides a potential opportunity for secondary prevention. Insular cortex involvement did not independently predict hyperglycaemia in acute stroke. Current management of hyperglycaemia is guided by consensus guidelines with little evidence base. Stroke unit practice varies with little change across stroke units over the years.

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Van, den Berg Marietta. "Observational analysis study on the influence of the physical hospital environment on aggressive behaviour and the management thereof in an adult acute psychiatric admission unit." Master's thesis, University of Cape Town, 2008. http://hdl.handle.net/11427/12578.

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Includes bibliographical references (leaves 81-96).
Aggression is a complex phenomenon that is influenced by a range of factors including individual patient factors, social-interactive factors and envirnmental factors. Many studies have tried and failed to demonstrate that changes such as physical environmental change, intensive case management, increased staff training or skills reduce the levele of violence, as captures by number of incidents accuring in in-patient units.

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Sullivan, Patricia D. "Enhancing the Resilience of Acute Care Psychiatric Nurses Through a Brief Gratitude Intervention." ScholarWorks, 2020. https://scholarworks.waldenu.edu/dissertations/7957.

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Stressors affecting healthcare providers have accelerated in recent years, causing increasing rates of burnout and emotional exhaustion. Evidence suggests that improving general mental well-being of nurses could enhance their resilience and ability to cope in stressful situations. Psychiatric nurses are at risk by caring for involuntary and manipulative patients who can be violent and abusive. The purpose of this project was to improve psychiatric nurses' mental well-being through the implementation of a gratitude practice and examined the effect of this brief gratitude intervention on their mental well-being. Models informing this project were human caring theory, resilience theory, and positive psychology models of gratitude benefits. Thirty psychiatric nurses participated; they were told to privately note 3 things they were grateful for in a gratitude journal each day. The Warwick-Edinburgh Mental Well-Being Scale was administered pre- and postintervention, and chi-square analysis was performed, converting sum scores into categories (low-moderate-high); statistical significance was not demonstrated (Pearson chi-square = .1.176, Crarmer's V of .183). Nonparametric Wilcoxin Signed Rank Test and Mann-Whitney U also compared scores of pr-e and posttests. The Wilcoxin Signed Rank revealed significant differences (Z = -1.402, p = .027) but only had 6 matched pairs. Mann-Whitney U showed no significant differences between the pre- and posttest scores (U = 108, p = .161). Limitations were the inability to match identification numbers except for 6. Recommendations are gratitude education and repeat the study. This could begin to affect positive social change by promoting self-care of the nurses via incorporating principles of positive psychology into daily practice.

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Power, Kathryn. "Experiences of aggression and violence across dementia and adult acute psychiatric facilities." Thesis, University of Warwick, 2016. http://wrap.warwick.ac.uk/88075/.

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This thesis explores care staff and nurses’ experiences of aggression and violence whilst working in dementia and adult acute psychiatric facilities. Chapter one presents a systematic literature review of studies based on the perceptions and impact of aggression from patients with dementia, adopting a care staff perspective. The findings highlighted the subjective experiences of aggression, care staff perceptions of its causes and the physical and psychological impact which aggression had on care staff. A key finding was that care staff perceptions of aggression and its impact influenced patient care and the reporting of aggression. The chapter discusses key implications for practice and policy and identifies recommendations for future research. Chapter two consists of an empirical study exploring nurses’ lived experiences of violence from patients whilst working on adult acute psychiatric facilities. Eight nurses were recruited from two hospital sites and completed semi-structured interviews. Analysis of the data revealed the personal perceptions of violence and its causes and the psychological, physical, occupational and relational impact that violence had on the nurses. All nurses employed individual and group survival strategies to help manage their experiences of violence and its impact. Implications for clinical practice and policy and recommendations for future research are discussed. Chapter three presents a reflective account of my research journey throughout training to be a Clinical Psychologist. I use a reflexive stance to explore the development of my research interest, the meaning of violence and to discuss my own responses to the nurses’ experiences. The paper also explores how I managed different roles during the research process and how I have developed as a clinician and researcher.

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Gescuk, Bryan D. "Examination of the cerebral metabolic effects of morphine in rats exposed to acute and chronic footshock and conditioned stress." Thesis, Boston University, 1994. https://hdl.handle.net/2144/36818.

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Thesis (Ph.D.)--Boston University
PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you.
The purpose of this research was to determine, using the 2[14C]deoxyglucose autoradiographic method, the local cerebral metabolic rates for glucose (LCMRglu) after the administration of morphine or saline in rats escaping from acute or chronic footshock or exposed to conditioned stress. All animals were given morphine (4mg/kg, sc) or saline 7 days, 3 days and 10 minutes prior to the tracer injection. The effects of stimulation in the acute and chronic footshock studies revealed that an identical noxious stimulus may not have similar effects on functional cerebral activity if there are differences in experience with the str1xsor. The results of the conditioned stress experiment demonstrate that simply placing an animal in an environment previously associated with footshock is sufficient to elicit changes in LCMRglu. The effects of morphine in the control and acute footshock experiments were similar in that nearly all of the 73 analyzed brain regions (99% and 93%, respectively) showed decreases in LCMRg1u. Morphine, however, caused fewer decreases (56%) in the chronic footshock study. Interestingly, the percentage of structures showing decreases in the conditioned stress study (79%) was approximately halfway between the effects seen in the two footshock studies. Morphine in the presence of acute footshock, compared to acute footshock alone, caused significant decreases in elements of the limbic telencephalon, basal forebrain and thalamic midline (paraventricular and paratenial nuclei). On the other hand, morphine did not cause any significant decreases in these structures (or others) in the chronic footshock study. Rather, the combination of morphine and chronic footshock, compared to morphine alone, caused significant increases in several brainstem structures previously implicated in opioid analgesia: the locus coeruleus, gigantocellular reticular nucleus and raphe magnus. Additionally, significant effects were seen in basal ganglia structures which are normally associated with the motor system. The effects seen in these structures, along with the significant effect demonstrated in the parafasicular thalamic nucleus, suggest that morphine works to attenuate pain in animals exposed to chronic footshock via neural networks responsible for sensorimotor reactions to pain. Alternatively, animals exposed to chronic footshock may have developed tolerance to the effects of morphine. The effects of morphine, however, in the chronic footshock experiment are much different from those seen in the acute footshock study where morphine acts primarily in limbic structures and midline thalamus to attenuate the affective reaction to pain.
2031-01-01

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Strout, Tania Denise Shaffer. "Development of an Agitation Rating Scale for Use with Acute Presentation Behavioral Management Patients." Thesis, Boston College, 2011. http://hdl.handle.net/2345/1839.

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Thesis advisor: June A. Horowitz
Agitation is a distressing set of behaviors frequently observed in emergency department psychiatry patients. Key to developing and evaluating treatment strategies aimed at decreasing and preventing agitation is the availability of a reliable, valid instrument to measure behaviors representative of agitation. Currently, an agitation rating instrument appropriate for use in the emergency setting does not exist and clinicians are left without standard language for communicating about the phenomenon. The Agitation Severity Scale was developed to fill this void using facilitated focus groups to generate an initial item pool. Beginning evidence of content validity was established through a survey of clinical providers and a panel of content experts. The objectives of this methodological study were to: (a) develop an observation-based rating scale to assess the continuum of behaviors known as agitation in adult emergency department patients, and (b) to evaluate the psychometric properties of the newly developed instrument. Psychometric evaluation was conducted using a sample of 270 emergency department psychiatric patients. A 17-item instrument with a standardized Cronbach's alpha coefficient of 0.91 resulted, providing evidence of a high degree of internal consistency reliability. Principle components analysis revealed a 4-component solution accounting for 69% of observed variance. Internal consistency reliability ranged from 0.71 to 0.91 for the scale components. Equivalence reliability was established through the evaluation of Agitation Severity Scores assigned by independent evaluators, r = 0.99, &kappa = 0.98. Construct validity was established through comparison of mean scores for subjects in the highest and lowest scoring quartiles. A statistically significant difference in scores was noted when comparing these groups, t = -17.688, df = 155, p < 0.001. Convergent validity was evaluated by testing the association between Agitation Severity Scores and scores obtained using a well-established instrument, the Overt Agitation Severity Scale. Pearson's correlation coefficient for the associations between the scores ranged from 0.91 to 0.93, indicating a strong, positive relationship between the scores. Finally, the Rasch measurement model was employed to further evaluate the functioning of the instrument. In sum, the Agitation Severity Scale was found to be reliable and valid when used to measure agitation in the emergency setting
Thesis (PhD) — Boston College, 2011
Submitted to: Boston College. Connell School of Nursing
Discipline: Nursing

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Murphy, Ellen M. "Effects of acute and chronic dopaminergic treatment on motor and non-motor function in the hemi-Parkinsonian rat." Thesis, Cardiff University, 2014. http://orca.cf.ac.uk/59308/.

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Parkinson’s disease (PD) is commonly treated with L-DOPA. Long-term treatment is associated with the development of motor side effects such as L-DOPA induced dyskinesia (LID), and pathological changes in the striatal circuitry. However, while this circuitry is implicated in both motor and non-motor behaviour, little is known about the effects of long-term L-DOPA treatment on non-motor function. This thesis used a rat model of PD and LID to test the hypothesis that long-term L-DOPA treatment also affects non-motor behaviour. Pharmacological studies typically utilise albino rats, while pigmented rats are preferred for operant studies. To guide later methodological decisions, Experiment 1 compared pigmented Listed Hooded and albino Sprague Dawley rats’ motor, dyskinetic, or operant response to L-DOPA. As there were no gross strain differences, and Lister Hooded rats are preferred in operant studies, they were used in later experiments measuring both LID and operant behaviour. Experiment 2 aimed to identify appropriate lesion screening tests. Success of unilateral 6-OHDA lesions is commonly measured using amphetamine-induced rotations. However, amphetamine interferes with goal-directed behaviour. The ability of amphetamine-induced rotations and four non-pharmacological motor tests to accurately identify lesion rats was therefore compared. The non-pharmacological spontaneous rotations and cylinder tests were identified as robust screening tests and used in later experiments. L-DOPA competes with dietary amino acids for transport across the blood-brain barrier, and chronic L-DOPA treatment sensitises dopamine receptors. It was therefore hypothesised that food restriction and chronic L-DOPA would both decrease the L-DOPA dose required to alleviate motor symptoms in the rat 6-OHDA model. Chapter 4 describes two dose response curves testing the effect of food restriction and chronic L-DOPA on the motor response to acute L-DOPA in rats with intra-striatal or MFB lesions. Chronic L-DOPA increased the motor response to acute L-DOPA in the MFB, but not intra-striatal, lesion model. Conversely, food restriction increased the motor response to acute L-DOPA in the intra-striatal, but not MFB, lesion model. Chapter 5 used microdialysis to test the hypothesis that the increased motor response following food restriction was caused by an increased influx of L-DOPA to the striatum. The data did not support the hypothesis but suggested that food restriction affects baseline neurotransmitter levels in the 6-OHDA lesion rat. Chapter 6 tested the hypothesis that LID onset, by disrupting cortico-striatal synaptic plasticity which is implicated in motor skill learning, impairs acquisition of novel motor skills by measuring rats’ performance on the staircase task. While an initial experiment suggested that chronic LID onset impaired lesion rats’ acquisition of the task, the phenomenon could not be replicated. Chapters 7 and 8 further explored the effect of chronic L-DOPA on non-motor function using a lateralized choice reaction time task reliant on the striatal system. Chronic L-DOPA exacerbated a lesion induced accuracy deficit that has been hypothesised to reflect extinction. This deficit was linked to LID onset, rather than L-DOPA exposure per se. The data therefore expand on current knowledge by suggesting that the effects of chronic L-DOPA extends beyond inducing motor side effects to also affect non-motor function.

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Mishra, Nishant Kumar. "Use of thrombolytic therapy beyond current recommendations for acute ischaemic stroke." Thesis, University of Glasgow, 2012. http://theses.gla.ac.uk/3083/.

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In Chapter 1, I introduce ischaemic stroke, thrombolytic therapy, thrombolysis trials and then discuss the rationale for exclusion criteria in stroke thrombolysis guidelines.In Chapter 2, I describe methods for examining outcomes in patients that are currently recommended for exclusions from receiving alteplase for acute ischaemic stroke. In Chapter 3, I examine Virtual International Stroke Trials Archive (VISTA) data to test whether current European recommendation suggesting exclusion of elderly patients (older than 80 years) from thrombolysis for acute ischaemic stroke is justified. Employing non-randomised controlled comparison of outcomes, I show better outcomes amongst all patients (P < 0.0001; OR, 1.39; 95% CI, 1.26 to 1.54), young patients (P < 0.0001; OR, 1.42; 95% CI, 1.26 to 1.59) and the elderly patients (P = 0.002; OR, 1.34; 95% CI, 1.05 to 1.70). Odds Ratios are consistent across all age deciles > 30 years. Outcomes assessed by National Institutes of Health Scale (NIHSS) score and dichotomised modified Rankin Scale score are consistently similar. In Chapter 4, I compare thrombolysed patients in Safe Implementation of Thrombolysis in Stroke International Stroke Thrombolysis Register (SITS-ISTR) with VISTA non-thrombolysed patients ("comparators" or "controls") and test exactly similar question as in Chapter 3. Distribution of scores on modified Rankin scale are better amongst all thrombolysis patients than controls (odds ratio 1.6, 95% confidence interval 1.5 to 1.7; Cochran-Mantel-Haenszel P<0.001). Association occurs independently amongst patients aged ≤80 (0R 1.6, 95%CI1.5 to 1.7; P<0.001; n=25,789) and in those aged >80 (OR 1.4, 95% CI 1.3 to 1.6; P<0.001; n=3439). Odds ratios are consistent across all 10 year age ranges above 30, and benefit is significant from age 41 to 90; dichotomised outcomes (score on modified Rankin scale 0-1 v 2-6; 0-2 v 3-6; and 6 (death) versus rest) are consistent with the results of ordinal analysis. These findings are consistent with results from VISTA reported in Chapter 3. Age alone should not be a criterion for excluding patients from receiving thrombolytic therapy.In Chapter 5, I employ VISTA data to examine whether patients having diabetes and previous stroke have improved outcomes from use of alteplase in acute ischaemic stroke. Employing a non-randomised controlled comparison, I show that the functional outcomes are better for thrombolysed patients versus nonthrombolysed comparators amongst non-diabetic (P < 0.0001; OR 1.4 [95% CI 1.3-1.6]) and diabetic (P = 0.1; OR 1.3 [95% CI1.05-1.6]) patients. Similarly, outcomes are better for thrombolysed versus nonthrombolysed patients who have not had a prior stroke (P < 0.0001; OR 1.4 [95% CI1.2-1.6]) and those who have (P = 0.02; OR 1.3 [95% CI1.04-1.6]). There is no interaction of diabetes and prior stroke with treatment (P = 0.8). Neurological outcomes (NIHSS) are consistent with functional outcomes (mRS). In Chapter 6, I undertake a non-randomised controlled comparison of SITS-ISTR data with VISTA controls and examine whether patients having diabetes and previous stroke have improved outcomes from use of alteplase in acute ischaemic stroke. I show that adjusted mRS outcomes are better for thrombolysed versus non-thrombolysed comparators amongst patients with diabetes mellitus (OR 1.45[95% CI1.30-1.62], N=5354), previous stroke (OR 1.55[95% CI1.40-1.72], N=4986), or concomitant diabetes mellitus and previous stroke (OR 1.23 [95% CI 0.996-1.52], P=0.05, N=1136), all CMH p<0.0001. These are comparable to outcomes between thrombolysed and non-thrombolysed comparators amongst patients suffering neither diabetes mellitus nor previous stroke: OR=1.53(95%CI 1.42-1.63), p<0.0001, N=19339. There are no interaction between diabetes mellitus and previous stroke with alteplase treatment (t-PA*DM*PS, p=0.5). Present data supports results obtained from the analyses of VISTA data in chapter 5. There is no statistical evidence to recommend exclusion of patients with diabetes and previous stroke from receiving alteplase.In Chapter 7, I examine VISTA data to test whether exclusion of patients having a mild or severe stroke at baseline would be justified. Stratifying baseline stroke severity for quintiles of NIHSS scores, I observe that there are significant associations of use of alteplase with improved outcomes for baseline NIHSS levels from 5 to 24 (p<0.05). This association lose significance for baseline NIHSS categories 1 to 4 (P = 0.8; OR, 1.1; 95% CI, 0.3-4.4; N = 8/161) or ≥ 25 (P = 0.08; OR, 1.1; 95% CI, 0.7-1.9; N = 64/179) when sample sizes are small and confidence interval wide. These findings fail to provide robust evidence to support the use of alteplase in the mild or severe stroke patients, though potential for benefit appears likely.In Chapter 8, I present a meta-analysis of trials that investigated mismatch criteria for patients’ selection to examine whether present evidence supports delayed thrombolysis amongst patients selected according to mismatch criteria. I collate outcome data for patients who were enrolled after 3 hours of stroke onset in thrombolysis trials and had mismatch on pre-treatment imaging. I compare favourable outcome, reperfusion and/or recanalisation, mortality, and symptomatic intracerebral haemorrhage between the thrombolysed and non-thrombolysed groups of patients and the probability of a favourable outcome among patients with successful reperfusion and clinical findings for 3 to 6 versus 6 to 9 hours from post stroke onset. I identify articles describing the DIAS, DIAS II, DEDAS, DEFUSE, and EPITHET trials, giving a total of 502 mismatch patients thrombolysed beyond 3 hours. The combined adjusted odds ratios (a-ORs) for favourable outcomes are greater for patients who had successful reperfusion (a-OR=5.2; 95% CI, 3 to 9; I2=0%). Favourable clinical outcomes are not significantly improved by thrombolysis (a-OR=1.3; 95% CI, 0.8 to 2.0; I2=20.9%). Odds for reperfusion/recanalisation are increased amongst patients who received thrombolytic therapy (a-OR=3.0; 95% CI, 1.6 to 5.8; I2=25.7%). The combined data show a significant increase in mortality after thrombolysis (a-OR=2.4; 95% CI, 1.2 to 4.9; I2=0%), but this is not confirmed when I exclude data from desmoteplase doses that are abandoned in clinical development (a-OR=1.6; 95% CI, 0.7 to 3.7; I2=0%). Symptomatic intracerebral haemorrhage is significantly increased after thrombolysis (a-OR=6.5; 95% CI, 1.2 to 35.4; I2=0%) but not significant after exclusion of abandoned doses of desmoteplase (a-OR=5.4; 95% CI, 0.9 to 31.8; I2=0%). Delayed thrombolysis amongst patients selected according to mismatch imaging is associated with increased reperfusion/recanalisation. Recanalisation/reperfusion is associated with improved outcomes. However, delayed thrombolysis in mismatch patients was not confirmed to improve clinical outcome, although a useful clinical benefit remains possible. Thrombolysis carries a significant risk of symptomatic intracerebral haemorrhage and possibly increased mortality. Criteria to diagnose mismatch are still evolving. Validation of the mismatch selection paradigm is required with a phase III trial. Pending these results, delayed treatment, even according to mismatch selection, cannot be recommended as part of routine care.In Chapter 9, I summarise the findings of my research, discuss its impact on the research community, and discuss weaknesses inherent in registry data and limitation of statistical methods. Then, I elaborate the future directions I may take to further research on the theme of this thesis.

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13

Roaldset, John Olav. "Risk assessment of violent, suicidal and self-injurious behaviour in acute psychiatry– a bio-psycho-social approach." Doctoral thesis, Norges teknisk-naturvitenskapelige universitet, Institutt for nevromedisin, 2010. http://urn.kb.se/resolve?urn=urn:nbn:no:ntnu:diva-11932.

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De psykiatriske avdelingene i Norge har vært utsatt for tildels sterk kritikk etter voldsdhandlinger og selvmord begått av pasienter under innleggelse, etter utskriving eller ved manglende innleggelse. Med innleggelsespress og kort liggetid er akuttavdelinger særlig utsatt. Ofte legges alene klinisk skjønn til grunn for en risikovurdering. Det foreligger imidlertid instrumenter til formålet, men de er tidkrevende og forutsetter spesiell ekspertise. Et av siktemålene med dette ”risikoprosjektet” ved Ålesund sjukehus var å identifisere tidlig hvilke pasienter som trenger videre utredning og oppfølging. Forskjellige metoder ble prøvet i et prospektivt, naturalistisk design. Denne avhandlingen tar for seg resultater fra deler av ”risikoprosjektet” og omfatter ulike metoder brukt til vurdering av risiko for vold, selvmord og selvskading: (i) Biologisk basert: Serotonin og lipider målt i blod, (ii) Pasientbasert: Pasientenes egen risikovurdering (SRS), samt (iii) et personalbasert, strukturert screening instrument for volds-risiko (V-RISK-10, utviklet for bruk i akuttpsykiatrien) . ”risikoprosjektet” og omfatter ulike metoder brukt til vurdering av risiko for vold, selvmord og selvskading: (i) Biologisk basert: Serotonin og lipider målt i blod, (ii) Pasientbasert: Pasientenes egen risikovurdering (SRS), samt (iii) et personalbasert, strukturert screening instrument for volds-risiko (V-RISK-10, utviklet for bruk i akuttpsykiatrien) . SRS og V-RISK-10 ble skåret ved innleggelse og utskriving. Blodprøver ble tatt ved innleggelse. Risikovurderingene og blodprøvesvarene ble sammenliknet med suicidalitet, selvskading og vold registrert under oppholdet og i løpet av første året etter utskriving. Målgruppen var alle akutt innlagte pasienter gjennom ett år, fra 07.03.06 – 07.03.07. Studien av biologiske variabler og SRS ble utført på ett sykehus (n=489 pasienter). V-RISK-10 studien ble gjennomført på to sykehus (n=1017). Antallet pasienter var henholdsvis 254 innlagte og 196 utskrevne for den biologiske studien, 429 og 266 for SRS, og 980 og 381 for V-RISK-10. Vold og sucidalatferd under innleggelse, dessuten vold de tre første månedene etter utskriving, ble predikert av lave verdier av total kolesterol. Noen få pasienter med flere innleggelser og gjentatte voldshandlinger var kjennetegnet ved lave verdier av HDL. Disse funn samsvarer med tidligere undersøkelser. Høye triglyceridverdier predikerte selvskade i løpet av oppholdet, og også suicidalitet og selvskade etter utskriving. Presisjonsnivået var størst for dem som ble registret med både suicidalatferd og selvskading. Resultatet støtter tre studier om virkningen av kortvarig og kronisk psykologisk stress, men er det motsatte av tidligere funn om lave triglyceridverdier ved sucidalitet. I vårt materiale ble det ikke funnet noen sammenheng mellom serotoninnivå og aggresjon. SRS predikerte vold, suicidalitet og selvskade. I løpet av innleggelsen var SRS mest presis for suicidalitet og selvskade. Etter utskriving var den mest nøyaktig for vold. Vi har ikke funnet andre rapporter om pasienters egne risikovurderinger. Valideringen av V-RISK-10 var like god eller bedre enn for andre etablerte risikoinstrumenter. Våre funn var gyldige både for kvinner og menn. Nøyaktigheten var størst ved alvorlige voldsepisoder. V-RISK-10 gav signifikante resultater for pasienter uten kjent voldshistorie. Resultatene for lipider og SRS var ikke gode nok til at disse metodene kan anbefales å bli brukt alene som screening instrumenter. De kan imidlertid vise seg nyttige som tillegg til etablerte prosedyrer. V-RISK-10 viste gode egenskaper som screeninginstrument. Resultatene bør bekreftes av annen forskning før metodene kan bli brukt med ønsket sikkerhet.
Recently, psychiatric hospitals in Norway have been criticised for premature discharges and for poor assessments of patients’ risks of violence or self-harm. Due to the high turnover of patients and the obligation to admit all acutely ill patients who are in need of hospitalisation, the acute wards are particularly exposed to such criticism. Unstructured clinical judgements alone still appear to be the dominant approach to risk assessments. Currently used instruments for risk assessment are time consuming, and their use require special expertise. The goal of the “Risk Project” at Ålesund Hospital was early identification of patients in need of risk assessments. Various screening methods were tested in a prospective, naturalistic design. This dissertation is a part of the larger Risk Project. In the dissertation, different approaches towards risk analyses of violence, suicide and self-injury were examined: (i) Biologically based, in which lipids and serotonin are measured in the blood; (ii) Patient based, in which patients’ self-reports of risk (SRS) are employed, and (iii) Structured professional, by applying a violence screening instrument developed for use in acute psychiatry (V-RISK-10). SRS and V-RISK-10 were scored both at the time of admittance and discharge. Blood was drawn at admission. These measures were then compared with the episodes of violent, suicidal and self-injurious behaviour recorded during the patient’s hospital stay and also, during the first year after discharge. The study sample for the biological markers and the SRSs included all of the acutely admitted patients during one year (n=489) in one acute psychiatric unit. The V-RISK-10 study included all admissions of two units (n=1017). The numbers of patients who completed the study were 254 during their hospital stay and 196 after discharge, all with regard to lipids/serotonin, 429 and 266 for SRS, and 980 and 381 for V-RISK-10, respectively. Similar to findings from other studies, low concentrations of total cholesterol were found to predict inpatient suicidal and violent behaviour and also, violent behaviour three months after discharge. Low HDL levels were predictive of violence repeaters. High triglyceride levels predicted self-injurious behaviour (SIB) during the hospital stay, and both suicidal behaviour and SIB during the first year after discharge. The best results were obtained among patients who had recorded episodes of both suicidal behaviour and SIB. This finding contradicts prior studies on self-harm but concurs with three recent studies that look at the effects of short-term and chronic psychological stress. No significant correlations between serotonin levels and violence, suicidal behaviour or SIB were found in our sample. SRS predicted violence, suicidal behaviour and SIB both during the hospital stay and at three months after discharge. In addition, SRS of violence was also significant at 12 months after discharge. The accuracy was higher for self-harm during the hospital stays and for violence after discharge. We found no other validation studies of patients’ self-reported risk of suicide or violence. The predictive validity of the V-RISK-10 was equal to or better than those of the comprehensive risk assessment instruments, and it was very high in relation to severe violence. The screening instrument was sensitive to the risk of violence independent of gender and even for patients without any known history of violence. Despite significant findings for the lipids and SRS, these methods are not recommended for regular clinical use as single predictor variables, but they may be used together in combination with established risk procedures or clinical judgements. V-RISK-10 demonstrated good psychometric properties as a violence screening tool for acute psychiatry. Further research should be undertaken to confirm the findings

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Stenhouse, Rosemary Clare. "Unfulfilled expectations : a narrative study of individuals' experiences of being a patient on an acute psychiatric inpatient ward in Scotland." Thesis, University of Edinburgh, 2009. http://hdl.handle.net/1842/4071.

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This study examines people’s experiences of being a patient on an acute psychiatric inpatient ward in Scotland. Within the existing research base few studies focus on the patient’s experience of acute psychiatric inpatient care, and none of these is set in Scotland. Those that do, indicate that the patient experience of acute psychiatric inpatient care is often negative. The theoretical perspective of this study conceptualises experience as represented in narrative form, thus the data take the form of narratives. Thirteen participants were recruited through the acute ward. Each participant participated in two unstructured interviews focussed on gathering narratives of their experience. Data analysis was holistic, guided by Gee’s (1991) socio-linguistic theories. This holistic analysis culminated in the presentation of each participant’s narrative in poetic form. From the holistic analysis I identified three themes - help, safety and power - that were evident in the analyses of all participants’ interviews. The theme of help represents participants’ expectations that they will receive help on the ward, and their experiences of trying to get this help. Safety represents participants’ expectations pertaining to the ward’s function in keeping them safe, their experience of threat and strategies to keep safe. The theme of power represents participants’ experiences of power relations within the acute ward. I conclude that participants’ experiences of being a patient on the ward are characterised by feelings of frustration, concerns about safety, and the perceived need to focus on self-presentation as they attempt to reach their desired goal of discharge.

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15

Tarr, David. "Imaging the effects of acute hyperglycaemia on early ischaemic injury using MRI in an experimental stroke model." Thesis, University of Glasgow, 2012. http://theses.gla.ac.uk/3757/.

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In the UK, stroke is the third most common cause of death after heart disease and cancer. Importantly, most strokes are not fatal meaning stroke is the leading cause of adult disability, with one third of survivors still functionally dependent after one year. Post stroke hyperglycaemia (PSH) predicts poor outcome independent of age, stroke type or severity and occurs in over 60% of patients without a diagnosis of diabetes and in more than 90% of diabetic patients. Around 56% of hyperglycaemic acute stroke patients are subsequently diagnosed with insulin resistance, manifesting as impaired glucose tolerance, impaired fasting glucose or the “metabolic syndrome.” Clinical guidelines recommend routine blood glucose monitoring, and intervention with insulin for hyperglycaemia. However, there is currently no clinical evidence of benefit from insulin use, and recent findings raise concerns about the safety of insulin use in predominantly non-diabetic acute stroke populations. Hyperglycaemia in animal models of cerebral ischaemia is associated with increased infarct size. However, a recent systematic review highlighted uncertainties about the relevance of many previously published preclinical studies to the typical clinical picture of PSH with respect to whether clinically relevant elevations in blood glucose exacerbate ischaemic brain damage in models other than those of type I diabetes, or whether responses are different in animals with and without features of metabolic syndrome. The aim of this thesis was to investigate the differential effects of clinically relevant hyperglycaemia on the acute evolution of damage in animals with and without features of the metabolic syndrome and to investigate the potential mechanistic role of oxidative stress in glucose mediated ischaemic damage. I hypothesised that hyperglycaemia would exacerbate acute lesion evolution and final infarct volume in animals with and without features of the metabolic syndrome and that oxidative stress mechanisms would be involved. Developing suitable animal models for investigating post stroke hyperglycaemia and metabolic syndrome The first aim of this thesis was to develop a series of animal models for the investigation of clinically relevant PSH, metabolic syndrome in the presence and absence of PSH, and an appropriate focal cerebral ischaemia model. A previously described model of metabolic syndrome using the spontaneously hypertensive stroke-prone rat (SHRSP) fed on a 60% fructose diet for two weeks was set up in the laboratory and glucose tolerance, adiposity, plasma insulin, plasma triglycerides, cholesterol were measured and compared to the SHRSP reference strain, the Wistar-Kyoto (WKY). Fructose fed-SHRSP rats exhibited glucose intolerance, hypertriglyceridaemia, hyperinsulinaemia, increase adiposity and reduced HDL cholesterol compared to the WKY controls. This suitably modelled the features of the metabolic syndrome. Clinically relevant levels of PSH were achieved using a bolus intraperitoneal injection of 15% glucose (10ml/kg) 10 minutes prior to permanent middle cerebral artery occlusion (MCAO). Two methods of MCAO were compared; intraluminal filament (ILF) model and a distal diathermy MCAO model. The ILF method produced expansive lesions incorporating the majority of the ipsilateral hemisphere whereas the distal diathermy occlusion produced smaller cortical infarcts which were shown to produce a large volume of penumbra. The diathermy model was selected for all future experiments. Investigating the effects of hyperglycaemia on acute lesion growth after focal cerebral ischaemia in rats with and without components of the metabolic syndrome The second aim of this thesis was to determine the effects of hyperglycaemia on acute ischaemic lesion evolution and infarct volume in rats with and without features of the metabolic syndrome. Hyperglycaemia was induced in WKY or fructose-fed SHRSP rats 10 minutes prior to permanent MCAO. Magnetic resonance imaging (MRI) was used to quantify the expansion of the lesion using ADC maps calculated from diffusion weighted imaging (DWI) carried out over the first 4 hours after MCAO. Acute hyperglycaemia, at clinically relevant levels, exacerbated early ischaemic damage in both normal and metabolic syndrome rats. Hyperglycaemia worsened infarct volume at 24h in normal but not metabolic syndrome rats. These data suggest that management of hyperglycaemia may be most beneficial in the absence of an underlying dysglycaemia. Using a marker of oxidative stress to probe the tissue sections suggested that perhaps hyperglycaemic effects were mediated through oxidative stress mechanisms. Investigation of oxidative stress mechanisms in hyperglycaemia-dependant ischaemic damage. Based on the potential involvement of oxidative stress mechanisms in hyperglycaemia-associated ischaemic damage this was investigated in a proof of concept study using pre-treatment with a SOD/catalase mimetic, EUK-134. The rationale for this study was based on the involvement of increased superoxide production in chronic hyperglycaemia and diabetic complications. Sprague-Dawley rats received the same dose of glucose previously used 10 minutes prior to MCAO by distal diathermy. EUK-134 (2.5mg/kg) or vehicle (saline) was administered 20 minutes prior to MCAO. Infarct volume, calculated from RARE T2-weighted MR images and neurological scoring was measured 24 hours post MCAO. Arterial superoxide levels were measured along with the lipid peroxidation marker malondialdehyde in cerebral tissue. Hyperglycaemia increased infarct volume although no effect of high blood glucose on tissue lipid peroxidation was observed. EUK-134 failed to reduce infarct volume. EUK-134 reduced lipid peroxidation in ipsilateral cortex of normoglycaemic rats but not in hyperglycaemic rats. Thus, hyperglycaemia associated damage was not reduced by attenuating oxidative stress. Generating a threshold for quantitative T2 maps Using the data generated in the previous Chapter a study was carried out to determine if improvements could be made in the analysis of MRI data in pre-clinical rat studies. RARE T2-weighted images, where T2 relaxation time denotes contrast, have been used for infarct quantification 24 hours post MCAO. Generating a lesion volume from these images requires manual tracing of the visually defined infarct from the images. A degree of error is associated with this methodology either as inter-investigator reproducibility or in repeats conducted by the same investigator. The RARE T2 images are not quantifiable as arbitrary values denote contrast and this prevents direct comparison of T2 relaxation times for a particular structure between subjects. Using a MSME T2 sequence, quantitative T2 maps can be generated which calculate absolute T2 relaxation times for each voxel. Using quantitative maps an attempt was made to establish a threshold to discriminate between normal and ischaemically damaged tissue in animals that had undergone MCAO using the distal diathermy model. This threshold aimed to minimise inter- or intra-investigator error. A T2 threshold of abnormality for the quantitative T2 maps was established from the RARE T2 weighted images. Tissue that had a T2 relaxation time of 76 ms or more was deemed to be infarct according to the derived threshold. The suitability of the threshold was then assessed in a separate cohort and was found to produce similar infarct volumes to the manual delineation of RARE T2-weighted images. The 76ms threshold was also applied to animals that had undergone MCAO using the intraluminal filament model. However, the calculated threshold was not suitable for the intraluminal filament model due to interferences from cerebrospinal fluid signal. A more selective method for determining infarct volume in animals subjected to intraluminal filament MCAO needs to be established.

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Ginty, Annie T. "The behavioural, cognitive, and neural correlates of blunted physiological reactions to acute psychological stress." Thesis, University of Birmingham, 2012. http://etheses.bham.ac.uk//id/eprint/3618/.

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The overarching aim of this thesis was to better understand the behavioural, cognitive, and neural corollaries of blunted cardiovascular and/or cortisol reactions to acute psychological stress. As such, it was also concerned to further test the proposition that blunted cardiovascular and cortisol reactions to acute psychological stress are markers of an unconscious dysfunction in the motivational areas of the brain. These aims were achieved by using a mixed methods interdisciplinary approach encompassing both laboratory stress studies and secondary analyses of epidemiological datasets. Chapter 2 adduced evidence that blunted cardiovascular and cortisol reactivity was associated with a non-substance addiction, namely exercise dependence. Chapter 3 demonstrated that blunted cardiovascular and cortisol reactivity was related to disordered eating behaviour. Differences in stress reactivity between healthy controls and exercise dependent individuals or disordered eaters could not be explained by actual stress task performance, how engaged or how stressful participants found the stress task, cardio-respiratory fitness, and a number of other potential confounders. Chapters 4, 5, and 6 demonstrated that poor cognitive ability was associated with blunted stress reactivity retrospectively, cross-sectionally, and prospectively. Additionally, Chapter 6 demonstrated that blunted cardiac reactivity predicted cognitive decline over a 7 year period. Chapter 7 revealed brain activation differences between pre-determined exaggerated and blunted cardiac stress reactors during an acute stress exposure in a fMRI paradigm. Blunted cardiac reactors showed hypo-activation in the areas of the brain associated with motivation and emotion compared to exaggerated reactors. There were no reactivity group differences in subjective measures of the stressfulness and difficulty of and engagement with the stress task. Overall, the research reported in this thesis provides further evidence that blunted cardiovascular and cortisol reactions to stress are associated with a number of adverse health and behavioural outcomes and may be a peripheral marker of some form of disengagement in those areas of the brain that support motivated behaviour.

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17

Ämtvall, Therese, and Jessica Ingvarsson. "Akuta hjälp- och stödinsatser inom psykiatrin : Vad är det som påverkar psykiatrins selektering och bedömning av de individer som söker akuta hjälp- och stödinsatser?" Thesis, University of Kalmar, University of Kalmar, University of Kalmar, 2009. http://urn.kb.se/resolve?urn=urn:nbn:se:hik:diva-2506.

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In this paper the authors are focusing on people that work in psychiatric acute care. How do they identify the individual that is in most need of acute care? How do they judge in this kind of cases?

The foundation in this study is in the qualitative method. The material to this study has been collected by doing qualitative interviews with six people in different professions and positions in psychiatric acute care.

The material that we collected from these six qualitative interviews has been analysed with help from Sherif’s and Hovland’s (1961) Social judgement theory. The theory describes people’s judgement based on certain criterions and how it affects them.

It has been noticed that the individuals who asses first acute care are usually the ones that has a suicidal behavior. The resources are decreasing while the need for psychiatric acute care is increasing. The personell have to make decisions about which individual that are in most need of acute care. Their judgments are very important for the indiviuals in need of immediate care. This judgement can be depending on which individual who is doing the judgemet. This paper has given us comprehension for the immortance of good individual properties for doing judgements, and that they are made in several positions.

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18

Roberts, Walter. "DECISION-MAKING PROCESSES, DRIVING PERFORMANCE, AND ACUTE RESPONSES TO ALCOHOL IN DUI OFFENDERS." UKnowledge, 2016. http://uknowledge.uky.edu/psychology_etds/89.

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Alcohol-impaired driving is a major cause of motor vehicle accident and death in the United States. People who are arrested for DUI (Driving under the Influence) are at high risk to reoffend; approximately one in three of these individuals will commit another DUI offense in the three years following their first conviction (Nochajski & Stasiewicz, 2006). This high risk for recidivism in these individuals suggests that cognitive characteristics may contribute to a pattern of pathological decision making leading to impaired driving. Indeed, individuals with a history of DUI report higher rates of impulsiveness and behavioral dysregulation compared to their nonoffending peers. Relatively little research, however, has used laboratory methods to identify the specific behavioral characteristics, such as poor inhibitory control or heightened sensitivity to immediate reward, which may differentiate DUI offenders from nonoffenders. Further, little is known about how individuals with a history of DUI respond following an acute dose of alcohol. Study 1 examined impulsivity in 20 adults with a recent DUI conviction and 20 adults with no history of DUI using self-report and behavioral measures of impulsivity. This study also used a novel decision-making paradigm to examine how different levels of risk and reward influenced the decision to drive after drinking in both groups. Results of this study found that DUI offenders did not differ from controls in their performance on behavioral measures of impulsivity. They did, however, report higher levels of impulsivity and demonstrated a greater willingness to tolerate higher levels of risk for more modest rewards. Study 2 examined the acute effects of alcohol and expectancy manipulation on driving performance and decision making in the same group of participants. Neither alcohol nor expectancy manipulation exerted a systematic effect on decision making in either group. Alcohol impaired driving performance equally in both groups, but the DUI group perceived themselves as less impaired by alcohol. Expectancy manipulation eliminated this group difference in perceived driving ability. Taken together, these findings identify processes that risk of impaired driving in DUI offenders. They may perceive themselves as less impaired by alcohol, leading to risky decision making when drinking. Expectancy manipulation may be a viable method of reducing risky decision making in DUI offenders.

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Gardner, Lea Anne. "Factors Associated with Hospital Commitment to Provide Child/Adolescent Psychiatric Services." VCU Scholars Compass, 2006. https://scholarscompass.vcu.edu/etd/788.

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General acute care hospitals play a particularly important role in the delivery of children's mental health given the extant lack of alternatives to long term hospitals for patients requiring a restrictive treatment environment (Glied and Cuellar, 2003). This cross-sectional study identifies environmental and organizational factors associated with general acute care and children's hospitals in the United States that provide hospital-based child/adolescent psychiatric services and the number of services. Two macro-level theories, Resource Dependence Theory and Institutional Theory were used to identify environmental and organizational factors. A nationwide sample of hospitals was drawn from the 2003 AHA annual survey. Data from the 2002 AHA annual survey, Area Resource File and American College of Graduate Medical Education was used for the independent variables. There were three analyses, correlation, descriptive and logistic regression. Results demonstrate that hospitals in markets with a low percentage of non-white children, higher family median income, high hospital community orientation, and high percentage of not for profit hospitals are more likely to offer child psychiatric services. Organizational factors associated with an increased likelihood to providing child psychiatric services include hospitals identified as Catholic, public or children's and those with a child psychiatric residency program. Three factors were associated with hospitals providing a high number of child psychiatric services and include hospitals in metropolitan statistical areas, system affiliation, and general acute care hospitals. This study demonstrated that 1. large hospitals are more likely to offer child psychiatric services and a high number of services, 2. children's hospitals provide child psychiatric services, but not a high number of them, and 3. hospitals with a high number of service offerings are mainly located in MSA's and more likely to offer outpatient substance abuse services. Significant results were obtained in the analysis of hospital characteristics and the provision of child psychiatric services, but weaker results were observed when analyzing the number of services. Further research is needed to identify factors with stronger associations to the level of service offerings.

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Tran, Hoang V. "Ventricular Arrhythmias Complicating Coronary Artery Disease: Recent Trends, Risk Associated with Serum Glucose Levels, and Psychological Impact." eScholarship@UMMS, 2018. https://escholarship.umassmed.edu/gsbs_diss/980.

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Introduction: Ventricular arrhythmias (VAs) are common after an acute coronary syndrome (ACS) and are associated with worse clinical outcomes. However, little is known about recent trends in their occurrence, their association with serum glucose levels, and their psychological impact in ACS setting. Methods: We examined 25-year (1986-2011) trends in the incidence rates (IRs) and hospital case-fatality rates (CFRs) of VAs, and the association between serum glucose levels and VAs in patients with an acute myocardial infarction (AMI) in the Worcester Heart Attack Study. Lastly, we examined the relationship between in-hospital occurrence of VAs and 12-month progression of depression and anxiety among hospital survivors of an ACS in the longitudinal TRACE-CORE study. Results: We found the IRs declined for several major VAs between 1986 and 2011while the hospital CFRs declined in both patients with and without VAs over this period. Elevated serum glucose levels at hospital admission were associated with a higher risk of developing in-hospital VAs. Occurrence of VAs, however, was not associated with worsening progression of symptoms of depression and/or anxiety over a 12-month follow-up period in patients discharged after an ACS. Conclusions: The burden and impact of VAs in patients with an AMI has declined over time. Elevated serum glucose levels at hospital admission may serve as a predictor for in-hospital occurrence of serious cardiac arrhythmias. In-hospital occurrence of VAs may not be associated with worsening progression of symptoms of depression and anxiety in patients with an ACS.

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21

Vaaler, Arne E. "Effects of a Psychiatric Intensive Care Unit in an Acute Psychiatric Ward." Doctoral thesis, Norwegian University of Science and Technology, Department of Neuroscience, 2007. http://urn.kb.se/resolve?urn=urn:nbn:no:ntnu:diva-1190.

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The psychiatric acute departments are intensive units serving patients with a broad spectrum of psychiatric conditions. Patients with the most florid psychiatric symptoms are admitted to Psychiatric Intensive Care Units (PICUs). These units are supposed to provide the necessary diagnostic and acute therapeutic help, control inappropriate behaviours, and provide the services in an environment which assists the patients’ recovery and is acceptable to patients, health workers and the general society. PICUs are criticised for poor environments, high levels of coercion and lack of evidence base from controlled trials or post occupancy evaluations. Long term studies of the rate of seclusion indicate no decrease in spite of changing political attitudes and hospital environments. There is a need fo new methods to treat violent or threatening incidents in psychiatric wards. Norwegian PICUs use segregation nursing with the patients placed in separately locked areas with staff. This model may be an alternative to seclusion. Controlled trials regarding effects of principles and facilities for such treatment are lacking. The general aim of the present study was to investigate effects of facilities for segregation, and several assumed risk factors in a Norwegian PICU.

The current thesis is based on data from 118 consecutively admitted patients to the PICU at St. Olavs University Hospital, Trondheim, Norway. The thesis has the following conclusions:

Main conclusions

1: Interior and furnishing like an ordinary home in the PICU create an environment with comparable treatment outcomes to the traditional dismal interior and has positive effects on many patients’ well being. Patient selfrating were significantly in favour of the ordinary home interior compared to the traditional interior

2: The principles of patient segregation in PICUs have favourable effects on behaviours associated with and the actual numbers of violent and threatening incidents. The changes in assessments of behaviour measured by differences in BVC ratings from baseline (admittance) to day 3 were significantly in favour of segregating the patients in the PICU compared to not segregating the patients in the same area. There were significantly lower reported incidents of violent or threatening incidents when using the PICU as a segregation area compared to not using the PICU as a segregation area.

3: In PICUs substance use is associated with favourable outcomes compared to patients not using substances. There was a significant difference in the changes of GAF-S –symptom ratings from admittance (baseline) to day three between the patient groups with or without a substance use diagnosis. The largest increase was in the patient group with a substance use diagnosis indicating more reduction of symptoms.

4: Threatening and violent incidents are not common acute manifestations of recent substance use in PICU populations. There was no significant difference in the number of threatening or violent incidents between the patient groups with or without a substance use diagnosis.

5: Substance use predicts shorter length of inpatient stay in PICU populations. The mean length of stay in the PICU was significantly shorter in the patient group with a substance use diagnosis compared to the patient group without a substance use diagnosis.

6: In PICUs prediction of short-term aggressive and threatening incidents should be based on clinical global judgement, and instruments designed to predict short-term aggression in psychiatric inpatients. In the hierarchical multiple linear regression analysis the global clinical evaluation from the physician on duty, the nurse clinicians’ global evaluation of “intensity of testing out and pushing limits”, and the observer rated scale scoring behaviours predicting imminent violence in psychiatric inpatients (BVC), were the factors positively associated with short-term threatening and violent incidents.

7: The predictive properties for BVC in the PICU-setting are satisfactory for the first three days after a single rating at admittance.

Additional conclusions:

1: Patients who have experienced segregation settings like seclusion have desires for alternative treatment conditions. These desires are to a large extent met by Norwegian PICUs. These PICUs are effective.

2: In the architecture and design of PICUs it is important to take into consideration the possibilities for segregation of patients.

Paper III reprinted with kind permission of Elsevier ScienceDirect.com

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22

Hodgson, Richard E. "The use of acute psychiatric beds in North Staffordshire." Thesis, Keele University, 1997. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.245408.

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23

Wong, Tak-po Mike. "Nursing stress in acute-care and psychiatric hospitals: a comparison." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 1996. http://hub.hku.hk/bib/B29697712.

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24

Thomas, Benjamin Lawrance. "The improvement of care planning documentation in acute psychiatric care." Thesis, King's College London (University of London), 2004. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.405733.

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25

Lad, Raina, Nisha Maymana, Trishna Kuber, and Lisa Goldstone. "Second Generation Antipsychotic Prescribing Patterns in an Acute Inpatient Psychiatric Setting." The University of Arizona, 2016. http://hdl.handle.net/10150/613987.

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Class of 2016 Abstract
Objectives: To determine if prescribers took into consideration patients’ metabolic risk factors when prescribing a low, medium or high risk second generation antipsychotic and if non-metabolic risk factors influenced prescribing. Methods: Adults 18 years or older who were admitted to an acute inpatient psychiatry unit and ordered at least one SGA were included in the study. Each patient’s metabolic syndrome risk score was determined using retrospective chart review and they were subsequently divided into low or high-risk groups. Clozapine and olanzapine were categorized as high risk for causing weight gain and diabetes, risperidone and quetiapine were moderate risk, and all others were considered low risk. A chi square test compared the two groups in regard to type of SGA selected, gender, and race, while an independent t-test analyzed the differences in age. Results: 300 patients were analyzed and divided into high (n=57) and low (n=253) risk groups. For the low risk group, 10.7%, 55.1%, and 34.2% were prescribed a low, moderate, or high risk SGA, respectively. For the high-risk group 17.5%, 56.1%, and 26.3% were prescribed a low, moderate, or high risk SGA, respectively. The type of SGA selected was not significantly different between the groups (p=0.262). Equivalence was shown between the two groups in terms of gender and race (p=0.68, p=0.65 respectively). Age was significantly different (p< 0.01). Conclusions: Prescribers may not consider metabolic risk factors when prescribing high risk SGAs such as clozapine and olanzapine.

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Brimblecombe, Neil. "An acute community mental health service : assessments, descriptions, predictions and implications." Thesis, Brunel University, 2002. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.250209.

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27

Carr, Catherine. "Modelling of intensive group music therapy for acute adult psychiatric inpatients." Thesis, Queen Mary, University of London, 2014. http://qmro.qmul.ac.uk/xmlui/handle/123456789/26966.

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Background: Acute inpatient stays are decreasing. Evidence for music therapy in mental healthcare exists but practice varies. Short admissions and therapy frequency (usually weekly), limit access, yet acceptability of increased frequency to patients is unknown. Research to model processes and outcomes of intensive provision may identify how best to provide for acute contexts informing clinical practice and future research. Methods: 114 patients admitted to hospital with acute mental health problems were recruited. Patients attended group music therapy 1-3 times per week during admission. Repeated measures assessing patient experiences, session appraisal, motivation and commitment were completed. Questionnaire thematic analysis identified important processes which were coded from session recordings. Multilevel modelling was used to examine associations between music therapy components, session appraisal, motivation, commitment and subsequent attendance. End of therapy interviews with 16 patients explored changes experienced and views on therapy frequency. Results: Attendance was 3 times greater for patients with 3 sessions per week. The majority found increased frequency acceptable and beneficial. Processes of engagement, emotional expression and social connection suggested active music-making, synchrony and singing to be important for group cohesion. Singing was significantly associated with appraisal and motivation. Musical initiation by group members was associated with motivation and commitment. All three outcomes were associated with each other, with session appraisal and increased frequency independently associated with subsequent attendance. Patient attributions for change included creativity, experiential learning and therapist directed reflective discussions. Conclusion: Intensive group music therapy is acceptable to the majority of patients, perceived as beneficial and increases access. Intensive provision is associated with greater engagement and positive experiences, which in turn, are associated with group commitment. Patient experiences can inform practice. Further research should examine effectiveness of intensive provision. Therapists should continue to prioritise engagement through active music-making and singing, and services consider implementation of intensive provision.

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28

Millar, Tracy. "A discourse analysis of young women's accounts of acute psychiatric hospitalisation." Thesis, University of London, 2002. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.252232.

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29

Reed, Alexander. "Social network meetings in an acute psychiatric setting : a practitioner research enquiry." Thesis, Northumbria University, 2004. http://nrl.northumbria.ac.uk/39/.

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Examination of the literature suggests that relationships between psychiatric staff and the families of service-users are often characterized as unsatisfactory, and that psychiatric hospitals provide an unconducive environment for the implementation of family and network-orientated approaches. This research focused upon the development in an adult psychiatric admissions unit of family- staff network meetings, that occurred when a person entered hospital. These network meetings, or 'reception meetings', were strongly influenced by the Finnish social network approach (Seikkula, Alakare & Aaltonen 2001), which focuses upon the creation of open dialogue between the service-user, family members and professionals. An overall aim of the study was to generate a body of practice-based narrative accounts which might act as a catalyst to practice developments in this field. Drawing upon a postmodern methodological framework, a range of methods were employed to engage with the multiple voices of service-users, family members and staff in the research site. Data sources included semi-structured interviews, participant observation, secondary data, and material from a research diary that was maintained as a reflexive tool in relation to the practitioner research process. A 'voice-centred relational method' (Brown and Gilligan 1992) provided a heuristic device for guiding data interpretation which facilitated multiple readings from different perspectives. A subsequent stage of data-analysis entailed developing more general connecting themes from across the data-set. A number of themes are developed in the research, which principally relate to the tensions associated with the introduction of a relationally orientated, reflective approach to practice within an individually-based medico-psychiatric organizational context. Practice approaches are discussed which appeared to facilitate an ethos of 'safe uncertainty' (Mason 1993) within network meetings, which is a necessary condition for dialogue. Connections are also drawn between themes generated in this study and the broader contexts of government policy, professional and organizational development, and practice-based research.

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30

Field, Thomas A. "Implementing Dialectical Behavior Therapy for Adolescents in an Acute Inpatient Psychiatric Setting." Thesis, James Madison University, 2014. http://pqdtopen.proquest.com/#viewpdf?dispub=3620455.

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Although evidence-based practices (EBPs) have been identified in the literature, insufficient information exists about how to successfully implement them. As a result, implementation efforts have been met with failures. Little is currently known about what affects the success of implementation efforts for best practices such as Dialectical Behavior Therapy for adolescents (DBT-A) in an acute inpatient psychiatric setting (AIPS). A longitudinal multiphase mixed methods case study examined an implementation effort to provide DBT-A in an AIPS over a 24-month period. The process of implementation was investigated through in-depth interviews, a focus group, and field observations. Six categories were identified that affected the DBT-A implementation in an AIPS: appeal of DBT as a treatment modality, impact on patients, implementer characteristics, the implementation process, organizational dynamics and structure, and staff support. Implications for implementing EBPs within organizational environments are discussed. This study represents the first attempt to use qualitative and mixed methodology to examine the process of DBT implementation in an AIPS.

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Ortiz, Marie Elois. "Educational Interventions to Improve Aggressive Behavior Recognition for an Acute Psychiatric Setting." ScholarWorks, 2017. https://scholarworks.waldenu.edu/dissertations/4550.

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Nurses working in an acute psychiatric setting within a veterans' administration hospital must maintain a therapeutic milieu by recognizing and managing aggressive behaviors before violence ensues to reduce injuries to staff nurses and patients. The purpose of this project was to develop an evidence-based and theoretically grounded educational program that will help staff nurses manage escalating aggression, violence, and acting out behaviors to provide a safe environment for patients and staff through high risk identifier recognition and intervention training. During the data and information gathering stage, 23 articles were reviewed, rated, and graded to provide the most significant information used to complete the project. The project is a workshop made up of a 6-module curriculum that will be used to train staff nurses. This workshop will be shared with the partnering organization including the recommendation that it is adopted and implemented at a later date. The educational training program will have the potential to become a practice standard for other acute psychiatric settings within the Veterans Integrated Service Network to provide a tool that will assist the nurses as they care for the patient and maintain safety. Social change will occur through the empowerment of nurses who interact with veterans to bring them better and safer care.

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Chabinska, Joanna. "Burnout, depression and job satisfaction in acute psychiatric and secure mental health settings." Thesis, University of Edinburgh, 2017. http://hdl.handle.net/1842/23570.

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Chapter 1: Objective: The systematic review aimed to review the literature on burnout and its relationship to depression within the acute in-patient mental health services: psychiatric units and specifically, secure forensic mental health services. Methods: The review process included a systematic search across five databases (Medline, PsychINFO, Cinahl Plus, EMBASE and SCOPUS). Eligible studies included a cross-sectional design, using validated measures on burnout and depression. Results: A strong relationship between depression and emotional exhaustion was found. The relationship between depression and two other burnout dimensions (personal accomplishment, depersonalisation) was weaker and better explained in the context of other predicting (anxiety) and mediating (transformational leadership) variables. While depression severity across the studies was mostly mild with average burnout, service-specific variations were observed. Chapter 2: Objective: The empirical study aimed to explore any direct relationships of subjectively perceived understanding, predictability, control (job demands) with burnout and job satisfaction, and direct/in-direct effects of social support, psychological mindedness and psychological inflexibility (external and internal resources) on these relationships. Methods: Data was collected among Scottish National Health Service (NHS) employees (n=198) working in secure mental health services; forensic (58.65%) or intellectual disability (41.35%). Data gathered from the final sample of 141 nursing staff was analysed using t-tests, bi-variate correlations, hierarchical regressions and a series of mediation, moderation and moderated-mediation analyses. Results: The empirical study revealed that individual burnout dimensions were predicted by different job demands. Social support appeared as predictor rather than a moderator of job satisfaction and emotional exhaustion while psychological inflexibility was a mediator for job demands and burnout. Overall Conclusions: Concluding remarks for both, systematic review and empirical study, identify the need for further research, especially within the forensic mental health speciality. Both highlight that direct and in-direct effects may be important in explaining burnout while the empirical study makes further suggestion with regards to likely individualised pathways and two important resources of social support and psychological flexibility.

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Smyth, Marcellino Gerard. "Exclusive home treatment and hospital treatment for acute psychiatric disorder : a controlled evaluation." Thesis, University of Birmingham, 1998. http://etheses.bham.ac.uk//id/eprint/206/.

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Home Treatment for acute psychiatric illness was compared to conventional hospitalisation in a design which focused on completed episodes of either exclusive alternative. The evaluation was conducted with the West Birmingham Home Treatment Team and All Saints Hospital, Birmingham. Forty cases in each group were examined with closely equivalent sociodemographic features and previous psychiatric history. The length of treatment, clinical outcome, identification and targeting of needs, readmission profile and client satisfaction were compared. The study focused on presentations involving mainly a diagnosis of severe mental illness. Home Treatment was significantly shorter and involved wider targeting of identified needs. There was no significant difference in terms of clinical outcome. Home Treatment and avoidance of admission were preferred by patients. The determinants of satisfaction with acute care in both settings was explored qualitatively. Significant design and sampling problems limit the generalisability of results. The case for and against Home Treatment is examined. The lessons learnt during the course of the study regarding the appropriate focused evaluation of Home Treatment and the place of Home Treatment as a particular model of intensive care are critically discussed.

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Mac, Gabhann Liam. "Improving nurse patient therapeutic interactions in acute inpatient psychiatric care through participatory action research." Thesis, Swansea University, 2008. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.517752.

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35

Kovane, Mvuselei. "Factors causing absenteeism of nurses in an acute psychiatric hospital : case study in Cape Town." University of the Western Cape, 2015. http://hdl.handle.net/11394/4729.

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Masters in Public Administration - MPA
Absenteeism is a serious problem globally, and it entails a high cost for organizations. Shortage of nurses is a world-wide concern and absenteeism worsens the existing shortage in hospitals. In order for hospitals to run smoothly and render quality nursing care, regular attendance is required. The South African health institutions are faced with challenges of poor working conditions, low pay, as well as physical exhaustion from the workload. These challenges are seen as contributing to nurse absenteeism. The overall aim of this study was to describe factors that contribute towards absenteeism among nurses in an acute psychiatric hospital in the Western Cape Province of South Africa. The study was carried out in an acute psychiatric hospital in Cape Town. Only permanently employed nursing staff at Valkenberg Hospital and Community service nurses were considered for the study. This study was quantitative in nature and it used the descriptive survey design. A self-administered questionnaire was used as a tool for data collection. The sample size of this study consisted of 135 (67.5%) nurses. It was drawn from a hospital population of 200 nursing staff. A number of factors emerged as significantly contributing to nurse absenteeism. The results show that 69% of participants agree that they were absent as they are dissatisfied with pension funds, medical aid contributions and the criteria for issuing incentive bonuses. Moreover the same percentage of participants, 69% strongly felt that the amount of work was overwhelming due to the fact that the staff patient ratio is too high. About 51% of participants were not satisfied with their progression in their career of nursing. About 68% of participants were not satisfied with the sufficiency of equipment and 51 % were unhappy with working conditions. The results also show a significant rate of absence of female nurses and older nurses. Absenteeism has become a major challenge that cuts across many organisations and national borders. It is a global phenomenon. The study, in hint sight, recommends that the physical working conditions of the institution need to be revamped to accommodate employees’ basic needs. It further recommended that staff patient ratio be revised, as it places tremendous pressure on nurses in terms of excessive workload. A facility like pre-school also needs to be provided as the female nurses appear to be more absent from work due to their multi-task roles.

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ESTEVE, REICH VERONIQUE. "Reflexion sur le concept d'acte." Angers, 1994. http://www.theses.fr/1994ANGE1057.

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37

Abderhalden, Christoph. "The systematic assessment of the short-term risk for patient violence on acute psychiatric wards." Maastricht : Maastricht : Universitaire Pers Maastricht ; University Library, Universiteit Maastricht [host], 2008. http://arno.unimaas.nl/show.cgi?fid=9705.

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38

Quirk, Alan. "Obstacles to shared decision-making in psychiatric practice : findings from three observational studies." Thesis, Brunel University, 2007. http://bura.brunel.ac.uk/handle/2438/5464.

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This thesis aims to make contributions at substantive, methodological and theoretical levels. First, the findings from three observational studies are combined to identify obstacles to the use of shared decision-making in modern psychiatric practice. Particular attention is paid to how patients' choices about their treatment are facilitated or constrained by the actions of mental health professionals. A typology of pressure is constructed, based on detailed analyses of how pressure is applied and resisted in routine encounters (outpatient consultations) and "crisis' situations (assessments for compulsory admission to hospital, and ward rounds in acute inpatient care). Findings from two ethnographies and one conversation analysis (CA) study are presented. 'Meaning' is central to the write-up of each set of findings, however while the analytic focus of the ethnographies is 'insider' knowledge and meanings, in the CA study it is gn the activities that make those meanings possible in the first place. The methodological contribution of the thesis stems from its demonstration of how to produce a coherent, unified research account from two very different versions of qualitative inquiry. Despite the potential for analytic inconsistency, the thesis arguably has far greater force and persuasiveness as a result of the attempt to combine, compare and contrast findings from three studies. It is contended that a sound theoretical base for sociological research may be created by combining Goffman's micro-sociology with Foucault's analyses of disciplinary power/knowledge in one of a number of ways. A Goffmanian 'home base' is adopted for this thesis, with Foucauldian thinking applied to add a historical, 'macro' dimension to the analysis that Goffman's work so conspicuously lacks. Foucault's work also provides the conceptual tools for examining the more subtle form of control through expertise that would be missed in a purely Goffmanian study.

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Llanes, Basulto Yasmani, Hernández Yanquiel Barrios, Hernández Ignacio Oliva, Noda Susel de la Caridad Pimentel, and Guerra Esvieta Calvo. "Depression in patients with schizophrenia admitted to the acute services of the Psychiatric Hospital of Havana." Pontificia Universidad Católica del Perú, 2014. http://repositorio.pucp.edu.pe/index/handle/123456789/100451.

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The presence of depression in the acute phase of schizophrenia is evaluated, and the clinical and psychosocial characteristics that can be associated with depression are identified. Participants included 73 patients that were admitted to the acute services of the Psychiatric Hospital of Havana, given that depression is a symptom in a significant amount of the patients with schizophrenia, 35.6% of the patients presented clinically significant symp- toms, and these were related significantly with unemployment, the separation of loved ones and a greater number of re-hospitalizations. It is important to consider depression and its causes to develop effective treatment strategies.
Se evalúa la presencia de depresión en la fase aguda de la esquizofrenia y se identifican las características clínicas y psicosociales que puedan estar asociadas a la depresión. Se estudiaron 73 pacientes ingresados en los servicios de agudos del Hospital Psiquiátrico de La Habana, identificándose que la depresión es un síntoma presente en una parte importante de los pacientes con esquizofrenia, el 35.6% de la muestra presentó síntomas clínicamente significativos, y relacionados significativamente con la ausencia de vínculo laboral, la separación de seres queridos y un mayor número de ingresos. Es importante considerar la depresión y sus causas para desarrollar estrategias de tratamiento eficaces en este tipo de pacientes.

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40

Batalla, Cases Albert. "Acute and chronic effects of cannabinoids on human brain: gene-environment interactions related to psychiatric disorders." Doctoral thesis, Universitat de Barcelona, 2014. http://hdl.handle.net/10803/283281.

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1) Introduction Cannabis use has been associated to mental health problems and worsened outcome of established psychiatric disorders. Disturbances of the endocannabinoid system may be responsible for long-lasting effects, such as neuropsychological deficits and morphological brain alterations. As not all the exposed individuals are equally affected, proneness to cannabis induced impairment may rely on key factors such as age of onset, cannabis use parameters and genetic background. The aim of the present thesis is to expand current knowledge of the effects of cannabinoids, while assessing gene-environment interactions that are relevant for psychiatric disorders, based on the following hypothesis: - Cannabis use in first-episode psychosis would be associated with worse outcome regarding readmission rates (Chapter 3). - Acute and chronic cannabis use would be associated with alterations on brain function and structure in key areas relevant for psychiatric disorders (Chapters 4-5). - Early-onset chronic cannabis users would show morphological brain alterations compared to non-using controls, and variation in the dopamine-regulating genes would result in diverse liability to experience cannabis-related brain impairment (Chapters 6-7). 2) Methods We assessed a cohort of 58 first-episode psychosis patients. The main outcome was the time until first readmission. All subjects were interviewed using the Structured Clinical Interview SCIO-I, the Positive and Negative Syndrome Scale (PANSS) and the Dartmouth Assessment of Lifestyle Inventory (DALI) scale. The subjects also underwent blood and urine sampling for drug use (Chapter 3). In addition, we conducted two systematic literature reviews in accordance with PRISMA guidelines. Chapter 4 included 43 neuroimaging studies of experimental administration of cannabinoids involving animals naive to cannabinoids and naive/occasional cannabis users. Chapter 5 considered 4S neuroimaging studies involving chronic cannabis users with a matched control group. Finally, we performed a case-control study in male Caucasians, 30 early-onset chronic cannabis users and 29 age-, education- and intelligence-matched non-using controls. All subjects were assessed by a structured interview (PRISM). Catechol-a-methyltransferase (COMT Val(158)Met] and dopamine transporter (DATI-VNTR) genotyping were performed. MRI data was analysed by VBM (Chapter 6) and manual tracing of the hippocampus via well-validated methods (Chapter 7). 3) Results Cannabis was the most common drug found in the first-episode psychosis cohort, either in urinalysis (38%) or self-reported (50%). Both the DALI cannabis/cocaine subscale (p=0.002) and urinalysis for cannabis (p=0.02) were associated with increased readmission risk in survival curves. The DALI cannabis/cocaine subscale at baseline was a significant predictor of readmission over the study period (HR = 4.5: 95% CI = 1.1 to 18.7; p=0.036) after controlling for potential confounders (Chapter 3). Studies included in Chapter 4 showed that acute administration of cannabinoids modulate resting state activity and alter neural activity during performance of several cognitive tasks in areas related with reward and psychiatric disorders. Chapter 5 indicated that chronic cannabis use is associated with alterations in brain function and structure, particularly in medial temporal regions. In the case-control study, chronic cannabis users showed morphologic brain alterations that were differently influenced by the COMT and DATI genotypes compared to controls. Variation in the COMT genotype affected the bilateral ventral caudate nucleus and left amygdala in both groups in an opposite direction (Chapter 6). Chapter 7 expanded these results by showing that COMT and DATI genes interacted with each other moderating individual differences also in the hippocampal volume. 4) Conclusion Together, these results proVide support for endocannabinoid Involvement in the outcome of psychiatric disorders, as well as in the control of different cognitive functions, dopamine release and brain volume. Findings also provide evidence that dopamine-regulating genes may playa particular role in the sensitivity to the effects of cannabis on brain morphology, providing further insights into the mechanisms of cannabis-related brain impairment and genetic vulnerability.
L'ús de cànnabis pot comportar l'aparició de trastorns mentals i un pitjor curs dels trastorns psiquiàtrics establerts. Alteracions del sistema endocannabinoid endogen podrien ser responsables també dels efectes a llarg termini associats amb el consum d'aquesta substància, com son les alteracions en la funció i estructura cerebral. Donat que no tots els individus es veuen igualment afectats, la probabilitat de patir danys associats al consum de cànnabis podria recaure en diversos factors clau, com són l'edat d'inici, els paràmetres de consum i aspectes relacionats amb la vulnerabilitat genètica individual. Aquesta tesi té com a objectiu eixamplar el coneixement actual sobre els efectes aguts i crònics dels cannabinoids, tot avaluant interaccions gen-ambient que són rellevants pels trastorns psiquiàtrics. Aquest objectiu s'assoleix a través de l'estudi de les conseqüències de l'ús de drogues d'abus en una cohort de primers episodis psicòtics (Capítol 3): dues revisions sistemàtiques de la literatura que inclouen estudis de neuroimatge sobre l'administració experimental de cannabinoids en animals no tractats prèviament i consumidors puntuals/ocasionals de cànnabis (Capítol 4), i estudis de neuroimatge funcional i estructural en consumidors crònics de cànnabis i un grup control aparellat (Capítol 5); i posteriorment per mitjà d'Un estudi cas-control sobre la influència dels gens reguladors de la dopamina ((catecol-O-metiltransferasa (COMT) Ya11S8Met) i transportador de la dopamina (DAT1•YNTR)] en l'estructura cerebral de consumidors crònics de cànnabis d'inici temprà comparats amb controls sans aparellats no consumidors. En conjunt, els resultats presentats en aquesta tesi donen suport a la participació del sistema endocannabinoid en el curs dels trastorns mentals, aixf com en el control de diverses funcions cognitives, modulació de dopamina i volum cerebral. Els resultats també demostren que els gens reguladors de la dopamina poden tenir un paper rellevant en la sensibilitat als efectes del cànnabis en la morfologia cerebral, proporcionant nous coneixements sobre el mecanismes subjacents al dany cerebral induït per cànnabis i sobre aspectes de vulnerabilitat genètica.

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41

Douglas, Catherine. "Factors that promote recovery : the views of service-users experiencing psychosis on an acute psychiatric ward." Thesis, University of Essex, 2018. http://repository.essex.ac.uk/22896/.

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Background: Psychosis was once considered a progressive and untreatable “illness” due to a “diseased brain”. Current thinking suggests childhood adversity along with a combination of psychological, biological and environmental factors influence the development of psychosis experiences, with recovery now considered an achievable aim. Recovery is a multifaceted concept. Research indicates that service-users hold different views about recovery, however research exploring recovery from the viewpoint of those who are currently inpatients is scarce. Aims: The aim of the current study is to explore the views that a group of service-users who are currently inpatients in a psychiatric hospital, hold about what is important to them in recovery. Method: Q-methodology allows the exploration of the distinct viewpoints that are present among a group of people in relation to a subject matter. Thirty-eight participants were recruited across four acute psychiatric wards from a London based psychiatric hospital. Using Q-methodology, participants engaged in a card sort task where they ordered 54 statements relating to recovery from most to least important to them. Results: The analysis revealed four distinct viewpoints held among the group regarding factors that are important to recovery from psychosis. These were: “Stability, independence, and having a roof over your head”, “Hope, optimism, and enhancing wellbeing”, “Emotional change through self-management and social support”, and “Symptom reduction through mental health support”. Conclusions: Service-users who experience psychosis and are currently inpatients, hold different views about what is helpful to them in recovery. Services must be sensitive to the subjective conceptualisations service-users hold of their experiences and be flexible in tailoring support to meet their needs. The findings from this study suggest that changes are required both within services and at a socio-political level, in order to support people with psychosis toward recovery. Clinical implications and areas for future research are discussed.

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42

Johnson, Isabella Sonia. "An evaluation of the crisis resolution team model, a proposed alternative to acute psychiatric hospital admission." Thesis, University of Oxford, 2006. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.432578.

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43

Sobekwa, Zintle Charles. "Experiences of nurses caring for mental health care users in an acute admission unit at a psychiatric hospital." University of the Western Cape, 2012. http://hdl.handle.net/11394/4538.

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Magister Curationis - MCur
The provision of mental health care, treatment and rehabilitation of the acutely ill mental health care users (MHCUS) poses a major challenge to the nurses working in acute units. Nurses spend long hours ensuring that acutely ill psychiatric patients receive quality patient care in acute admission units in different psychiatric hospitals in South Africa. With few studies showing a rise in the prevalence of mental disorders in the South Africa and the Western Cape Province, acute psychiatric inpatient units across the province have experienced intense pressure and persistent rise in the number of acute patient admissions. Dealing with this group of patients is a difficult task particularly for nurses who spent prolonged hours caring for them. Despite the continuing provision of care to MHCUS by nurses in acute admission units, very little is known about the lived experiences of nurses in acute admission units. The aim of this study was to explore and describe the lived experiences of nurses who care for the acutely ill MHCUS in an acute male admission unit at a psychiatric hospital in the Western Cape. Acutely ill MHCUS in acute psychiatric units show severely disturbed behaviour at times, aggression, hostility, acute psychotic symptoms and many other symptoms related to psychiatric illness. Methods: a qualitative, descriptive phenomenological research design was used to explore and describe the lived experiences of nurses who care for acutely ill patients in an acute admission unit. A purposive sample of eight nurses was selected. Individual, semi structured phenomenological interviews were used to collect data from nurses caring for MHCUS in an acute admission unit. Data saturation was reached after carrying out the eight interviews. These interviews were audio taped and transcribed verbatim and Collaizi’s (1978) seven steps method of qualitative data was applied to analyse the collected data. Findings: The study found that nurses in the acute admission unit experienced several challenges while caring for MHCUs. Nurses reported both negative and positive experiences. Positive experiences included MHCUs recovery, teamwork and passion for caring while negative experiences were feeling unappreciated and unsupported by authorities. Furthermore, they reported physical assault by MHCUs which led to fear. Challenges experienced included shortage of staff and increased workload which led to burnout amongst nurses in acute admission units.

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Patton, Declan. "A critical analysis of acute psychiatric admission unit nursing : the perspectives of staff nurses and service users." Thesis, Staffordshire University, 2009. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.522129.

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45

Jacobsen, Pamela. "Mindfulness-Based Crisis Interventions (MBCI) for psychosis within acute inpatient psychiatric settings : a feasibility randomised controlled trial." Thesis, King's College London (University of London), 2018. https://kclpure.kcl.ac.uk/portal/en/theses/mindfulnessbased-crisis-interventions-mbci-for-psychosis-within-acute-inpatient-psychiatric-settings(f99f9294-c04b-405b-8f1f-45569ad4d7cf).html.

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Background: Inpatient psychiatric care is a scarce and expensive resource in the National Health Service (NHS), with chronic bed shortages being partly driven by high re-admission rates. People often need to go into hospital when they have a mental health crisis due to overwhelming distressing psychotic symptoms, such as hearing voices (hallucinations) or experiencing unusual beliefs (delusions). Brief talking therapies may be helpful for people during an acute inpatient admission as an adjunct to medication in reducing re-admission rates, and despite promising findings from trials in the USA, there have not yet been any clinical trials on this kind of intervention within NHS settings. Objectives: The primary objective of the study was to find out whether it was possible to carry out this kind of trial successfully within UK inpatient settings in terms of successfully recruiting and retaining patients in the trial. The secondary objective was to collect pilot data on clinical outcome measures, including re-admission rates at 6-month follow-up. Method: The amBITION study (BrIef Talking therapIes ON wards; ISRCTN376253384) was a parallel groups, feasibility randomised controlled trial (RCT) of a manualised brief talking therapy (Mindfulness-Based Crisis Intervention; MBCI). Inpatients on acute psychiatric wards were eligible for the study if they reported at least one positive psychotic symptom, and were willing and able to engage in a talking therapy. In addition to treatment as usual (TAU), participants were randomly allocated to receive either MBCI or a control intervention (Social Activity Therapy; SAT) which involved doing activities on the ward with the therapist. Results: Fifty participants were recruited to the trial (26 MBCI; 24 TAU). No participants dropped-out during the therapy phase, and everyone in the trial received at least one therapy session. The average number of sessions per participant was 3 in both arms of the trial. Retention in the trial was excellent, and exceeded the pre-set benchmark of no more than 20% loss to follow-up at trial end-point (6-month follow-up after discharge). The follow-up rate at 6-month follow-up was 98% for service use data extracted from clinical notes, and 86% for self-report questionnaire measures. Three participants experienced adverse events, but none of these were considered to be related to their participation in the trial. Conclusions: It is feasible to recruit and retain participants in the trial. The therapy was acceptable to patients, and satisfaction ratings with therapy was high. Progression to a further trial is warranted based on these encouraging feasibility outcomes.

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Chyan, Vivian, Megan Shell, and Lisa Goldstone. "Evidence-Based Use of Prophylactic Anticholinergic Medication in Combination with Antipsychotic Pharmacotherapy in an Acute Inpatient Psychiatric Setting." The University of Arizona, 2015. http://hdl.handle.net/10150/614026.

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Class of 2015 Abstract
Objectives: The study aimed to increase EPS risk factor assessment when prescribers order prophylactic anticholinergics with antipsychotics. An evidence-based pharmacist checklist card was developed to aid in this decision making process. Methods: A retrospective chart review of patients admitted to the acute inpatient psychiatry units at an academic medical center was conducted to determine baseline prophylactic anticholinergic prescribing habits over a two-month period. Charts were included if the patient was at least 18 years old and ordered at least one scheduled antipsychotic during the admission. An educational intervention session introduced the pharmacist checklist card and shared baseline findings. Post-intervention data was collected during a two-month period following the intervention. The percentage of prophylactic anticholinergic orders based upon pharmacist checklist card parameters pre and post-intervention was analyzed using chi-square test. Results: There was a significant decrease in the total percentage of orders for prophylactic anticholinergics from 72.7% in the pre-intervention period to 50.8% in the post-intervention period (p<0.001). Significant changes in the percentage of orders for prophylactic anticholinergics were also found for patients at no-to-low risk for EPS (56.4% versus 31.8%, p=0.014) and at low-to-moderate risk for EPS (79.6% versus 50.8%, p=0.003). There were no significant changes observed in the percentage of orders for prophylactic anticholinergics for patients at moderate-to-high risk for EPS. A lower percentage of patients prescribed a prophylactic anticholinergic experienced adverse effects in the post versus the pre-intervention period (52.31% versus 75.27%, p=0.003). Conclusions: Significant differences were found between pre and post-intervention anticholinergic medication prescribing habits. This suggests that increased patient risk factor assessment in the form of a pharmacist checklist card is effective in decreasing orders for prophylactic anticholinergic medications not clinically indicated and reducing the incidence of adverse effects.

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Quinlan, John. "The essence of pastoral care an investigation of patient satisfaction with pastoral care in an acute general and psychiatric hospital /." Online full text .pdf document, available to Fuller patrons only, 2000. http://www.tren.com.

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Ravello, Cherrie Valerie. "An investigation into nurses' views and experiences of what creates a clinical learning environment within acute in-patient psychiatric wards." Thesis, University of Bedfordshire, 2013. http://hdl.handle.net/10547/337218.

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Although I was trained as a nurse, I became curious about the views of psychiatric nursing staff as to what they feel would create a clinical learning environment for them. This was as a result of having my dearly beloved father admitted to a medical ward, and being on the receiving side of care. This created a fear in me that surprised me. I was scared at how my father would be treated if I was not present to witness his care. As a nurse, strangely, I felt that I could not trust the nurses to provide safe clinical care for/with my father. I began to feel concerned about the competencies of nurses as I observed the care that was being offered to him. My observation and experience was that the ward environment generated an atmosphere that needed a form of nursing care that was collaborative and transparent where the hand-over between professionals communicated the needs of the patients in their care – from making sure that patients’ bedding is comfortable, to checking whether they are trying to communicate something, to being sure that their medication has been properly given. This aroused my curiosity as to whether nursing staff themselves had views as to what is needed to have, or to create, an environment that sustained their original urge to take up nursing in the first place. I thus became curious to investigate the views and experiences of both qualified and non-qualified psychiatric nurses with the aim of improving the clinical learning environment within acute adult inpatient wards, as well as secure adult and male adolescent mental health inpatient wards, as these wards raise crucial issues to do with control, power, seclusion, rights and responsibilities, issues that are not easy for nurses to learn to deal with in their classroom training. For this study I interviewed sixteen staff members of wards within the National Health Service and the private sector. The staff varied in their experiences and qualification, from qualified mental health nurses to non-qualified nurses. My findings show that: (1) Nurses often felt the ward organisation had hindered their learning through the way in which it worked to organise them. (2) Nurses would have liked to experience a different kind of learning. However they were not sure in what way or how they would like the learning experience to be. (3) The expert nurses were able to work in a competent manner despite the sense of the organisation organising their practices, as they were able to sense which of the limited number of organisational possibilities were open to them so that their choices allowed for their practices to be learning experiences as well as providing sound clinical care. (4) Learning dialogues happen in contexts where nurses feel supported and where the episode of care in which they are engaged is also supported by a team approach and resourceful pulling together of skills and abilities. (5) There was a lack of space(s) for the nurses to use for reflection. (6) Nurses also expressed the need for supervision after an episode or critical event had taken place. (7) Throughout all the areas I inquired into, what was strongly echoed was that the psychiatric nurses all felt that they needed a voice within the organisation and its hierarchy of team structures within these wards. There was a felt sense that the nurses wanted and at times needed more expert nurses working in the teams. Overall, I was struck by the abilities which were brought to the forefront as the nurses shared their views and experiences of how they felt organised by the organisation. They were able to explore the factors that they felt would improve the quality of care that nurses provide and were able to share what they believe will help them in co-creating standards for how the clinical environment could become a learning environment for the nurses.

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Malgas, Fikile Nelson. "Exploration of nurses' experiences of the assessment and management of patients at risk of absconding from an acute psychiatric ward in the Western Cape." University of the Western Cape, 2017. http://hdl.handle.net/11394/5682.

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Magister Curationis - MCur
Unlawful absence of patients from the acute psychiatric ward increases concern on the part of the professionals responsible for their care. Patients who abscond from psychiatric hospitals represent a risk of potential harm to patients or the general public. Consequences of absconding may include physical harm and prolonged treatment time, as well as considerable economic cost to the family and government. The aim of the study was to explore and describe the nurse's experiences of assessment and management for patients at risk of absconding from an acute psychiatric ward in the Western Cape. A qualitative approach using an exploratory descriptive design was applied to conduct this study. The target population was mental health nurses working in acute psychiatric wards where patients were at risk of absconding. A sample of ten (n=10) mental health nurses was purposively selected to participate in the study. Semistructured interviews were used to collect the data from participants. Data collection continued until data saturation was reached (until no further new information emerged). Data was analysed manually by coding, categorizing and identifying similar patterns. Trustworthiness of the study was ensured through addressing the confirmability, transferability; credibility and dependability. Ethics approval was obtained from the University Research Ethics Committee and Ethics Committee of the Department of Health and the selected psychiatric hospital. The ethical principles of the right to self-determination, withdrawal from the research study, privacy, autonomy and confidentiality, fair treatment, protection from discomfort and harm, and obtaining informed written consent were adhered to. Three themes emerged from the data: risk assessment, risk management, and increased observations. The results of the study was discussed with relevant recent literature evidence. The qualitative research is limited to few study sample size, and the results cannot be generalized to other similar population.

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Bogen, Sarah [Verfasser], Martin [Gutachter] Holtmann, and Silvia [Gutachter] Schneider. "Feasibility and efficacy of morning bright light therapy for depressed adolescents in an acute psychiatric care setting / Sarah Bogen ; Gutachter: Martin Holtmann, Silvia Schneider." Bochum : Ruhr-Universität Bochum, 2016. http://d-nb.info/1119447283/34.

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Dissertations / Theses on the topic 'Acute psychiatry'

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