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Accessible Summary: What is known about the subject: Caring for a family member with a mental illness induces a burden on the caregiver, an impact on their quality of life and premature ageing of more than ten years. What the paper adds to existing knowledge: We conducted systematised and individualised nursing interviews with family members, on the first days of a relative's hospitalisation, during hospitalisation and three months after discharge.We observed persistent depressive symptoms during and after hospitalisation. Burden and depression were higher, and quality of life was lower, for women caregivers and when the caregivers admitted the patients involuntarily in the hospital ward. When the caregivers were experiencing a patient's first hospitalisation, we also found higher depressive symptoms and lower quality of life. What are the implications for practice: This study emphasises the need for new interventions such as psychoeducation to alleviate the suffering of families. Considering the burden of families could become a prevention objective from the patient's first hospitalisation and prevent them from mental or physical health problems. Introduction: The burden consequent to providing care to patients with psychiatric chronic conditions is often overlooked by health professionals. Aim: We assessed the impact of patients' psychiatric hospitalisation on their caregivers, through evaluating their suffering, burden and quality of life, in three stages: upon the patients' admission, their discharge and 3 months after their discharge. Method: In total, 127 caregivers of adult patients whose first hospitalisation was less than 5 years ago were assessed using the 36‐item Short‐Form Health Survey, the Zarit Burden Interview and the Center for Epidemiologic Studies Depression scale. Results: Females and caregivers who admitted patients against their will experienced higher burden and depression and lower mental quality of life. We also found higher depressive symptoms and lower quality of life among caregivers during a patient's first hospitalisation. The caregiver's familial relationship to the patient was not associated with these outcomes. Finally, burden decreased and quality of life increased over time. Discussion: Results suggest that several variables associated with patient hospitalisations were correlated with burden, depression or quality of life. Implications for Practice: Burden could be targeted with interventions such as group psychoeducation for caregivers during or after the patient's hospitalisation, in order to reduce their distress and improve their quality of life. Psychiatric and mental health nurses can provide support to caregivers with systematic assessments of their burden and quality of life, so as to better meet their needs and promote their ability to cope with mental illness. [ABSTRACT FROM AUTHOR]

This research aims to summarize and discuss issues related to psychiatric drugs by using the classification system of the Pharmaceutical Care Network Europe (PCNE) and to provide a reference for the development and direction of clinical pharmacists' work in the future. Psychiatric patients who were hospitalized in our hospital from Janurary 2023 to December 2023 were enrolled. Drug-related problems (DRPs) were evaluated using the PCNE classification system (version 9.0). The types, causes, intervention plans, acceptance of intervention plans, and statuses of DRPs were analyzed. A total of 362 patients were included, covering 405 DRP cases, with an average DRP of 1.12 for each patient. All 405 DRP cases underwent interventions, with a success rate of 83.46%. The main categories of related drugs were psychotropic drugs (70.37%), anti-infective drugs (8.89%), and cardiovascular system drugs (5.19%). The main DRPs were possible adverse drug events (21.24%), poor treatment effects (69.14%), and unnecessary medication treatment (9.63%). The main causes of DRPs were inappropriate drug selection (18.52%), inappropriate combinations of drugs (16.05%), and excessive drug dosage (13.58%). The PCNE classification system helps clinical pharmacists improve their ability to identify and solve DRPs faced by psychiatric departments, improve pharmaceutical care efficiency, and ensure rational drug use. [ABSTRACT FROM AUTHOR]

Background: Japan has one of the lowest COVID-19 death rates, while the annual suicide rate in 2020 has risen for the first time since 2007. This study aimed to identify high-risk populations and assess the impact of medical visits on suicide trends post-COVID-19 pandemic in Japan. Method: This quasi-experimental study analyzed a population-based database from Hyogo Prefecture (2012–2022). Interrupted time-series analyses identified level and trend changes in monthly suicide rates per 1 million population during the exposure period (2020–2022) versus the control period (2012–2019). Regular visits to primary care and psychiatry stratified analysis. Results: 2181 cases were analyzed, with two-thirds male and a median age of 54. Primary care physicians and psychiatric history were present in 69% and 40% of patients. The study found significant level changes in suicide rates overall (4.14, 95% CI: 1.70, 6.58) among individuals without regular primary care physician visits (2.83, 95% CI: 1.35, 4.32) and without psychiatric visits (2.85, 95% CI: 0.56, 5.14). In contrast, no significant changes were observed in individuals with regular primary care (0.99, 95% CI: -0.78, 2.76) or regular psychiatric visits (0.59, 95% CI: -0.98, 2.16). The trend changes were not significant in any of the groups. Conclusion: This study suggests that a history of attending a medical institution may have prevented the rapid increase in suicides during the early stages of the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

ABSTRACT Lesbian, gay, bisexual, transgender, queer and other diverse sexual orientations and gender identity groups (LGBTQ+) face high rates of poor mental health. In the most severe and emergent of instances, inpatient psychiatric care may be required. LGBTQ+ people report experiences of mistreatment in healthcare settings broadly, such as denial of healthcare services and harassment from healthcare providers and other patients. However, little is known about the experiences of LGBTQ+ people in inpatient psychiatric care settings, specifically. The purpose of this review was to assess the existing literature for descriptions of LGBTQ+ people's experiences within inpatient psychiatric care. We searched multiple databases (i.e., PubMed, PsychINFO, CINAHL, Web of Science and Google Scholar) for peer‐reviewed articles that described the experiences of LGBTQ+ people within inpatient psychiatric care that were published in English. The included articles (N = 14) were analysed using a conceptual model of stigma and organised within those strata (structural, interpersonal and individual stigma) across the inpatient experience, (admission, inpatient unit, and discharge). Themes identified included: noninclusive intake tools and pervasive misgendering during the admission process; lack of healthcare infrastructure, inadequate training and lack of cultural humility, pervasive discrimination and victimization, silencing of LGBTQ+ patients, and feelings of fear and shame while on inpatient units, and lack of community resources during the discharge process. Clinicians should consider the perspectives and experiences of LGBTQ+ people to enact identity‐affirming care practices that may increase mental healthcare engagement and improve long‐term mental health outcomes. [ABSTRACT FROM AUTHOR]

Forecasting inpatient and outpatient visits is essential for successful resource allocation and clinical decision-making. The techniques used by previous researchers for forecasting, primarily based on statistical approaches, which often require extensive data preprocessing and expert knowledge, can be time-consuming and difficult. Therefore, this study analyses three current deep learning (DL) algorithms, recurrent neural network (RNN), long short-term memory (LSTM) and gated recurrent unit (GRU), for forecasting inpatient and outpatient visits for depressive disorders. These algorithms are among the most familiar DL techniques for time series and have been used with remarkable success in various contexts. The DL algorithms were evaluated using mean squared error (MSE), root mean squared error (RMSE) and mean absolute error (MAE). Based on the results comparison, LSTM has the best performance (lowest error values) compared to the RNN and GRU. The DL algorithms are also being compared to state-of-the-art algorithms, and the results show that the DL algorithms can accurately forecast inpatient and outpatient visits compared to the previously proposed algorithms. The findings from this study could be helpful in clinical decision-making and resource allocation in mental health care.

Abstract Background The current pandemic situation led to deep changes not only in social relationships, but also on clinical care and access to healthcare facilities. The authors aimed to understand whether this context affected the main characteristics of psychiatric hospitalizations, measured by admissions in a portuguese acute psychiatric ward. Methods Retrospective data collection of all patients admitted in Centro Hospitalar Psiquiátrico de Lisboa, in two different time periods: pre-COVID-19 (march 11th, 2019 to march 10th, 2020, n = 1845) and COVID-19 (march 11th, 2020 to march 10th, 2021, n = 1278); comparing the number of total admissions, compulsory ones, age, sex, median days of admission, median days to readmission and diagnosis at discharge. Distribution of disorders in both groups, as well as in compulsory admissions were also evaluated. The same comparisons were evaluated in the 15–25-year-old patient group. Results Statistical significance was found regarding total number of admissions (reduction of around 30.7%), as well as compulsory ones (reduction of 14%, although the relative frequency had increased), days of admission and distribution between admissions (with lower reductions regarding dementias, schizophrenia and affective disorders, while substance use disorders and intellectual disabilities presented reductions of over 50%), with no differences between gender, median age, previous admissions or readmissions. Distribution between compulsory admissions did not present differences before and during COVID periods. For patients between 15 and 25 years of age, statistical significance was found regarding total number of compulsory ones (94 versus 44, p-value = 0.01), and in all groups of diagnoses (all with p-value = 0.001). Conclusions While there was a general reduction in the overall number of patients admitted, in the most severe conditions (compulsory admissions and schizophrenia diagnosis) did not present such a reduction. Difficulties in social, clinical and family networks can explain the reduction of the time to readmission. Future research could show whether there is a rebound increase number of admissions in the other diagnoses. Trial Registration The current study was approved by the hospital’s scientific and ethics committees (CCP number 0060/2021 and CES 09/2021).

Returning to daily life after psychiatric admission can be difficult and complex. We aimed to explore, describe and interpret the lived experience of returning to everyday life after the first psychiatric admission. We designed this research as a qualitative study, using van Manen's phenomenology of practice. We collected experiential material through phenomenological interviews with 12 participants, from 5 June 2018 to 18 December 2018. From the thematic and hermeneutic analysis, we captured seven themes: (1) (un)veiling the imprint within the self; (2) the haunting memories within the self; (3) from disconnection to the assimilation of the medicated body in the self; (4) from recognition to overcoming the fragility within the self; (5) the relationship with health professionals: from expectation to response; (6) the relationship with others: reformulating the bonds of alterity; (7) the relationship with the world: reconnecting as a sense of self. The results allow us to establish the phenomenon as a difficult, complex, demanding and lengthily transitional event that calls into question the person's stability and ability for well-being and more-being. Thus, implementing structured transitional interventions by health services seems crucial. Mental health specialist nurses can present a pivotal role in establishing a helping relationship with recovery-oriented goals, coordinating patients' transitional care, and assuring continuity of care sensitive to the person's subjective experiences, volitions, and resources. [ABSTRACT FROM AUTHOR]

To analyze and integrate the incidence and its influencing factors on workplace violence among psychiatric nurses in China. Despite the fact that an increasing number of studies in China and elsewhere have focused on workplace violence among psychiatric nurses, there is presently no research to thoroughly explain the determining variables of violence faced by psychiatric nurses. A systematic review and meta-analysis was conducted. PubMed, Embase, Cohrane Library, CNKI database, Wanfang database, and VIP database were used to search for English-language literature. The search deadline is June 15, 2021. The quality of the included literature was assessed, data was retrieved, and the meta-analysis was performed using Stata 16.0 software. A total of 19 works of literature, including 5926 patients, were included. Meta-analysis results showed that the incidence of workplace violence was about 78%[ES = 0.78, 95%CI(0.65,0.88)]. The possible factors for Chinese psychiatric nurses suffering from violence include gender, education, working years, whether they are an only child, age, height, working hours, and the form of employment. The incidence of workplace violence incidence among psychiatric nurses in China is high, and managers should employ individualized intervention methods based on the variables that influence it. Managers should attach great importance to the occurrence of workplace violence. In training to prevent workplace violence, we should pay attention to the disparities in age and working abilities of nurses. Nurses should be trained in recognizing violent conduct, early warning indications, communication skills, and emergency response tactics. Managers should be able to schedule shifts in a flexible manner. Various techniques to enhance the nurse's working environment. • Through meta-analysis, it is firstly concluded that the incidence of workplace violence among psychiatric nurses in China is 78%. • Furthermore, the elements of violent episodes are presented according to systematic studies, which further enhances nursing managers' grasp of risk variables. A more thorough reminder that nurse supervisors should track violent episodes by gender, working hours, marital status, and psychological nursing practices. [ABSTRACT FROM AUTHOR]

Background: Falls among psychiatric inpatients are common and have significant health consequences. The purpose of this study is to systematically review the published research on risk factors and consequences. Methods: PubMed and Embase were searched for relevant studies. A total of 18 studies were included in this systematic review. The heterogeneity and low quality of the reviewed studies limit the generalizability of the results. Results: Several intrinsic and extrinsic factors are reported. Some of these factors are unique to psychiatric inpatients such as acute mental state, psychotic symptoms, and bipolar disorder leading to cognitive distortions and risk-taking; psychotropic medications inducing side effects like sedation and orthostatic hypotension; while others are similar to those found among general medical inpatients. Conclusion: Given the clinical importance of a fall and its implication on residential treatment, there is a need for targeted fall prevention programs. In order to further identify and quantify these risks and consequences, prospective research and additional study designs, describing and recording risk factors in a systematic and standardized way with the underlying etiological processes in mind, are needed. [ABSTRACT FROM AUTHOR]

Background: The current pandemic situation led to deep changes not only in social relationships, but also on clinical care and access to healthcare facilities. The authors aimed to understand whether this context affected the main characteristics of psychiatric hospitalizations, measured by admissions in a portuguese acute psychiatric ward.Methods: Retrospective data collection of all patients admitted in Centro Hospitalar Psiquiátrico de Lisboa, in two different time periods: pre-COVID-19 (march 11th, 2019 to march 10th, 2020, n = 1845) and COVID-19 (march 11th, 2020 to march 10th, 2021, n = 1278); comparing the number of total admissions, compulsory ones, age, sex, median days of admission, median days to readmission and diagnosis at discharge. Distribution of disorders in both groups, as well as in compulsory admissions were also evaluated. The same comparisons were evaluated in the 15-25-year-old patient group.Results: Statistical significance was found regarding total number of admissions (reduction of around 30.7%), as well as compulsory ones (reduction of 14%, although the relative frequency had increased), days of admission and distribution between admissions (with lower reductions regarding dementias, schizophrenia and affective disorders, while substance use disorders and intellectual disabilities presented reductions of over 50%), with no differences between gender, median age, previous admissions or readmissions. Distribution between compulsory admissions did not present differences before and during COVID periods. For patients between 15 and 25 years of age, statistical significance was found regarding total number of compulsory ones (94 versus 44, p-value = 0.01), and in all groups of diagnoses (all with p-value = 0.001).Conclusions: While there was a general reduction in the overall number of patients admitted, in the most severe conditions (compulsory admissions and schizophrenia diagnosis) did not present such a reduction. Difficulties in social, clinical and family networks can explain the reduction of the time to readmission. Future research could show whether there is a rebound increase number of admissions in the other diagnoses.Trial Registration: The current study was approved by the hospital's scientific and ethics committees (CCP number 0060/2021 and CES 09/2021). [ABSTRACT FROM AUTHOR]

Patients at tertiary hospitals may find themselves in need of mental health support due to the distress associated with the illness that may or not lead to a psychiatric condition. Here is an overview of the clinical cases treated by the liaison psychiatry service of a public tertiary hospital from Southeast Mexico during its first years of operation (2008–2018), with the purpose of gathering information about the status and needs of this population. A sample of 304 clinical records of patients treated for the first time by the psychiatry service was reviewed, and the distribution by demographic characteristics, diagnosis of mental illness and medical area of reference was analyzed. Anxiety and depression symptoms were the most frequent. Most patients were women, lived in Merida and returned after the first appointment. The neurology service referred most patients, yet most attended directly. General tertiary hospitals should prioritize integrating ad hoc mental and physical health care. Adult women with a profile of anxiety and/or depression would be the first target group. Some areas of opportunity for further research and improvement of mental health services are: preventive services for anxiety and depression, follow-up of patients, attention to relatives of patients at intensive care units, implementation of telehealth alternatives, training on mental health screening and inter- and intra-institutional collaboration. [ABSTRACT FROM AUTHOR]

Introduction Routine outcome assessment is helpful to inform decision-making, resource allocation, and health policy design. Routine outcome assessment in the hospital setting for children and adolescents with psychiatric disorders remains limited. The clinical instrument HoNOSCA (Health of the Nation Outcome Scales for Children and Adolescents), which has recently become available in Spanish and Catalan, allows outcome assessment in this population from the perspective of patients, their parents or legal guardians, and clinicians. HoNOSCA measures 13 areas of health and psychosocial functioning. Objectives The aim of this study was to assess mental health outcomes in psychiatric day hospital pediatric patients from three perspectives (patient, parent/legal guardian, clinician), using the Spanish and Catalan versions of HoNOSCA. Methods We recruited patients up to 18 years old with any psychiatric disorder at the day unit of the Salut Mental Parc Taulí Hospital Universitari (Sabadell, Catalonia, Spain). We obtained admission and discharge HoNOSCA scores for the patients, their parents or legal guardians, and their clinicians. Results We recruited 99 patients over the study period (January 2015 to December 2017), 11 of which were lost to follow-up. Among the remaining 88, we found significant improvement in HoNOSCA scores from admission to discharge. Agreement between the HoNOSCA scores for the three different groups of evaluators (patients, parents/legal guardians, and clinicians) was weak at admission but better at discharge. In general, evaluations from patients and their parents or legal guardians had lower HoNOSCA scores (indicating a better mental health status) at admission compared to those from clinicians. At discharge, however, the scores were more homogenous across the three groups of stakeholders. Conclusions Use of HoNOSCA allows for routine evaluation of mental health outcomes in the psychiatric day hospital setting from the perspective of patients, their parents or legal guardians, and clinicians.

Introduction: Mental health warrants exist in most countries and are issued when patients have severe mental illness, refuse treatment, and present a serious risk to themselves or others. We describe the epidemiology of mental health warrant requests received, and warrants issued by a Public Health Unit in a Portuguese region, as well as subsequent hospital admissions before and during the COVID-19 pandemic., Methods: We used routine administrative data of mental health warrant request entries from a Public Health Unit serving a population of 219 739 individuals and compared the average of monthly requests, issued warrants, and hospital admissions during two separate periods (January 2013 to January 2021 and February 2021 to October 2022) as well as the proportion of warrants issued, hospital admissions among requests, and other patient characteristics. We identified factors associated with hospital admissions among the requests using logistic regression., Results: Monthly average warrant requests, issued warrants and hospital admissions increased after February 2021 (x̄ 2.87 vs 7.09 p < 0.001; x̄ 2.67 vs 6.42 p < 0.001; x̄ 1.55 vs 3.58 p < 0.001). We found no differences by period in the proportion of requests with issued warrants (92.8% vs 90.6% p = 0.42) nor the proportion of requests with subsequent hospital admissions (54.0% vs 49.0% p = 0.33). In the second period, there were differences in the proportion of patients with a previously diagnosed mental health disorder (95.3% vs 90.4% p = 0.049). There were significant differences in the distribution of the origin of requests. Being unemployed (OR:2.5 CI:1.2 - 5.2), not having completed high school (OR:2.01 CI:1.12 - 3.77) and having university education (OR:3.67 CI:1.27 - 10.57) degree were associated with hospital admission., Conclusion: Severe mental illness with criteria for mental health warrants may require more resources and different approaches due to a possible increase during and after the COVID-19 pandemic. Community based mental healthcare, incentivized follow-up by primary care and ambulatory treatment may be considered. Further research should evaluate both the national and international trends and associated factors.

Background: Benzodiazepine and z-hypnotic prescribing has slowly decreased over the past 20 years, however long-term chronic prescribing still occurs and is at odds with prescribing guidance. Objectives: To identify the pattern of benzodiazepine and z-hypnotic prescribing in psychiatric inpatients at discharge and 12 months post-discharge. Methods: Retrospective observational longitudinal cohort study of patients admitted to two adult psychiatric wards between June and November 2012 (inclusive) who were discharged with a prescription for a benzodiazepine or z-hypnotic drug. Routinely collected prescription data available from NHS Scotland Prescribing Information System was used to identify and follow community prescribing of benzodiazepine and z-hypnotics for a 12 month period post-discharge. Data were entered in Excel® and further analysed using SPSS 23. Ethical approval was not required for this service evaluation however Caldicott Guardian approval was sought and granted. Results: Eighty patients were admitted during the study period however only those patients with a single admission were included for analysis (n=74). Thirty per cent (22/74) of patients were prescribed a benzodiazepine or z-hypnotics at discharge; 14 of whom received 'long-term' benzodiazepine and z-hypnotics i.e. continued use over the 12 month period. Seven patients received a combination of anxiolytics and hypnotics (e.g., diazepam plus temazepam or zopiclone). Long-term use was associated with a non-significant increase in median benzodiazepine or z-hypnotic dose, expressed as diazepam equivalents. Conclusions: One in three patients were prescribed a benzodiazepine or z-hypnotics at discharge with 1 in 5 receiving continuous longterm treatment (prescriptions) for 12 months post-discharge. As chronic long-term B-Z prescribing and use still remains an issue, future strategies using routine patient-level prescribing data may support prescribers to review and minimise inappropriate long-term prescribing. [ABSTRACT FROM AUTHOR]

Introduction: Psychiatric patients are at increased risk of death from a number of natural and unnatural causes. This study examines the mortality causes of all psychiatric inpatients of an acute psychiatric unit at a general hospital in Portugal for sixteen years (1998 to 2013). Material and Methods: Twenty-one inpatients died at the inpatient unit between 1998 and 2013 (average 1.3 per year). A retrospective study through case-file review was carried to collect demographic characteristics, medical and psychiatry diagnosis. Patients transferred to other wards during their admission were not included. Results: Circulatory system diseases were the most prevalent causes of death, occurring in 2/3 of patients and include pulmonary embolism (n = 6), acute stroke (n = 3), cardiac arrhythmia (n = 2), acute myocardial infarction (n = 1), abdominal aortic aneurysm rupture (n = 1) and heart failure (n = 1). Two patients died with pneumonia and in four cases the cause of death was undetermined. Only one case of suicide was registered. Discussion: Circulatory conditions were the most frequent causes of death in our inpatient unit. Albeit a relatively rare event, inpatient suicide does occur and, in addition to its complex consequences on staff, family and patients should remain a focus for continued prevention. Conclusion: Mortality studies are important for determining quality of health care and to create recommendations for preventive measures.

Background: Despite clinical practice guidelines recommending the routine provision of nicotine dependence treatment to smokers in inpatient psychiatric facilities, the prevalence of such treatment provision is low. The aim of this study was to examine the effectiveness of a clinical practice change intervention in increasing clinician recorded provision of nicotine dependence treatment to patients in inpatient psychiatric facilities. Methods: We undertook an interrupted time series analysis of nicotine dependence treatment provision before, during and after a clinical practice change intervention to increase clinician recorded provision of nicotine dependence treatment for all hospital discharges (aged >18 years, N= 4175) over a 19 month period in two inpatient adult psychiatric facilities in New South Wales, Australia. The clinical practice change intervention comprised six key strategies: leadership and consensus, enabling systems and procedures, training and education, information and resources, audit and feedback and an on-site practice change support officer. Systematic medical record audit and segmented logistic regression was used to determine differences in proportions for each nicotine dependence treatment outcome measure between the 'pre', 'during' and 'post-intervention' periods. Results: The prevalence of all five outcome measures increased significantly between the pre and post-intervention periods, including clinician recorded: assessment of patient smoking status (36.43 to 51.95%; adjusted odds ratio [AOR] = 2.39, 99% Confidence Interval [CI]: 1.23 to 4.66); assessment of patient nicotine dependence status (4.74 to 11.04%; AOR = 109.67, 99% CI: 35.35 to 340.22); provision of brief advice to quit (0.85 to 8.81%; AOR = 97.43, 99% CI: 31.03 to 306.30); provision of nicotine replacement therapy (8.06 to 26.25%; AOR = 19.59, 99% CI: 8.17 to 46.94); and provision of nicotine dependence treatment on discharge (8.82 to 13.45%, AOR = 12.36; 99% CI: 6.08 to 25.14). Conclusions: This is the first study to provide evidence that a clinical practice change intervention may increase clinician recorded provision of nicotine dependence treatment in inpatient psychiatric settings. The intervention offers a mechanism for psychiatric facilities to increase the provision of nicotine dependence treatment in accordance with clinical guidelines. [ABSTRACT FROM AUTHOR]

The article presents a study on the impact of a smoke-free psychiatric hospitalization on patients' smoking-related behaviours. It mentions the smoking ban implemented in general hospital settings around the world that reportedly have a positive impact on the patients' motivation to quit and abstain post discharge. It is concluded that continued cessation support post discharge is also important.

Objectives: To examine the impact of restructuring a child and adolescent psychiatry inpatient unit on reportable incidents (including verbal or physical aggression), seclusion, security, constant observation, sick leave and lengths of stay. Methods: Data was collected regarding a seven-bed child and adolescent psychiatric unit between 2008 and 2010, comparing data from 2008 and 2009 (before) to 2010 (after). Results: Occurrences, sick leave, security, seclusion and constant observation all decreased in 2010 compared to 2008 and 2009, although only the decrease in constant observation was statistically significant. Length of stay was not affected. Conclusions: A broad representation of multidisciplinary team members, increased consistency and improved communication may be associated with reductions in reportable incidents, seclusion, security and constant observation. [ABSTRACT FROM AUTHOR]

Objective: The present study was conducted to determine the frequency of lifetime suicide attempts and suicidal ideations and to determine related risk factors on patients admitted to psychiatry outpatient clinic of Erzincan State Hospital. Material and Method: All the patients were asked for their suicidal ideations and behaviors in their lifetime. The sociodemographic data, number of application to outpatient clinics, the presence of a psychiatric disorder and a history of a suicide attempt within the family were questioned and recorded. The diagnosis based on DSM-1V-TR was determined after the psychiatric interview by the same psychiatrist. Among 1378 invited, 1073 participate in the study (77.9%). Results: Suicidal ideations were 28.3% (n=303) and attempts were 18.5% (n=198) during lifetime. Rate of suicidal attempts was 65.3% (198/303). Patients who considered or attempted suicide were more common among women than men. The most frequently diagnosed psychiatric condition was mood disorders followed by anxiety disorders for the patients with suicidal ideations and suicide attempts. For the group with suicidal attempts, the third most frequent diagnosis was somatoform disorders. Undiagnosed cases ranked third for the group with suicidal ideations. Conclusion: It is crucial to examine suicidal ideations and suicide attempts in all psychiatric patients. Following mood and anxiety disorders, the third most common diagnosis was somatoform disorders in patients living in rural areas of Eastern Turkey. Suicide attempts may be used as a non-verbal language as part of somatization. [ABSTRACT FROM AUTHOR]

Clinical pathways have been defined as an optimal sequencing and timing of interventions by staff for a particular diagnosis or procedure, designed to better utilize resources, maximize quality of care and minimize delays. The aim of the present study was to develop a clinical pathway for long-term inpatients with schizophrenia. A review of clinical records was conducted for 17 patients with schizophrenia who had stayed in one psychiatric hospital for >1 year, and who remained in the community >3 months after hospital discharge. A review of clinical routine records was conducted. The discharge process of each patient was expressed in a clinical pathway around phases and care components. They were integrated into one clinical pathway. The discharge process was divided into assessment and goalsetting, preparation, and discharge phases. Care components included discharge planning, daily activity, living environment, health management, and basic life skills. Discharge planning was an important care component that was combined with all three phases. A clinical pathway was developed from reviewing past patient records, and discharge planning was found to be an important care component, which was combined with all three phases: assessment and goalsetting, preparation, and discharge. Further study is needed to examine the validity of the pathway for use in other hospitals. [ABSTRACT FROM AUTHOR]

Abstract: Successful mental healthcare can be given to people with intellectual disabilities in general psychiatry settings with appropriately skilled supports and safeguards. This requires development of local expertise and availability of specialist advice. Systematic application of standard psychiatric assessment methods, with some modification, is effective for most people with mild intellectual disability with mental ill health. Suggestions are given for improving communication. Staff of acute psychiatry units may have negative attitudes based on lack of confidence, rather than evidence. Organizational support could include identifying a nurse with an interest in learning disability to act as ‘named nurse’. [Copyright &y& Elsevier]

The aim of this study was to examine to what extent the different subscales of the Ward Atmosphere Scale (WAS) are related to patient satisfaction on wards for psychotic patients. We wanted to examine if it was possible to replicate previous findings from cross-sectional studies and improve the understanding of which of the WAS subscales that should be considered the most important for patient satisfaction. From 1981 through 2000, the ward atmosphere, in an acute psychiatric ward, was evaluated 11 times with the Ward Atmosphere Scale (WAS). A total of 129 patients completed the WAS as well as a General Satisfaction Index (GSI) comprising three items. Z -scores were calculated to describe the fluctuations in the GSI and the WAS subscales. Four of the WAS subscales, Involvement, Practical orientation, Angry and aggressive behavior and Staff control, strongly co-varied with patient satisfaction. Unexpectedly, the Support and Order and organization subscales correlated only moderately with patient satisfaction. The remaining five WAS subscales (Spontaneous behavior, Autonomy, Personal problem orientation, Program clarity and Staff attitude to expressed feelings) were only weakly correlated with patient satisfaction. This study confirms that four of the six assumedly most important WAS subscales are strongly related to patient satisfaction on wards for psychotic patients. Changes in these WAS subscales seems to be paralleled by changes in patient satisfaction in the expected direction. [ABSTRACT FROM AUTHOR]

Røssberg JI, Friis S. A suggested revision of the Ward Atmosphere Scale. Acta Psychiatr Scand 2003: 108: 374–380. © Blackwell Munksgaard 2003. In a previous study, we have suggested a revision of the Anger/Aggression and the Spontaneity subscales. The main aim of this study was to re-evaluate the psychometric properties of the other eight subscales of the Ward Atmosphere Scale. A total of 550 patients and 822 staff members on 54 psychiatric wards for psychotic patients completed the WAS and the Good Milieu Index (GMI). We calculated Cronbach's α, the Corrected Item Total subscale Correlation, subscale intercorrelations and the correlation between subscales and GMI. By removing a total of 16 items, the psychometric properties improved. The revised subscales had acceptable psychometrics and gave a clearer picture of the relationship between the perceived level of patient satisfaction and the WAS subscale scores. The revision suggested in this study ‘modernized’ several of the subscales. We suggest that this revision is implemented in the future use of the WAS. [ABSTRACT FROM AUTHOR]

Objective: The main aim of this study was to examine the psychometric properties of the two subscales of the Ward Atmosphere Scale (WAS), Spontaneity and Anger and Aggression, which measure the level of expressed emotion. We wanted to examine if the items measuring attitude and behavior form different dimensions. Method: A total of 550 patients in 54 different psychiatric wards for psychotic patients completed the WAS and the Good Milieu Index. Results: Removing, respectively, four items from the Spontaneity subscale, three items from the Anger and Aggression subscale the psychometric properties improved. The two revised subscales were named Spontaneous Behavior (SB) and Angry, Aggressive Behavior (AAB). A new ‘attitude’ subscale, comprising three items, was named Staff Attitude to Expressed Feelings (SAEF). Conclusion: For patients the attitude and behavior items seem to form separate dimensions. The three subscales examined are probably of central importance for patient satisfaction. [ABSTRACT FROM AUTHOR]

Objective: To investigate the relationship between patients' perception of the real and ideal ward atmosphere and their satisfaction. Method: Patients filled in the Ward Atmosphere Scale (WAS, Real and Ideal Form) and a satisfaction questionnaire. Patient characteristics were derived from clinical assessments. Results: WAS ratings were almost independent of patient characteristics. Patients in locked wards perceived more anger and aggression and patients subjected to coercive measures perceived less autonomy and practical orientation. Patient satisfaction was predicted by higher scores on the WAS Relationship‐ and System Maintenance dimensions, explaining 41% of the variance. In particular support, order and organization predicted satisfaction. Except from the areas of anger/aggression and staff control, patients gave the 'ideal' ward higher ratings on all subscales. The perceived gap between the 'ideal' and 'real' ward explained 45% of variance in satisfaction. Conclusion: Patients' perception of ward atmosphere is a clinically meaningful measure appearing to be a strong predictor of satisfaction. [ABSTRACT FROM AUTHOR]

• The first large-scale study of psychiatric emergency patients in China. • It is relatively rare to study etiology in psychiatric emergency patients. • This is the first research on symptom groups rather than disease. • Positive result can be used as a predictor of suicide risk in clinical applications. Psychiatric emergency patients constitute a population at high risk of suicidal thoughts and behaviors (STB). However, the risk factors for STB in this population have not been clearly defined. This study aimed to explore the risk factors for STB in psychiatric emergency patients in China. A cross-sectional analysis was conducted at the emergency department of psychiatry, Anding Hospital, Capital Medical University from 2015 to 2017. The Chinese suicide risk factors scale was used to test the STB of the patients. Multivariable logistic regression analysis was used to determine the risk factors of STB. A total of 12,345 patients were included. Their average age was 36 years. According to the suicide risk scale, 3436 cases (27.83%) were at risk of STB, mainly young adults. The multivariable analysis showed that urban residence, years of education, living in Beijing, ethnic Han, living alone, unemployment, poor relationship with parents, one or more siblings, visit time in the night, family history, disease course, total duration, the total number of psychiatric hospitalizations, a clear diagnosis, Brief Psychiatric Rating Scale total score ≥28.5, Hamilton Depression Rating Scale total score ≥20, and Young Mania Rating Scale total score ≥12 were independent risk factors for STB. [ABSTRACT FROM AUTHOR]

Introduction: Self-report scales have been considered to be useful for evaluating and monitoring symptoms of manic-depressive illnesses. The EMUN-AR scale is one of such scales but it has not been validated. Objective: To validate the EMUN-AR scale using Rasch models. Materials and methods: The EMUN-AR scale measures 26 items to assess comprehensively symptoms of manic-depressive illnesses in three domains: Frequency, severity, and level of disturbance caused by the symptoms. To test the psychometric properties of this scale, we used the exploratory factorial and Rasch analyses. The Rasch analysis included unidimensionality, reliability, item fit, threshold ordering, and person-item maps. Results: The study included 267 hospitalized patients, most of them with a manic episode diagnosis (n=204, 76.4%), and receiving pharmacological treatment. The factor structure was summarized in four domains: Activation, inhibition, depressive ideation, and maladaptive behavior. The Rasch analysis supported unidimensionality of the EMUN-AR factors, satisfactory levels of reliability, and appropriate item fit, except for one of the items measuring death or suicidal thoughts. However, the scale did not measure adequately the mild forms of the illness given its redundant and unordered thresholds. Conclusion: The EMUN-AR was modified in two aspects: An item whose marginal indicators were poorly adjusted and the reduction in the number of categories. In its current form, the EMUN-AR is appropriate for measuring severe forms of the illnesses, but it does not adequately measure the mild forms of manic-depressive illnesses.

Background: Aims of this study are to explore the associations of readmission to psychiatric hospital over time, to develop a statistical model for early readmission to psychiatric hospital and to assess the feasibility of predicting early readmission., Method: The sample comprised 7891 general psychiatric discharges in South London, taken from a large anonymised repository of electronic patient records. We initially explored time to readmission using Cox regression - this included investigation of time-dependent effects. Subsequently, we used logistic regression to create a predictive model for 90-day readmission. We investigated the effect on readmission of a set of variables that included demographic variables, diagnosis and legal status during the index admission, previous service use, housing variables and individual item scores on the Health of the Nation Outcome Scales (HoNOS) at admission and at discharge., Results: Fifteen per cent of those discharged were readmitted within 90 days. Cox regression demonstrated that the estimated baseline hazard of readmission declined steeply after discharge and that the effects of several predictors, especially diagnosis, changed over time - most notably, personality disorder was associated with increased readmission relative to schizophrenia at the time of discharge, but did not significantly differ by 1-year postdischarge. In the logistic regression, increased readmission was associated with personality disorder diagnosis; shorter length of the index admission (excepting zero length admissions); number of discharges in the preceding 2 years; and having a high score at discharge on the HoNOS overactive and aggressive behaviour item, cognitive problems item or hallucinations and delusions items. Detention under Section 3 or a forensic section of the Mental Health Act during the index admission was associated with reduced readmission. The coefficient of discrimination for the logistic regression, which is equivalent to r 2, was 0.04 and the estimated area under the receiver operating curve was 0.65., Conclusions: The association found between early readmission and personality disorder diagnosis merits further investigation, as does the possible trade-off between reduction in length of stay and increased readmission. Other novel findings such as the associations found with HoNOS item scores also merit replication. As with previous studies, we found that the rate of readmission declines steeply after hospital discharge, so that the period immediately subsequent to discharge is a period of comparatively high risk. However, prediction of early readmission within this high-risk group remains challenging - it seems most likely that many unmeasured influences operate subsequent to the time of discharge.

The implementation of smoke-free policies in inpatient psychiatric facilities, including patient adherence, mental health nursing staff support, and provision of nicotine-dependence treatment to patients, has been reported to be poor. The extent to which the quality of smoke-free policy implementation is associated with patient views of a policy is unknown. We conducted a cross-sectional survey of 181 patients (53.6%, n = 97 smokers; and 46.4%, n = 84 non-smokers) in an Australian inpatient psychiatric facility with a total smoke-free policy. Smokers' adherence to the policy was poor (83.5% smoked). Only half (53.6%) perceived staff to be supportive of the policy. Most smokers used nicotine-replacement therapy (75.3%); although few received optimal nicotine-dependence treatment (19.6%). Overall, 45.9% of patients viewed the smoke-free policy in the unit as positive (29.9% smokers; 64.3% non-smokers). For smokers, adhering to the ban, perceiving staff to be supportive, and reporting that the nicotine-replacement therapy reduced cravings to smoke were associated with a more positive view towards the smoke-free policy. These findings support the importance of patient adherence, mental health nursing staff support, and adequate provision of nicotine-dependence treatment in strengthening smoke-free policy implementation in inpatient psychiatric settings., (© 2015 Australian College of Mental Health Nurses Inc.)