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Sample records for acute psychiatric units

  1. Admissions to acute adolescent psychiatric units: a prospective study of clinical severity and outcome

    PubMed Central

    2011-01-01

    Background Several countries have established or are planning acute psychiatric in-patient services that accept around-the-clock emergency admission of adolescents. Our aim was to investigate the characteristics and clinical outcomes of a cohort of patients at four Norwegian units. Methods We used a prospective pre-post observational design. Four units implemented a clinician-rated outcome measure, the Health of the Nation Outcome Scales for Children and Adolescents (HoNOSCA), which measures mental health problems and their severity. We collected also data about the diagnoses, suicidal problems, family situations, and the involvement of the Child Protection Service. Predictions of outcome (change in HoNOSCA total score) were analysed with a regression model. Results The sample comprised 192 adolescents admitted during one year (response rate 87%). Mean age was 15.7 years (range 10-18) and 70% were girls. Fifty-eight per cent had suicidal problems at intake and the mean intake HoNOSCA total score was 18.5 (SD 6.4). The largest groups of main diagnostic conditions were affective (28%) and externalizing (26%) disorders. Diagnoses and other patient characteristics at intake did not differ between units. Clinical psychiatric disorders and developmental disorders were associated with severity (on HoNOSCA) at intake but not with outcome. Of adolescents ≥ 16 years, 33% were compulsorily admitted. Median length of stay was 8.5 days and 75% of patients stayed less than a month. Compulsory admissions and length of stay varied between units. Mean change (improvement) in the HoNOSCA total score was 5.1 (SD 6.2), with considerable variation between units. Mean discharge score was close to the often-reported outpatient level, and self-injury and emotional symptoms were the most reduced symptoms during the stay. In a regression model, unit, high HoNOSCA total score at intake, or involvement of the Child Protection Service predicted improvement during admission. Conclusions Acute

  2. Clinical features and therapeutic management of patients admitted to Italian acute hospital psychiatric units: the PERSEO (psychiatric emergency study and epidemiology) survey

    PubMed Central

    Ballerini, Andrea; Boccalon, Roberto M; Boncompagni, Giancarlo; Casacchia, Massimo; Margari, Francesco; Minervini, Lina; Righi, Roberto; Russo, Federico; Salteri, Andrea; Frediani, Sonia; Rossi, Andrea; Scatigna, Marco

    2007-01-01

    Background The PERSEO study (psychiatric emergency study and epidemiology) is a naturalistic, observational clinical survey in Italian acute hospital psychiatric units, called SPDCs (Servizio Psichiatrico Diagnosi e Cura; in English, the psychiatric service for diagnosis and management). The aims of this paper are: (i) to describe the epidemiological and clinical characteristics of patients, including sociodemographic features, risk factors, life habits and psychiatric diagnoses; and (ii) to assess the clinical management, subjective wellbeing and attitudes toward medications. Methods A total of 62 SPDCs distributed throughout Italy participated in the study and 2521 patients were enrolled over the 5-month study period. Results Almost half of patients (46%) showed an aggressive behaviour at admission to ward, but they engaged more commonly in verbal aggression (38%), than in aggression toward other people (20%). A total of 78% of patients had a psychiatric diagnosis at admission, most frequently schizophrenia (36%), followed by depression (16%) and personality disorders (14%), and no relevant changes in the diagnoses pattern were observed during hospital stay. Benzodiazepines were the most commonly prescribed drugs, regardless of diagnosis, at all time points. Overall, up to 83% of patients were treated with neuroleptic drugs and up to 27% received more than one neuroleptic either during hospital stay or at discharge. Atypical and conventional antipsychotics were equally prescribed for schizophrenia (59 vs 65% during stay and 59 vs 60% at discharge), while atypical drugs were preferred in schizoaffective psychoses (72 vs 49% during stay and 70 vs 46% at discharge) and depression (41 vs 32% during stay and 44 vs 25% at discharge). Atypical neuroleptics were slightly preferred to conventional ones at hospital discharge (52 vs 44%). Polypharmacy was in general widely used. Patient attitudes toward medications were on average positive and self-reported compliance

  3. Perceptions on the development of a care pathway for people diagnosed with schizophrenia on acute psychiatric units.

    PubMed

    Jones, A

    2003-12-01

    Policy development and practice for hospital mental health care has shifted towards a user-focused and evidence-based direction. Important within this policy development has been a guideline for inpatient care, particularly the establishment of an inpatient Acute Care Forum. A vehicle to both commission and develop this agenda is the Implementation of a care pathway. A research study was designed to explore how a care pathway could be developed for inpatients diagnosed with schizophrenia. Interviews with a range of health care professionals and observation of the process of care pathway development were the data-collection tools. Analysis was driven by emergent themes across the data set. Themes were then presented as one possible interpretation of the factors to be considered for the development of a care pathway for people diagnosed with schizophrenia. Clinicians experienced many difficulties in finding and including evidence-based practice (EBP) within a care pathway. Professions on the whole felt that there was a certain futility to psychiatric care given the paucity of evidence to support practice. This may contribute towards the poor use of hospital care as a therapeutic intervention as part of the wider spectrum of care. Difficulties arise when trying to develop a care pathway with EBP, given the paucity of knowledge on why certain interventions are only partially effective. The development of a care pathway may inform the priorities of the inpatient Acute Care Forum for people diagnosed with schizophrenia. A care pathway should not be constrained, however, to EBP and should incorporate therapeutic activities to improve the overall experience of service users. Limitations on the study and the collection of evidence supporting these conclusions conclude the paper. PMID:15005479

  4. Psychiatric Symptoms and Acute Care Service Utilization over the Course of the Year Following Medical-Surgical Intensive Care Unit Admission: A Longitudinal Investigation

    PubMed Central

    Davydow, Dimitry S.; Hough, Catherine L.; Zatzick, Douglas; Katon, Wayne J.

    2014-01-01

    Objective To determine if the presence of in-hospital substantial acute stress symptoms, as well as substantial depressive or posttraumatic stress disorder (PTSD) symptoms at 3-months post-intensive care unit (ICU), are associated with increased acute care service utilization over the course of the year following medical-surgical ICU admission. Design Longitudinal cohort study. Setting Academic medical center. Patients 150 patients ≥ 18 years old admitted to medical-surgical ICUs for over 24 hours. Measurements and Main Results Participants were interviewed in-hospital to ascertain substantial acute stress symptoms using the PTSD Checklist-civilian version (PCL-C). Substantial depressive and PTSD symptoms were assessed using the Patient Health Questionnaire-9 and the PCL-C respectively at 3 months post-ICU. The number of rehospitalizations and emergency room (ER) visits were ascertained at 3 and 12 months post-ICU using the Cornell Services Index. After adjusting for participant and clinical characteristics, in-hospital substantial acute stress symptoms were independently associated with greater risk of an additional hospitalization (Relative Risk [RR]: 3.00, 95% Confidence Interval [CI]: 1.80, 4.99) over the year post-ICU. Substantial PTSD symptoms at 3 months post-ICU were independently associated with greater risk of an additional ER visit during the subsequent 9 months (RR: 2.29, 95%CI: 1.09, 4.84) even after adjusting for both rehospitalizations and ER visits between the index hospitalization and 3 months post-ICU. Conclusions Post-ICU psychiatric morbidity is associated with increased acute care service utilization during the year after a medical-surgical ICU admission. Early interventions for at-risk ICU survivors may improve longer-term outcomes and reduce subsequent acute care utilization. PMID:25083985

  5. Effects of music therapy on self- and experienced stigma in patients on an acute care psychiatric unit: a randomized three group effectiveness study.

    PubMed

    Silverman, Michael J

    2013-10-01

    Stigma is a major social barrier that can restrict access to and willingness to seek psychiatric care. Psychiatric consumers may use secrecy and withdrawal in an attempt to cope with stigma. The purpose of this study was to determine the effects of music therapy on self- and experienced stigma in acute care psychiatric inpatients using a randomized design with wait-list control. Participants (N=83) were randomly assigned by cluster to one of three single-session group-based conditions: music therapy, education, or wait-list control. Participants in the music therapy and education conditions completed only posttests while participants in the wait-list control condition completed only pretests. The music therapy condition was a group songwriting intervention wherein participants composed lyrics for "the stigma blues." Results indicated significant differences in measures of discrimination (experienced stigma), disclosure (self-stigma), and total stigma between participants in the music therapy condition and participants in the wait-list control condition. From the results of this randomized controlled investigation, music therapy may be an engaging and effective psychosocial technique to treat stigma. Limitations, suggestions for future research, and implications for clinical practice and psychiatric music therapy research are provided. PMID:24070990

  6. Psychiatric Disease and Post-Acute Traumatic Brain Injury.

    PubMed

    Zgaljardic, Dennis J; Seale, Gary S; Schaefer, Lynn A; Temple, Richard O; Foreman, Jack; Elliott, Timothy R

    2015-12-01

    Psychiatric disorders are common following traumatic brain injury (TBI) and can include depression, anxiety, and psychosis, as well as other maladaptive behaviors and personality changes. The epidemiologic data of psychiatric disorders post-TBI vary widely, although the incidence and prevalence rates typically are higher than in the general population. Although the experience of psychiatric symptoms may be temporary and may resolve in the acute period, many patients with TBI can experience psychopathology that is persistent or that develops in the post-acute period. Long-term psychiatric disorder, along with cognitive and physical sequelae and greater risk for substance use disorders, can pose a number of life-long challenges for patients and their caregivers, as they can interfere with participation in rehabilitation as well as limit functional independence in the community. The current review of the literature considers the common psychiatric problems affecting individuals with TBI in the post-acute period, including personality changes, psychosis, executive dysfunction, depression, anxiety, and substance misuse. Although treatment considerations (pharmacological and nonpharmacological) are referred to, an extensive description of such protocols is beyond the scope of the current review. The impact of persistent psychiatric symptoms on perceived caregiver burden and distress is also discussed. PMID:25629222

  7. Implementing a Music Therapy Program at a New 72-Hour Acute Psychiatric Admissions Unit: A Case Study of a Patient Who Was Malingering

    ERIC Educational Resources Information Center

    Silverman, Michael J.

    2009-01-01

    Because of the relatively poor treatment available, the high financial costs of hospitalization, multiple and complex issues of persons with severe mental illnesses, and advancements in pharmacotherapy, psychiatric patients are often only hospitalized for a few days before they are discharged. Thus, brief psychosocial interventions for persons who…

  8. Multiple sclerosis presenting with acute remitting psychiatric symptoms.

    PubMed Central

    Matthews, W B

    1979-01-01

    Two patients are described in whom acute symptoms of apparently primary psychiatric disease could be diagnosed in retrospect as due to multiple sclerosis. In both patients the initial symptoms recovered completely. In a third patient, also presenting with mental symptoms, this diagnosis would not have been suspected on clinical grounds but is suggested by the results of modern diagnostic techniques. Images PMID:501386

  9. Neuropsychological and psychiatric profiles in acute encephalitis in adults.

    PubMed

    Pewter, Stephen M; Williams, W Huw; Haslam, Catherine; Kay, Janice M

    2007-01-01

    Acute encephalitis is an inflammation of brain tissue that can result from activity in the central nervous system (CNS) of a number of viruses. Although the neurological and psychiatric effects of encephalitis in the acute phase of the illness are well-known (Caroff, Mann, Gliatto, Sullivan, & Campbell, 2001), larger scale studies of the pattern of neuropsychological and psychiatric impairment following recovery from the acute inflammatory phase are less apparent. This paper reports the results of neuropsychological testing with a range of standardised cognitive measures in a case series of long-term post-acute participants. Psychiatric abnormality is examined using the SCL-90-R self-report scale of distress (Derogatis, 1983). We also examined the role of emerging insight in the aetiology of depression in this population. Two clusters of cognitive dysfunction were observed, one group of primarily herpes simplex cases showing a severe generalised deficit across a number of cognitive domains and a second cluster showing a variety of more isolated disorders of executive function. Abnormally high levels of distress were reported by participants, with depression, obsessive-compulsive symptoms, interpersonal sensitivity and phobic anxiety most significantly increased. Depression was found to be least severe in those with most accurate insight into their problems. Examining the correlations between cognitive and psychiatric test results demonstrates a relationship between depression and interpersonal anxiety and specific cognitive measures. Obsessive-compulsive behaviour and phobic anxiety, however, appear to exist independently of the assessed cognitive deficits. PMID:17676531

  10. Admissions to a prison psychiatric unit.

    PubMed

    Glaser, W F

    1985-03-01

    Fifty consecutive admissions to the psychiatric division in a central metropolitan goal were given DSM III diagnoses and their psychiatric, social and criminal histories analysed. Seventy-two per cent suffered from schizophrenic, affective or organic mental illness, 56% had chronic physical disabilities and 84% had had previous in-patient treatment in either hospital or prison or both. Fifty-four per cent exhibited psychopathology that most clinicians would have thought required urgent attention. Of the current offences committed by this group 54% were against the person (murder, assaults, sex offences and robbery). A significant proportion of these were committed by a distinct subgroup composed of socially isolated schizophrenics with no prior convictions, no physical illness, apparently normal premorbid personalities, and a greater current level of psychiatric disturbance. It is argued that the group as a whole, and this subgroup in particular exemplify the problems of the psychiatrically disturbed offender. Prison psychiatric facilities are inadequate for the range of functions they are being asked to serve and their token placement in the correctional services by-passes many important clinical, social and legal issues. PMID:3859284

  11. Suicide-specific Safety in the Inpatient Psychiatric Unit.

    PubMed

    De Santis, Mark L; Myrick, Hugh; Lamis, Dorian A; Pelic, Christopher P; Rhue, Colette; Rhue, Collete; York, Janet

    2015-03-01

    In total, 75% of suicides reported to the Joint Commission as sentinel events since 1995, have occurred in psychiatric settings. Ensuring patient safety is one of the primary tasks of inpatient psychiatric units. A review of inpatient suicide-specific safety components, inclusive of incidence and risk; guidelines for evidence-based care; environmental safety; suicide risk assessment; milieu observation and monitoring; psychotherapeutic interventions; and documentation is provided. The Veterans Health Administration (VA) has been recognized as an exemplar system in suicide prevention. A VA inpatient psychiatric unit is used to illustrate the operationalization of a culture of suicide-specific safety. We conclude by describing preliminary unit outcomes and acknowledging limitations of suicide-specific inpatient care and gaps in the current inpatient practices and research on psychotherapeutic interventions, observation, and monitoring. PMID:25898018

  12. Day hospital versus admission for acute psychiatric disorders

    PubMed Central

    Marshall, Max; Crowther, Ruth; Sledge, William Hurt; Rathbone, John; Soares-Weiser, Karla

    2014-01-01

    Background Inpatient treatment is an expensive way of caring for people with acute psychiatric disorders. It has been proposed that many of those currently treated as inpatients could be cared for in acute psychiatric day hospitals. Objectives To assess the effects of day hospital versus inpatient care for people with acute psychiatric disorders. Search methods We searched the Cochrane Schizophrenia Group Trials Register (June 2010) which is based on regular searches of MEDLINE, EMBASE, CINAHL and PsycINFO. We approached trialists to identify unpublished studies. Selection criteria Randomised controlled trials of day hospital versus inpatient care, for people with acute psychiatric disorders. Studies were ineligible if a majority of participants were under 18 or over 65, or had a primary diagnosis of substance abuse or organic brain disorder. Data collection and analysis Two review authors independently extracted and cross-checked data. We calculated risk ratios (RR) and 95% confidence intervals (CI) for dichotomous data. We calculated weighted or standardised means for continuous data. Day hospital trials tend to present similar outcomes in slightly different formats, making it difficult to synthesise data. We therefore sought individual patient data so that we could re-analyse outcomes in a common format. Main results Ten trials (involving 2685 people) met the inclusion criteria. We obtained individual patient data for four trials (involving 646 people). We found no difference in the number lost to follow-up by one year between day hospital care and inpatient care (5 RCTs, n = 1694, RR 0.94 CI 0.82 to 1.08). There is moderate evidence that the duration of index admission is longer for patients in day hospital care than inpatient care (4 RCTs, n = 1582, WMD 27.47 CI 3.96 to 50.98). There is very low evidence that the duration of day patient care (adjusted days/month) is longer for patients in day hospital care than inpatient care (3 RCTs, n = 265, WMD 2.34 days

  13. 42 CFR 412.27 - Excluded psychiatric units: Additional requirements.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... health nursing, or its equivalent, from a school of nursing accredited by the National League for Nursing... personnel, psychological services, social work services, psychiatric nursing, and therapeutic activities. (c... provided by the medical staff. (3) Nursing services. The unit must have a qualified director of...

  14. 42 CFR 412.27 - Excluded psychiatric units: Additional requirements.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... health nursing, or its equivalent, from a school of nursing accredited by the National League for Nursing... personnel, psychological services, social work services, psychiatric nursing, and therapeutic activities. (c... provided by the medical staff. (3) Nursing services. The unit must have a qualified director of...

  15. 42 CFR 412.27 - Excluded psychiatric units: Additional requirements.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... health nursing, or its equivalent, from a school of nursing accredited by the National League for Nursing... personnel, psychological services, social work services, psychiatric nursing, and therapeutic activities. (c... provided by the medical staff. (3) Nursing services. The unit must have a qualified director of...

  16. 42 CFR 412.27 - Excluded psychiatric units: Additional requirements.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 2 2014-10-01 2014-10-01 false Excluded psychiatric units: Additional requirements. 412.27 Section 412.27 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICARE PROGRAM PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES Hospital Services Subject to and Excluded From...

  17. 42 CFR 412.27 - Excluded psychiatric units: Additional requirements.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 2 2010-10-01 2010-10-01 false Excluded psychiatric units: Additional requirements. 412.27 Section 412.27 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICARE PROGRAM PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES Hospital Services Subject to and Excluded From...

  18. Delivering Perinatal Psychiatric Services in the Neonatal Intensive Care Unit

    PubMed Central

    Friedman, Susan Hatters; Kessler, Ann; Yang, Sarah Nagle; Parsons, Sarah; Friedman, Harriet; Martin, Richard J.

    2015-01-01

    Aim To describe characteristics of mothers who would likely benefit from on-site short-term psychiatric services while their infant is in the Neonatal Intensive Care Unit (NICU). Methods For 150 consecutive mothers who were referred for psychiatric evaluation and psychotherapeutic intervention in an innovative NICU mental health program, baseline information was collected. Data regarding their referrals, diagnosis, treatments, and their infants was analyzed. Results Most mothers were referred because of depression (43%), anxiety (44%), and/ or difficulty coping with their infant's medical problems and hospitalization (60%). Mothers of VLBW infants were disproportionately more likely to be referred. A majority of mothers accepted the referral and were treated; most only required short-term psychotherapy. A minority resisted or refused psychiatric assessment; a quarter of these had more difficult interactions with staff or inappropriate behaviors. In these cases the role of the psychiatrist was to work with staff to promote healthy interactions and to foster maternal-infant bonding. Conclusion Overall, on-site psychiatric services have been accepted by a majority of referred NICU mothers, and most did not require long-term treatment. A considerable need exists for psychiatric services in the NICU to promote optimal parenting and interactions. PMID:23772977

  19. Main clinical features in patients at their first psychiatric admission to Italian acute hospital psychiatric wards. The PERSEO study

    PubMed Central

    Ballerini, Andrea; Boccalon, Roberto M; Boncompagni, Giancarlo; Casacchia, Massimo; Margari, Francesco; Minervini, Lina; Righi, Roberto; Russo, Federico; Salteri, Andrea; Frediani, Sonia; Rossi, Andrea; Scatigna, Marco

    2007-01-01

    Background Few data are available on subjects presenting to acute wards for the first time with psychotic symptoms. The aims of this paper are (i) to describe the epidemiological and clinical characteristics of patients at their first psychiatric admission (FPA), including socio-demographic features, risk factors, life habits, modalities of onset, psychiatric diagnoses and treatments before admission; (ii) to assess the aggressive behavior and the clinical management of FPA patients in Italian acute hospital psychiatric wards, called SPDCs (Servizio Psichiatrico Diagnosi e Cura = psychiatric service for diagnosis and management). Method Cross-sectional observational multi-center study involving 62 Italian SPDCs (PERSEO – Psychiatric EmeRgency Study and EpidemiOlogy). Results 253 FPA aged <= 40 were identified among 2521 patients admitted to Italian SPDCs over the 5-month study period. About half of FPA patients showed an aggressive behavior as defined by a Modified Overt Aggression Scale (MOAS) score greater than 0 Vs 46% of non-FPA patients (p = 0.3651). The most common was verbal aggression, while about 20% of FPA patients actually engaged in physical aggression against other people. 74% of FPA patients had no diagnosis at admission, while 40% had received a previous psychopharmacological treatment, mainly benzodiazepines and antidepressants. During SPDC stay, diagnosis was established in 96% of FPA patients and a pharmacological therapy was prescribed to 95% of them, mainly benzodiazepines, antipsychotics and mood stabilizers. Conclusion Subjects presenting at their first psychiatric ward admission have often not undergone previous adequate psychiatric assessment and diagnostic procedures. The first hospital admission allows diagnosis and psychopharmacological treatment to be established. In our population, aggressive behaviors were rather frequent, although most commonly verbal. Psychiatric symptoms, as evaluated by psychiatrists and patients, improved

  20. Switch Function and Pathological Dissociation in Acute Psychiatric Inpatients

    PubMed Central

    Chiu, Chui-De; Tseng, Mei-Chih Meg; Chien, Yi-Ling; Liao, Shih-Cheng; Liu, Chih-Min; Yeh, Yei-Yu; Hwu, Hai-Gwo

    2016-01-01

    Swift switching, along with atypical ability on updating and inhibition, has been found in non-clinical dissociators. However, whether swift switching is a cognitive endophenotype that intertwines with traumatisation and pathological dissociation remains unknown. Unspecified acute psychiatric patients were recruited to verify a hypothesis that pathological dissociation is associated with swift switching and traumatisation may explain this relationship. Behavioural measures of intellectual function and three executive functions including updating, switching and inhibition were administered, together with standardised scales to evaluate pathological dissociation and traumatisation. Our results showed superior control ability on switching and updating in inpatients who displayed more symptoms of pathological dissociation. When all three executive functions were entered as predictors, in addition to intellectual quotient and demographic variables to regress upon pathological dissociation, switching rather than updating remained the significant predictor. Importantly, the relationship between pathological dissociation and switching became non-significant when the effect of childhood trauma were controlled. The results support a trauma-related switching hypothesis which postulates swift switching as a cognitive endophenotype of pathological dissociation; traumatisation in childhood may explain the importance of swift switching. PMID:27123578

  1. Human Bite of a Staff Nurse on a Psychiatric Unit.

    PubMed

    Suguna, Anbazhagan; Joseph, Bobby

    2016-04-01

    Occupational violence among health care professionals is a cause for concern, although often neglected especially in developing countries like India. Violence undermines the healing mission of the health care organization and interferes with the ability of the health care team to optimally contribute to positive patient outcomes. The authors discuss a case of a human bite of a staff nurse on a psychiatric unit in a tertiary care Indian hospital. The reported violence against this staff nurse lead to her admission for emergency care followed by emotional stress. Issues related to prevention of occupational violence are also discussed. PMID:26245465

  2. Electroconvulsive therapy in a psychiatric intensive care unit.

    PubMed

    Hafner, R J; Holme, G

    1994-06-01

    This study reviewed all patients (N = 37) treated with ECT in a psychiatric intensive care unit during 1989-91. Diagnoses were: psychotic depression (8); bipolar disorder, manic phase (13); schizoaffective disorder (14); and schizophrenia (2). All patients were very severely disturbed and had failed to respond to medication given at highest levels judged to be safe, usually over 3-4 weeks. Response to ECT was generally rapid and marked, allowing substantial reductions in medication. To achieve the same clinical outcome for each course of ECT, 50% more unilateral than bilateral treatments were required, suggesting that bilateral ECT has a more rapid effect in this highly disturbed population. PMID:7993281

  3. Quantitative EEG findings in patients with acute, brief depression combined with other fluctuating psychiatric symptoms: a controlled study from an acute psychiatric department

    PubMed Central

    Bjørk, Marte Helene; Sand, Trond; Bråthen, Geir; Linaker, Olav M; Morken, Gunnar; Nilsen, Brigt M; Vaaler, Arne Einar

    2008-01-01

    Background Patients with brief depressive episodes and concurrent rapidly fluctuating psychiatric symptoms do not fit current diagnostic criteria and they can be difficult to diagnose and treat in an acute psychiatric setting. We wanted to study whether these patients had signs of more epileptic or organic brain dysfunction than patients with depression without additional symptomatology. Methods Sixteen acutely admitted patients diagnosed with a brief depressive episode as well as another concurrent psychiatric diagnosis were included. Sixteen patients with major depression served as controls. Three electroencephalographic studies (EEG) were visually interpreted and the background activity was also analysed with quantitative electroencephalography (QEEG). Results The group with brief depression and concurrent symptoms had multiple abnormal features in their standard EEG compared to patients with major depression, but they did not show significantly more epileptiform activity. They also had significantly higher temporal QEEG delta amplitude and interhemispheric temporal delta asymmetry. Conclusion Organic brain dysfunction may be involved in the pathogenesis of patients with brief depressive episodes mixed with rapidly fluctuating psychiatric symptoms. This subgroup of depressed patients should be investigated further in order to clarify the pathophysiology and to establish the optimal evaluation scheme and treatment in an acute psychiatric setting. PMID:19014422

  4. Introducing Narrative Practices in a Locked, Inpatient Psychiatric Unit

    PubMed Central

    Mehl-Madrona, Lewis

    2007-01-01

    Introduction: Narrative approaches to psychotherapy are becoming more prevalent throughout the world. We wondered if a narrative-oriented psychotherapy group on a locked, inpatient unit, where most of the patients were present involuntarily, could be useful. The goal would be to help involuntary patients develop a coherent story about how they got to the hospital and what happened that led to their being admitted and link that to a story about what they would do after discharge that would prevent their returning to hospital in the next year. Methods: A daily, one-hour narrative group was implemented on one of three locked adult units in a psychiatric hospital. Quality-improvement procedures were already in place for assessing outcomes by unit using the BASIS-32 (32-item Behavior and Symptom Identification Scale). Unit outcomes were compared for the four quarters before the group was started and then four months after the group had been ongoing. Results: The unit on which the narrative group was implemented had a mean overall improvement in BASIS-32 scores of 2.8 units, compared with 1.0 unit for the other locked units combined. The results were statistically significant at the p < 0.0001 level. No differences were found between units for the four quarters prior to implementation of the intervention, and no other changes occurred during the quarter in which the group was conducted. Qualitative descriptions of the leaders' experiences are included in this report. Conclusions: A daily, one-hour narrative group can make a difference in a locked inpatient unit, presumably by creating cognitive structure for patients in how to understand what has happened to them. Further research is indicated in a randomized, controlled-trial format. PMID:21412477

  5. Characterization of Older Emergency Department Patients Admitted to Psychiatric Units

    PubMed Central

    Stiffler, Kirk A.; Kohli, Erol; Chen, Oriana; Frey, Jennifer A.

    2015-01-01

    Background Many older patients presenting to emergency departments (EDs) with psychiatric complaints require admission to geropsychiatric units (GPUs). The medical evaluation needed prior to this is not understood. Our goal was to understand ED evaluation practices for patients admitted to the GPU through the ED and understand the medical problems identified after admission. Methods Via retrospective chart review, we abstracted demographics, medical history, ED complaint, evaluation, length of stay, and diagnosis. The number of patients later transferred from the GPU and the reasons for such transfers were also recorded. Results Of 100 patients reviewed, the average age was 78 years. Admission diagnoses were agitation/mania (30%), depression/suicidal ideation (28%), change in mental status/confusion (12%) and other (30%). Most had at least one prior psychiatric and medical diagnosis (77%, 60%). Common ED tests ordered were basic metabolic panel (BMP) (96%), complete blood count (CBC) (94%), urinalysis (UA) (89%), electrocardiogram (EKG) (69%), alcohol level (62%), urine toxicology (61%), chest X-ray (51%), and CT scan of the head (71%). Abnormal findings included urinalysis (24.7%), CBC (23.4%), toxicology (23%), BMP (21.9%), head CT (21.1%), chest X-ray (13.7%), ECG changes (10.1%), and alcohol (4.8%). Five of the 100 GPU admissions were later transferred to a medical floor. Conclusion Most GPU admissions have previous psychiatric and medical issues and are admitted for agitation/mania or depression/suicidal ideation. A certain percentage of patients are transferred out due to medical issues despite ED evaluation. However, it is unlikely that further ED testing would reduce this percentage. Further research of medical screening for geropsychiatric patients may elucidate ideal medical clearance procedures. PMID:26491495

  6. Reducing conflict and containment rates on acute psychiatric wards: The Safewards cluster randomised controlled trial

    PubMed Central

    Bowers, Len; James, Karen; Quirk, Alan; Simpson, Alan; Stewart, Duncan; Hodsoll, John

    2015-01-01

    Background Acute psychiatric wards manage patients whose actions may threaten safety (conflict). Staff act to avert or minimise harm (containment). The Safewards model enabled the identification of ten interventions to reduce the frequency of both. Objective To test the efficacy of these interventions. Design A pragmatic cluster randomised controlled trial with psychiatric hospitals and wards as the units of randomisation. The main outcomes were rates of conflict and containment. Participants Staff and patients in 31 randomly chosen wards at 15 randomly chosen hospitals. Results For shifts with conflict or containment incidents, the experimental condition reduced the rate of conflict events by 15% (95% CI 5.6–23.7%) relative to the control intervention. The rate of containment events for the experimental intervention was reduced by 26.4% (95% CI 9.9–34.3%). Conclusions Simple interventions aiming to improve staff relationships with patients can reduce the frequency of conflict and containment. Trial registration IRSCTN38001825. PMID:26166187

  7. How can we reduce violence and aggression in psychiatric inpatient units?

    PubMed

    Antonysamy, Arokia

    2013-01-01

    The inpatient environments in psychiatric units are not always conducive to patients' recovery. Male patients can easily feel bored especially when they are not interested in indoor activities like arts and crafts. Outdoor activities were little explored in our psychiatric intensive care unit and partly this may reflect a 'risk averse' approach. Like a pressure cooker, the patients' anger and frustration build up and unfortunately they may lash out on staff and other patients placing them at risk. The incidents of violence and aggression in our unit rose to 482 in 2011. The Blackpool zoo was close to our unit and it was felt that our patients may benefit a weekly trip to the zoo. Other activities like computer and gym sessions were maintained. Although there were initial reluctance and anxiety amongst staff to escort patients outside the unit, regular support and encouragement made them more confident and less risk averse. Our patients provided lots of positive feedback and felt better equipped to 'fit in' with their community after discharge. The initial discrimination against our patients at the zoo slowly transformed into partnership working and the authorities at the zoo have offered a training programme for our patients on animal care and hygiene. Over a period of 12 months, the incidence of aggression and violence in the ward reduced to 126. The average length of stay reduced by about 50%. We also discharged patients who recovered remarkably well, directly from the unit rather than stepping down to acute wards. Staff motivation and enthusiasm continued to improve and this was reflected in the reduction in staff sickness rates by more than 50%. Student nurses and doctors were able to understand the positive aspects of patients' lives and skills and felt able to boost their hope and determination. PMID:26734168

  8. Spasm or transformation? Advanced practice psychiatric nursing education in the United States.

    PubMed

    Olson, Tom

    2004-08-01

    Psychiatric nursing graduate programs are in precipitous decline in the United States, leading many advanced practice psychiatric nurses to question the viability of their field. This article examines the current crisis in advanced practice psychiatric nursing education in the United States by identifying core concerns and exploring the reasons for these concerns. Suggestions for securing the future of this practice area are also discussed. These suggestions include identifying a more clearly focused role for advanced practice psychiatric nurses, development of realistic educational expectations, achievement of greater uniformity in curricula, and the establishment of a strong and rigorous process of accreditation. PMID:15468608

  9. Psychiatric Information Systems: An Analysis of Inpatient and Outpatient Unit Capabilities

    PubMed Central

    Wisdom, Jennifer; Bielavitz, Sarann; French, Robert

    2011-01-01

    This paper describes how a sample of inpatient and out-patient psychiatric treatment units use technology to aid in patient care through scheduling, tracking, billing, and documenting clinical services. We conducted semi-structured interviews (n = 68) at four inpatient and four outpatient psychiatric facilities in Oregon. Results indicate psychiatric facilities are assembling systems for managing information that include a combination of electronic linked clinical records, paper records, and unit-specific, unlinked databases. Barriers remain in (1) improving the sophistication of psychiatric information systems, (2) improving linkages of behavioral health with other medical information systems, and (3) increasing information technology support. PMID:21603591

  10. Early sleep psychiatric intervention for acute insomnia: implications from a case of obsessive-compulsive disorder.

    PubMed

    Abe, Yuichiro; Nishimura, Go; Endo, Takuro

    2012-04-15

    Insomnia is a common problem among patients with obsessive-compulsive disorder (OCD), and patients suffering from acute insomnia with psychiatric comorbidity are more likely to develop chronic insomnia without appropriate intervention. Here we report a case of obsessive-compulsive disorder with acute insomnia, successfully treated with early sleep psychiatric non-pharmacological intervention. The augmentation of medication runs a risk of exacerbating daytime impairment. Clinicians usually prescribe medication, such as antidepressants and hypnotics without reflections for such complaints. However, the use of these sedative agents is often problematic, especially when patients have kept a good QOL activity in daily life. The rapid recovery from acute insomnia in this case suggests that the appropriate use of actigraphy is a favorable non-pharmacological intervention in acute insomnia. PMID:22505865

  11. Psychiatric treatment and research unit for adolescent intensive care: the first adolescent forensic psychiatric service in Finland.

    PubMed

    Kahila, K; Kilkku, N; Kaltiala-Heino, R

    2004-04-01

    Finland does not have a history of providing forensic adolescent psychiatric units although the need for this kind of service has been established. According to legislation patients who are minors have to be treated separately from adults, however, this has not been possible in practice. Also, adolescent psychiatric wards have not always been able to admit the most severely ill patients, those with impulsive and aggressive behaviours, because of lack of staff resources, problems associated with protecting other vulnerable patients and a shortage of secure environments. A previous report demonstrated the significant increase in adolescent's involuntary treatment within adult psychiatric wards. Data from this report were acknowledged as an important starting point in the planning process for the psychiatric treatment and research unit for adolescent intensive care. This paper describes the background, development process, plan of action, tailor-made education programme and supporting evidence for the first Finnish adolescent forensic service opened in April 2003 in the Department of Psychiatry, Tampere University Hospital. The tool used for planning the unit's activities and staff education programme was the Balanced Score Card approach, the structure and development of which is also outlined within the paper. PMID:15009502

  12. Clinical Application of the "Scribble Technique" with Adults in an Acute Inpatient Psychiatric Hospital.

    ERIC Educational Resources Information Center

    Hanes, Michael J.

    1995-01-01

    The "scribble technique," described by Florence Cane's book, "The Artist in Each of Us" (1983), has historically been employed by art therapists as a technique to reduce inhibitions and liberate spontaneous imagery from the unconscious. Reviews the technique and presents examples produced by adult patients in an acute inpatient psychiatric ward.…

  13. Sexual Health Competence of International Medical Graduate Psychiatric Residents in the United States

    ERIC Educational Resources Information Center

    Sciolla, Andres; Ziajko, Lauretta A.; Salguero, Mario L.

    2010-01-01

    Objective: Currently in the United States, more than one in three psychiatric residents are international medical graduates (IMGs). In light of forecasts of physician shortages, this proportion is likely to continue growing. Although central to psychiatric care, sexual health competence levels of IMGs may be lower than those of U.S. graduates.…

  14. 42 CFR 485.647 - Condition of participation: psychiatric and rehabilitation distinct part units.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... rehabilitation distinct part units. 485.647 Section 485.647 Public Health CENTERS FOR MEDICARE & MEDICAID... Condition of participation: psychiatric and rehabilitation distinct part units. (a) Conditions. (1) If a CAH... rehabilitation services in a distinct part unit, the services furnished by the distinct part unit must...

  15. 42 CFR 485.647 - Condition of participation: psychiatric and rehabilitation distinct part units.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... rehabilitation distinct part units. 485.647 Section 485.647 Public Health CENTERS FOR MEDICARE & MEDICAID... Condition of participation: psychiatric and rehabilitation distinct part units. (a) Conditions. (1) If a CAH... rehabilitation services in a distinct part unit, the services furnished by the distinct part unit must...

  16. Aripiprazole treatment of Asperger’s syndrome in the acute psychiatric setting: case report

    PubMed Central

    Dratcu, Luiz; McKay, Gavin; Singaravelu, Vinod; Krishnamurthy, Venkat

    2007-01-01

    Asperger’s syndrome (AS) is under-recognized and may be misdiagnosed as schizophrenia in adults because of symptom overlap. Pharmacological treatment usually targets associated behavioral and mental symptoms rather than the actual core features of AS. We report a middle-aged male patient who, after many years of previous contact with mental health services, and on account of his psychotic symptoms and diagnosis of schizophrenia, was admitted to an inner-city acute psychiatric unit, where a primary diagnosis of AS was established for the first time in his life. His impairing clinical features of AS improved markedly following treatment using aripiprazole, a novel atypical antipsychotic that acts as a partial agonist at dopamine D2 receptors. As well as sharing clinical features, there is an overlap in underlying neurobiology of AS and schizophrenia, including dopamine dysfunction, that provides a rationale for using antipsychotics of this class in the clinical management not only of associated psychotic symptoms but also of the core features of AS itself. PMID:19300548

  17. Identifying Patients in the Acute Psychiatric Hospital Who May Benefit From a Palliative Care Approach.

    PubMed

    Burton, M Caroline; Warren, Mark; Cha, Stephen S; Stevens, Maria; Blommer, Megan; Kung, Simon; Lapid, Maria I

    2016-04-01

    Identifying patients who will benefit from a palliative care approach is the first critical step in integrating palliative with curative therapy. Criteria are established that identify hospitalized medical patients who are near end of life, yet there are no criteria with respect to hospitalized patients with psychiatric disorders. The records of 276 consecutive patients admitted to a dedicated inpatient psychiatric unit were reviewed to identify prognostic criteria predictive of mortality. Mortality predictors were 2 or more admissions in the past year (P = .0114) and older age (P = .0006). Twenty-two percent of patients met National Hospice and Palliative Care Organization noncancer criteria for dementia. Palliative care intervention should be considered when treating inpatients with psychiatric disorders, especially older patients who have a previous hospitalization or history of dementia. PMID:25318929

  18. A Systematic Review of Music Therapy Practice and Outcomes with Acute Adult Psychiatric In-Patients

    PubMed Central

    Carr, Catherine; Odell-Miller, Helen; Priebe, Stefan

    2013-01-01

    Background and Objectives There is an emerging evidence base for the use of music therapy in the treatment of severe mental illness. Whilst different models of music therapy have been developed in mental health care, none have specifically accounted for the features and context of acute in-patient settings. This review aimed to identify how music therapy is provided for acute adult psychiatric in-patients and what outcomes have been reported. Review Methods A systematic review using medical, psychological and music therapy databases. Papers describing music therapy with acute adult psychiatric in-patients were included. Analysis utilised narrative synthesis. Results 98 papers were identified, of which 35 reported research findings. Open group work and active music making for nonverbal expression alongside verbal reflection was emphasised. Aims were engagement, communication and interpersonal relationships focusing upon immediate areas of need rather than longer term insight. The short stay, patient diversity and institutional structure influenced delivery and resulted in a focus on single sessions, high session frequency, more therapist direction, flexible use of musical activities, predictable musical structures, and clear realistic goals. Outcome studies suggested effectiveness in addressing a range of symptoms, but were limited by methodological shortcomings and small sample sizes. Studies with significant positive effects all used active musical participation with a degree of structure and were delivered in four or more sessions. Conclusions No single clearly defined model exists for music therapy with adults in acute psychiatric in-patient settings, and described models are not conclusive. Greater frequency of therapy, active structured music making with verbal discussion, consistency of contact and boundaries, an emphasis on building a therapeutic relationship and building patient resources may be of particular importance. Further research is required to

  19. Acute behavioral crises in psychiatric inpatients with autism spectrum disorder (ASD): recognition of concomitant medical or non-ASD psychiatric conditions predicts enhanced improvement.

    PubMed

    Guinchat, Vincent; Cravero, Cora; Diaz, Lautaro; Périsse, Didier; Xavier, Jean; Amiet, Claire; Gourfinkel-An, Isabelle; Bodeau, Nicolas; Wachtel, Lee; Cohen, David; Consoli, Angèle

    2015-03-01

    During adolescence, some individuals with autism spectrum disorder (ASD) engage in severe challenging behaviors, such as aggression, self-injury, disruption, agitation and tantrums. We aimed to assess risk factors associated with very acute behavioral crises in adolescents with ASD admitted to a dedicated neurobehavioral unit. We included retrospectively in 2008 and 2009 29 adolescents and young adults with ASD hospitalized for severe challenging behaviors and proposed a guideline (Perisse et al., 2010) that we applied prospectively for 29 patients recruited for the same indications between 2010 and 2012. In total, 58 patients were admitted (n=70 hospitalizations, mean age=15.66 (±4.07) years, 76% male). We systematically collected data describing socio-demographic characteristics, clinical variables (severity, presence of language, cognitive level), comorbid organic conditions, etiologic diagnosis of the episode, and treatments. We explored predictors of Global Assessment Functioning Scale (GAFS) score and duration of hospitalization at discharge. All but 2 patients exhibited severe autistic symptoms and intellectual disability (ID), and two-thirds had no functional verbal language. During the inpatient stay (mean=84.3 (±94.9) days), patients doubled on average their GAFS scores (mean=17.66 (±9.05) at admission vs. mean=31.4 (±9.48) at discharge). Most common etiologies for acute behavioral crises were organic causes [n=20 (28%), including epilepsy: n=10 (14%) and painful medical conditions: n=10 (14%)], environmental causes [n=17 (25%) including lack of treatment: n=11 (16%) and adjustment disorder: n=6 (9%)], and non-ASD psychiatric condition [n=33 (48%) including catatonia: n=5 (7%), major depressive episode: n=6 (9%), bipolar disorder: n=4 (6%), schizophrenia: n=6 (9%), other/unknown diagnosis: n=12 (17%)]. We found no influence of age, gender, socio-economic status, migration, level of ID, or history of seizure on improvement of GAFS score at discharge

  20. Forensic psychiatric units in Italy from the 1960s to the present.

    PubMed

    De Vito, Christian Giuseppe

    2014-01-01

    This article addresses the long-standing continuities in the history of the Italian forensic psychiatric units and views them as the result of conflicting forces, interests, mentalities and strategies at the cross-road of forensic psychiatry, psychiatry, prison and health services. It focuses on the period from the 1960s to the present and deals with, among other issues, the long-term impact of the anti-asylum movements and the on-going debate on the 'phasing out' of the forensic psychiatric units. PMID:24125959

  1. Treatment needs, diagnoses and use of services for acutely admitted psychiatric patients in northwest Russia and northern Norway

    PubMed Central

    2013-01-01

    Background We compared demography, diagnoses and clinical needs in acutely admitted psychiatric hospital patients in northwest Russia and northern Norway. Method All acutely admitted psychiatric patients in 1 psychiatric hospital in north-west Russia and 2 in northern Norway were in a three months period assessed with HoNOS and a Norwegian form developed to study acute psychiatric services (MAP). Data from a total of 841 patients were analysed (377 Norwegian, 464 Russian) with univariate and multivariate statistics. Results Russian patients were more often males who had paid work. 2/3 were diagnosed with alcohol and organic disorders, and 70% reported problems related to sleep. Depression was widespread, as were problems associated with occupation. Many more Norwegian patients were on various forms of social security and lived in community supported homes. They had a clinical profile of affective disorders, use of drugs, suicidality and problems with activities involved of daily life. Slightly more Norwegian patients were involuntary admitted. Conclusion Acutely admitted psychiatric patients in North West Russia and Northern Norwegian showed different clinical profiles: alcohol, depression and organic disorders characterised Russian patients, affective disorders, suicidality and use of drugs characterised the Norwegians. Whereas Norwegian patients are mainly referred from GPs the Russians come via 1.line psychiatric services (“dispensaries”). Average length of stay for Russian patients was 2.5 times longer than that of the Norwegian. PMID:23317010

  2. Registration of aggressive incidents in an adolescent forensic psychiatric unit and implications for further practice.

    PubMed

    Tremmery, S; Danckaerts, M; Bruckers, L; Molenberghs, G; De Hert, M; Wampers, M; De Varé, J; de Decker, A

    2014-09-01

    Although aggression is part of daily life in psychiatric units for adolescents, empirical data on its prevalence are sparse. Only few studies have described prevalence of aggressive incidents in adolescent psychiatric wards, and data in forensic psychiatric care are even more limited. Available studies reported high prevalence rates of aggression, ranging from 0.4 to 2.4 incidents of aggression per day across (forensic) child and adolescent psychiatric units. Between 27 and 78 % of all admitted youth committed an aggressive act. In this study, we collected systematically registered data of all aggressive incidents from the first 2 years (2010-2012) on a newly established forensic adolescent psychiatric unit, which used a formal aggression management program embedded in the social competence model, which is based on early intervention in the 'chain of behavior' to prevent any further escalation. The inclusion of also minor aggressive incidents is unique in the literature and the clinical relevance is highlighted. A mean of one incident a day took place, with each adolescent involved in at least one incident. Notably, 1.7 aggressive incidents per month made seclusion of restraint use necessary. Based on the social competence theory, the aggression management model suggests intervening early in the cascade of aggression, in order to prevent further escalation and reduce the need for intrusive interventions. Evidence supported that aggression is a contextual event, as external factors clearly influence the incidence of aggression. Aggression management should be built on both relational and structural security. PMID:24682593

  3. Psychiatric Emergencies.

    PubMed

    Wheat, Santina; Dschida, Dorothy; Talen, Mary R

    2016-06-01

    Psychiatric emergencies are acute disturbances in thought, behavior, mood, or social relationship that require immediate intervention as defined by the patient, family, or social unit to save the patient and/or others from imminent danger. Ensuring the safety of the patient, surrounding persons, and the medical team is the first step of evaluation. Treatment focuses on stabilization of the patient, then on specific symptoms and ultimately the cause of symptoms. There are important legal considerations, particularly regarding involuntary admissions. It is important to debrief with the patient, surrounding family, and the health care team to ensure a continued therapeutic alliance and the emotional health of all involved. PMID:27262012

  4. Team climate and attitudes toward information and communication technology among nurses on acute psychiatric wards.

    PubMed

    Koivunen, Marita; Anttila, Minna; Kuosmanen, Lauri; Katajisto, Jouko; Välimäki, Maritta

    2015-01-01

    Objectives: To describe the association of team climate with attitudes toward information and communication technology among nursing staff working on acute psychiatric wards. Background: Implementation of ICT applications in nursing practice brings new operating models to work environments, which may affect experienced team climate on hospital wards. Method: Descriptive survey was used as a study design. Team climate was measured by the Finnish modification of the Team Climate Inventory, and attitudes toward ICT by Burkes' questionnaire. The nursing staff (N = 181, n = 146) on nine acute psychiatric wards participated in the study. Results: It is not self-evident that experienced team climate associates with attitudes toward ICT, but there are some positive relationships between perceived team climate and ICT attitudes. The study showed that nurses' motivation to use ICT had statistically significant connections with experienced team climate, participative safety (p = 0.021), support for innovation (p = 0.042) and task orientation (p = 0.042). Conclusion: The results suggest that asserting team climate and supporting innovative operations may lead to more positive attitudes toward ICT. It is, in particular, possible to influence nurses' motivation to use ICT. More attention should be paid to psychosocial factors such as group education and co-operation at work when ICT applications are implemented in nursing. PMID:24393065

  5. Acute Suicidal Affective Disturbance (ASAD): A confirmatory factor analysis with 1442 psychiatric inpatients.

    PubMed

    Stanley, Ian H; Rufino, Katrina A; Rogers, Megan L; Ellis, Thomas E; Joiner, Thomas E

    2016-09-01

    Acute Suicidal Affective Disturbance (ASAD) is a newly proposed diagnostic entity that characterizes rapid onset suicidal intent. This study aims to confirm the factor structure of ASAD among psychiatric inpatients, and to determine the clinical utility of ASAD in predicting suicide attempt status. Overall, 1442 psychiatric inpatients completed a battery of self-report questionnaires assessing symptoms theorized to comprise the ASAD construct. Utilizing these data, a confirmatory factor analysis with a one-factor solution was performed. Regression analyses were employed to determine if the ASAD construct predicted past suicide attempts, and analyses of variance (ANOVAs) were employed to determine if ASAD symptoms differed by the presence and number of past suicide attempts. The one-factor solution indicated good fit: χ(2)(77) = 309.1, p < 0.001, Tucker-Lewis Index (TLI) = 0.96, comparative fit index (CFI) = 0.97, root-mean-square error of approximation (RMSEA) = 0.05. Controlling for depressive disorders and current symptoms, the ASAD construct significantly predicted the presence of a past suicide attempt. Moreover, ASAD differentiated in the expected directions between individuals with a history of multiple suicide attempts, individuals with a single suicide attempt, and individuals with no history of a suicide attempt. Acute Suicidal Affective Disturbance (ASAD) appears to be a unified construct that predicts suicidal behavior and is distinct from an already-defined mood disorder. PMID:27344228

  6. An exploratory analysis of the relationship between psychiatric nurses' perceptions of workload and unit activity.

    PubMed

    Gerolamo, Angela M

    2009-06-01

    Although research exists relative to psychiatric nurses' perceptions of their work conditions, the relationship between nurses' perceptions of their workloads and the activities in which they engage has been unexplored. The purpose of this study is to examine the relationship between unit activity and nurses' perceptions of their workloads. The design is a secondary analysis using two data sources: (a) reports from 36 psychiatric nurses consisting of perceptions of their work conditions (n = 383) and (b) the hospital census and activity and acuity 24-hour shift reports (n = 384). Nurses' perceptions of workloads were related to unit activity; the greater the number of heavy and medium-to-heavy workloads, the higher the unit activity. This evidence contributes to the growing body of research demonstrating that nurses accurately provide information related to the hospital environment. PMID:19446779

  7. Correlates of MMPI--a scales in acute psychiatric and forensic samples.

    PubMed

    Veltri, Carlo O C; Graham, John R; Sellbom, Martin; Ben-Porath, Yossef S; Forbey, Johnathan D; O'Connell, Carol; Rogers, Robert; White, Robert S

    2009-05-01

    The purpose of this study was to expand the empirical basis for interpretation of the Minnesota Multiphasic Personality Inventory-Adolescent (MMPI-A; Butcher et al., 1992). Participants were 157 boys from a forensic setting and 197 girls from an acute psychiatric inpatient setting. Criterion variables were identified from sources such as psychiatrist report, parent report, and psychosocial history. Results generally support the construct validity of MMPI-A scales. Scales measuring internalizing problems were more highly correlated with criterion measures of internalizing behaviors than measures of externalizing behaviors, whereas scales measuring externalizing problems were more highly correlated with externalizing variables than with internalizing criteria. Implications of this study include an expanded empirical foundation for interpretation of the MMPI-A, greater understanding of the constructs it measures, and evidence supporting the generalizability of these constructs across settings. PMID:19365769

  8. [Schizophrenia diagnostic announcement in a French psychiatric unit].

    PubMed

    Rocamora, J F; Benadhira, R; Saba, G; Stamatadis, L; Kalalaou, K; Dumortier, G; Plaze, M; Aubriot-Delmas, B; Glikman, J; Januel, D

    2005-01-01

    Announcement of schizophrenia diagnostic to the patients is a topical issue in France. The evolution in clinical practices, a better efficiency in therapeutic procedures and the fundamental right of the patient to obtain information have initialised the discussion of its interest. Spontaneous claim for information from the patient is rarely observed although awareness troubles might be reported at the instauration of the mental disorder or during its evolution. Methodological studies concerning the diagnostic announcement are limited. Except the Bayle studies recently published, only a few publications are available in France about the knowledge of their pathology and their need to be clearly informed. French scientific literature deals generally about medico-legal aspects of this information and consisted of survey about diagnostic announcement. International literature is more abundant and presents positive and negative aspects of the announcement. An information procedure of schizophrenia announcement to the patient has been developed in our hospitalisation unit of psychiatry. This procedure has taken place on the basis of the literature data, our specificity and our clinical experiences. For some Anglo-American psychiatrists who have proceeded to semi-structured interview in order to announce the diagnostic, information to the patients might improve the clinical relationship. Thus, compliance to the treatment is significantly increased. The ability of the patient to recognise the symptoms of the disease and to accept their consequences and the treatments is associated to a better social prognosis, daily activities and response to the treatment. The announcement impact justifies the prescription of neuroleptics, treatment that is notoriously perceived as prejudicial by the patients themselves or more commonly in the basic population. To obtain compliance to the treatment, a satisfactory acceptance of the mental disorder is required. Compliance is based on

  9. Acute lead poisoning in nursing home and psychiatric patients from the ingestion of lead-based ceramic glazes.

    PubMed

    Vance, M V; Curry, S C; Bradley, J M; Kunkel, D B; Gerkin, R D; Bond, G R

    1990-10-01

    To our knowledge, acute inorganic lead poisoning from single ingestions of lead compounds has been only rarely reported. During a 14-month period, we were contacted regarding eight instances of acute ingestions of liquid lead-based ceramic glazes by mentally impaired residents of nursing homes or psychiatric facilities participating in ceramic arts programs. While some ingestions did not cause toxic effects, some patients developed acute lead poisoning characterized by abdominal pain, anemia, and basophilic stippling of red blood cells. In the blood of several patients, lead concentrations were far above normal (4 to 9.5 mumol/L). Urinary lead excretions were tremendously elevated during chelation therapy, with one patient excreting 535.9 mumol/L of lead during a 6-day period, the largest lead excretion ever reported in a patient suffering from acute lead poisoning, to our knowledge. All patients recovered following supportive care and appropriate use of chelating agents. Lead-based glazes are commonly found in nursing homes and psychiatric facilities. We suspect that acute or chronic lead poisoning from the ingestion(s) of lead-based ceramic glazes may be an unrecognized but not uncommon problem among such residents. We urge physicians to take ingestions of lead-based glazes seriously and to consider the diagnosis of lead poisoning in nursing home and psychiatric patients who have participated in ceramic crafts programs. PMID:2222094

  10. Evaluating outcomes of the child and adolescent psychiatric unit: A prospective study

    PubMed Central

    2011-01-01

    Background The aims of this prospective study are to clarify the outcomes of child psychiatric inpatient treatment and to identify factors associated with patient improvement. Methods The attending psychiatrist used the Children's Global Assessment Scale (CGAS) to assess youths at admission to and discharge from a child and adolescent psychiatric unit in Japan(N = 126, mean age = 12.8, SD = 1.9). Hospital records gathered sociodemographic and clinical variables. In addition, youths and their primary caregivers assessed themselves using the Youth Self Report (YSR) and the Child Behavior Checklist (CBCL), respectively. Longitudinal analyses compared each scales' baseline and discharge scores. We also examined factors associated with changes in functioning (CGAS). Results Longitudinal comparisons revealed that CGAS, CBCL and YSR scores showed improvement over time (CGAS: t = -14.40, p = 0.00; CBCL: t = 3.80, p = 0.00; YSR: t = 2.40, p = 0.02). Linear regressions determined that the factors associated with improvement in CGAS included age, lower CGAS scores at admission, frequency of group therapy and psychiatric diagnosis. Conclusions This evaluation of children and adolescents in an inpatient unit demonstrated clinical improvement over time and identified factors associated with said improvement. PMID:21453481

  11. Relationship between Psychiatric Nurse Work Environments and Nurse Burnout in Acute Care General Hospitals

    PubMed Central

    Hanrahan, Nancy P.; Aiken, Linda H.; McClaine, Lakeetra; Hanlon, Alexandra L

    2010-01-01

    Following deinstitutionalization, inpatient psychiatric services moved from state institutions to general hospitals. Despite the magnitude of these changes, evaluations of the quality of inpatient care environments in general hospitals are limited. This study examined the extent to which organizational factors of the inpatient psychiatric environments are associated with psychiatric nurse burnout. Organizational factors were measured by an instrument endorsed by the National Quality Forum. Robust clustered regression analysis was used to examine the relationship between organizational factors in 67 hospitals and levels of burnout for 353 psychiatric nurses. Lower levels of psychiatric nurse burnout was significantly associated with inpatient environments that had better overall quality work environments, more effective managers, strong nurse-physician relationships, and higher psychiatric nurse-to-patient staffing ratios. These results suggest that adjustments in organizational management of inpatient psychiatric environments could have a positive effect on psychiatric nurses’ capacity to sustain safe and effective patient care environments. PMID:20144031

  12. Prevalence of psychiatric morbidity and psychological adaptation of the nurses in a structured SARS caring unit during outbreak: a prospective and periodic assessment study in Taiwan.

    PubMed

    Su, Tung-Ping; Lien, Te-Cheng; Yang, Chih-Yi; Su, Yiet Ling; Wang, Jia-Horng; Tsai, Sing-Ling; Yin, Jeo-Chen

    2007-01-01

    To assess the rapidly changing psychological status of nurses during the acute phase of the 2003 SARS outbreak, we conducted a prospective and periodic evaluation of psychiatric morbidity and psychological adaptation among nurses in SARS units and non-SARS units. Nurse participants were from two SARS units (regular SARS [N=44] and SARS ICU [N=26]) and two non-SARS units (Neurology [N=15] and CCU [N=17]). Participants periodically self-evaluated their depression, anxiety, post-traumatic stress symptoms, sleep disturbance, attitude towards SARS and family support. Results showed that depression (38.5% vs. 3.1%) and insomnia (37% vs. 9.7%) were, respectively, greater in the SARS unit nurses than the non-SARS unit nurses. No difference between these two groups was found in the prevalence of post-traumatic stress symptoms (33% vs. 18.7%), yet, three unit subjects (SARS ICU, SARS regular and Neurology) had significantly higher rate than those in CCU (29.7% vs. 11.8%, respectively) (p<0.05). For the SARS unit nurses, significant reduction in mood ratings, insomnia rate and perceived negative feelings as well as increasing knowledge and understanding of SARS at the end of the study (all p<0.001) indicated that a gradual psychological adaptation had occurred. The adjustment of nurses in the more structured SARS ICU environment, where nurses care for even more severely ill patients, may have been as good or better than that of nurses in the regular SARS unit. Occurrence of psychiatric symptoms was linked to direct exposure to SARS patient care, previous mood disorder history, younger age and perceived negative feelings. Positive coping attitude and strong social and family support may have protected against acute stress. In conclusion, the psychological impact on the caring staffs facing future bio-disaster will be minimized with lowered risk factors and a safer and more structured work environment. PMID:16460760

  13. Handover of patient information from the crisis assessment and treatment team to the inpatient psychiatric unit.

    PubMed

    Waters, Amanda; Sands, Natisha; Keppich-Arnold, Sandra; Henderson, Kathryn

    2015-06-01

    Handover, or the communication of patient information between clinicians, is a fundamental component of health care. Psychiatric settings are dynamic environments relying on timely and accurate communication to plan care and manage risk. Crisis assessment and treatment teams are the primary interface between community and mental health services in many Australian and international health services, facilitating access to assessment, treatment, and admission to hospital. No previous research has investigated the handover between crisis assessment and treatment teams and inpatient psychiatric units, despite the importance of handover to care planning. The aim of the present study was to identify the nature and types of information transferred during these handovers, and to explore how these guides initial care planning. An observational, exploratory study design was used. A 20-item handover observation tool was used to observe 19 occasions of handover. A prospective audit was undertaken on clinical documentation arising from the admission. Clinical information, including psychiatric history and mental state, were handed over consistently; however, information about consumer preferences was reported less consistently. The present study identified a lack of attention to consumer preferences at handover, despite the current focus on recovery-oriented models for mental health care, and the centrality of respecting consumer preferences within the recovery paradigm. PMID:25438620

  14. A plea for the establishment of psychiatric forensic units in Israel.

    PubMed

    Weil, F

    1992-01-01

    The growing interaction between psychiatric and legal systems justifies the establishment of specialized services. From a theoretical viewpoint, the obligation of judges to apply a dichotomic categorization between 'mentally ill' offenders and the rest--encompassing a wide spectrum of normal people as well as those suffering from severe personality disorders--contradicts the psychiatrist's conception of continuum in pathology and liability. In practice, the criterion of accountability determines whether an offender will be punished or treated in a mental institution. Mentally disturbed but non-psychotic offenders cannot benefit from advances in psychiatric techniques. This article details suggestions for change: The decision about mentally disturbed offenders should be based on two criteria--liability and chance of improvement through treatment. The judicial decision may then integrate punishment and treatment. The establishment of psychiatric forensic units would significantly add to the present range of services handling mentally disturbed offenders, would end the dispersion of the professionals (psychiatrists, psychologists, criminologists, social workers, probation officers) involved in the management of such offenders, and could provide an academic base and a framework for training residents. PMID:1484468

  15. Interaction between psychiatric and autoimmune disorders in celiac disease patients in the Northeastern United States

    PubMed Central

    GARUD, S.; LEFFLER, D.; DENNIS, M.; EDWARDS-GEORGE, J.; SARYAN, D.; SHETH, S.; SCHUPPAN, D.; JAMMA, S.; KELLY, C. P.

    2009-01-01

    Summary Background Previous studies yielded conflicting results regarding the presence of an association between celiac disease (CD) and psychiatric disorders including depression. This association has not been studied in the United States. Aim To determine the prevalence of psychiatric and autoimmune disorders in patients with CD in the US compared to control groups. Methods In a case control study, the prevalence of psychiatric and autoimmune disorders was compared in 600 CD patients, 200 irritable bowel syndrome (IBS) patients and 200 healthy controls. Results The prevalence of depression in CD was 17.2% and was similar to that in IBS (18.5%, P = 0.74) and controls (16.0%, P = 0.79). Among CD patients, type I DM was identified as a significant risk factor for depression (P < 0.01) with 37% of patients with both CD and type I DM having clinical depression. Conclusion The prevalence of depression in CD is similar to that in other chronic gastrointestinal diseases and healthy controls. However, there is a markedly elevated risk of depression in patients with both type I DM and CD. Differing rates of type 1 DM among celiac populations may account for disparity in published rates of depression in patients with CD. PMID:19183153

  16. Acute effects of electroconvulsive therapy on regional cerebral blood flow (rCBF) in psychiatric disorders

    SciTech Connect

    Prohovnik, I.; Alderson, P.O.; Sackheim, H.A.; Decina, P.; Kahn, D.

    1984-01-01

    Electroconvulsive therapy (ECT) is frequently used in the treatment of major depression and other psychiatric disorders; its mechanism of action is not established, but previous evidence suggests that it is associated with postictal metabolic suppression. The authors have used measurements of rCBF as an index of cortical metabolic activity to study the acute effects of ECT. Measurements of rCBF were made in 32 cortical regions in 10 patients (pts) following one minute breathing of Xe-133 (5mCi/L); the measurements were performed 30min before and 50min after ECT. Bilateral ECT was administered to six pts (five diagnosed as major depressives and one schizophrenic) and unilateral ECT to four (all diagnosed as unipolar or bipolar affective disorder). The total rCBF material consists of 52 measurements in these pts, made before and after 16 bilateral and 10 unilateral treatments. ECT was found to cause significant reduction of rCBF. Mean hemispheric flows (using the Initial Slope Index to measure grey-matter flow) were reduced by about 5% in both hemispheres following bilateral treatment. Unilateral treatment caused a 9% reduction of flow in the treated hemisphere, but only 2% contralaterally. Regional patterns of flow decreases also differed between the two treatment modes: bilateral frontal reductions were found after bilateral treatment, whereas unilateral ECT caused a widespread flow reduction in the treated hemisphere, and almost no effect contralaterally. These results suggest that rCBF studies are useful for assessing ECT, and indicate that the acute cerebral effects of ECT vary with the mode of treatment.

  17. Paranoid symptoms in patients on a general hospital psychiatric unit. Implications for diagnosis and treatment.

    PubMed

    Freedman, R; Schwab, P J

    1978-03-01

    Paranoid symptoms were found in 40% of patients admitted to a university general hospital psychiatric unit during a ten-month period. Fifty-eight percent of this group had frank paranoid delusions, while the rest had ideas of reference or generalized suspiciousness. Only one half of those who had paranoid delusions had paranoid schizophrenia. A significant number had affective disorders or organic brain disorder. Ideas of reference and suspiciousness were found in many patients who were not psychotic. The therapeutic implications of these findings are reported in three patients who were inadequately treated for affective disorders because the presence of paranoid symptomatology had led to an incorrect diagnosis of schizophrenia. PMID:727891

  18. Psychiatric Comorbidity in Patients from the Addictive Disorders Assistance Units of Galicia: The COPSIAD Study

    PubMed Central

    Pereiro, César; Pino, Carlos; Flórez, Gerardo; Arrojo, Manuel; Becoña, Elisardo

    2013-01-01

    The objective of this study is to assess the prevalence of psychiatric comorbidity in patients under treatment within the addictive disorders assistance units of Galicia (Spain). Material and Methods A total of 64 healthcare professionals performed clinical diagnosis of mental disorders (on DSM IV-TR criteria) in 2300 patients treated throughout March 2010 in 21 addictive disorders assistance units. Results 56.3% of patients with substance abuse/dependency also showed some other mental disorder, 42.2% of patients suffering from at least an Axis I condition and 20.2% from some Axis II condition. Mood and anxiety disorders and borderline and antisocial personality disorders were the most frequent disorders in both axes. Conclusions A high comorbidity was found between mental and substance use disorders (SUD) in patients seen at the addictive disorders assistance units of Galicia. PMID:23823135

  19. Retrospective analysis of absconding behaviour by acute care consumers in one psychiatric hospital campus in Australia.

    PubMed

    Mosel, Krista A; Gerace, Adam; Muir-Cochrane, Eimear

    2010-06-01

    Absconding is increasingly being recognized as a problem within mental health settings with significant risks for consumers. This study examines absconding behaviours across three acute care wards within an Australian psychiatric hospital campus over a 12-month period. A descriptive statistical analysis determined the rate of absconding from 49 consumers who absconded 64 times. The absconding rate was 13.33% (absconding events), with most absconding events arising from males diagnosed with schizophrenia (57.14%) aged between 20 and 29 years, and with 62.50% of absconding events occurring whilst consumers were on their first 21-day detention order. Nearly half of all absconding events were by consumers who had absconded previously, with the highest proportion of events occurring during nursing handover. A profile of people who abscond, time of day of absconding, legal status and repeated absconding behaviours are described. The emergent profile of consumers who absconded within this study bears some similarities to that described in overseas research, although in this study consumers were slightly older and 25% of absconders were female. Of particular interest are findings that identify the timings of absconding events in relation to a consumer's legal status. Implications for practice, including assessment of risk of absconding and management, are considered. PMID:20550641

  20. 'Real relationships': sociable interaction, material culture and imprisonment in a secure psychiatric unit.

    PubMed

    Parrott, Fiona R

    2010-12-01

    Research into the character of social relationships in psychiatric inpatient facilities has focused on face-to-face interaction between individuals and within groups in the communal areas of wards. Using theories developed in material culture and media studies, this article argues that patients' relationships to goods, namely, photographs, cards and gifts from family or friends, televisions and radios, are important mediators and constituents of sociability. In an ethnographic study of a medium-secure psychiatric unit, I show how these goods are put to use in private space in ways that reflect and mitigate the constraints of incarceration and stigmatization. The data were derived from 3 months of participant observation on a male and a female ward at a unit in the south of England, including a series of anthropological interviews with 19 patients. This article highlights two important findings. First, potentially isolating activities are perceived by patients as sociable, in that watching television and looking at photographs in their room helps to counter feelings of loneliness and isolation. Second, potentially sociable activities, exchanging goods or watching the communal television, are often practiced in such a way as to maintain distance between patients in acknowledgment of the constrained and volatile nature of these relationships. This suggests that patients aspire to retain a sense of the artificiality of their situation, preferring to confine their notion of 'real' relationships to those that exist outside the institution. PMID:20811936

  1. The institutional response to mental disorder in Ireland: censuses of Irish asylums, psychiatric hospitals and units 1844-2014.

    PubMed

    Walsh, D; Daly, A; Moran, R

    2016-08-01

    Before the eighteenth century, there was limited response to the problem of psychiatric illness in Ireland as in many other countries. The asylums of the 1820s and 1830s were no sooner opened than they were overcrowded. A second wave of asylum building commenced in the second half of the nineteenth century continuing up to the early twentieth century. In 1966, the Report of the Commission on Mental Illness noted that the rate of psychiatric beds in Ireland per 1,000 was one of the highest in the world. The report called for a change in the policy of caring for the mentally ill in psychiatric hospitals to more community-based settings and in psychiatric units located in general hospital settings, along with a call for more research into mental illness. The result of the latter was the establishment of the first census of psychiatric patients resident in psychiatric hospitals. Thus began fifty years of census reporting and the subsequent establishment of the National Psychiatric Inpatient Reporting System (NPIRS). PMID:26667467

  2. Associations between sleep disturbance and suicidal ideation in adolescents admitted to an inpatient psychiatric unit.

    PubMed

    Kaplan, Sebastian G; Ali, Shahzad K; Simpson, Brittany; Britt, Victoria; McCall, W Vaughn

    2014-01-01

    The goals of our study were to: 1) describe the incidence of disturbances in sleep quality, sleep hygiene, sleep-related cognitions and nightmares; and 2) investigate the association between these sleep-related disturbances and suicidal ideation (SI), in adolescents admitted to a psychiatric inpatient unit. Our sample consisted of 50 adolescents between the ages of 12 and 17 years (32 females and 18 males; 41 Caucasian and nine African American). Our cross-sectional design involved the administration of the Adolescent Sleep Wake Scale (ASWS), the Adolescent Sleep Hygiene Scale (ASHS), the Dysfunctional Beliefs and Attitudes about Sleep-Short version for use with children (DBAS-C10), the Disturbing Dreams and Nightmare Scale (DDNSI), and the Suicidal Ideation Questionnaire Jr (SIQ-JR). Analyses were conducted using Pearson correlations, as well as univariate and multivariate regression. Results indicated that our sample experienced sleep disturbances and SI to a greater degree than non-clinical samples. Sleep quality was correlated with nightmares, while sleep quality and nightmares were each correlated with SI. Sleep quality, dysfunctional beliefs, and nightmares each independently predicted SI. Our study was the first to use the four sleep measures with an adolescent psychiatric inpatient sample. It is important to develop sleep-related assessment tools in high-risk populations given the link between sleep disturbances and suicidality. Furthermore, a better understanding of the relationships between SI and sleep quality, sleep-related cognitions, and nightmares is needed to develop potential prevention and treatment options for suicidality in adolescents. PMID:24356389

  3. Psychiatric side effects of acute high-dose corticosteroid therapy in neurological conditions.

    PubMed

    Lotan, Itay; Fireman, Liora; Benninger, Felix; Weizman, Abraham; Steiner, Israel

    2016-07-01

    It has been implied that high-dose corticosteroids (CSs) commonly cause psychiatric side effects. Here, we examined the rate and risk factors of psychiatric side effects during high-dose CS treatment in patients with neurological disorders. Patients treated with high-dose intravenous CSs for neurological disorders were evaluated for depression, mania, and psychosis using the Beck Depression Inventory, the Geriatric Depression Scale, the Young Mania Rating Scale, and the Brief Psychiatric Rating Scale before CS treatment, immediately after, and 1 month following treatment. Forty-nine consecutive patients were monitored. There was a reduction in the Beck Depression Inventory and Geriatric Depression Scale scores as well as in the Brief Psychiatric Rating Scale scores throughout the study period and a transitory increase in the Young Mania Rating Scale score immediately after CS administration. Thus, a tendency to develop transient mild euphoria during high-dose CS treatment exists, but is reversible at 1 month, whereas a reduction in depressive symptoms tended to persist. Overall, our data indicate that high-dose CS treatment for neurological diseases is relatively safe with respect to psychiatric complications. PMID:26938038

  4. Challenges in Obtaining HIV Testing in an Acute Involuntary Inpatient Psychiatric Setting.

    PubMed

    Weller, Jennifer; Levitt, Gwen; Myers, Robert; Riley, Aaron; Gesmundo, Celsius-Kit

    2016-01-01

    Even in health care professions, a stigma remains for patients with co-occurring HIV and serious mental illness. Researchers at a large, urban medical center encountered this stigma when they attempted to initiate a study of cognition in psychiatric inpatients with and without HIV who were seen as vulnerable in the context of research. Education efforts and advocacy on the part of the research team was instrumental and resulted in system-wide changes in the hospital, including the addition of HIV testing to the psychiatric admission laboratory panel. Within the first year that routine laboratory orders included an HIV test, the rate of testing ordered by inpatient-attending psychiatrists reached 60% of admissions. As of 2014, 13 HIV tests were found to be HIV seropositive in inpatients, with four of those cases classified as new-onset, as opposed to two positive tests in the year prior to our study. PMID:27426407

  5. The Revolving Door Phenomenon in an Italian Acute Psychiatric Ward: A 5-Year Retrospective Analysis of the Potential Risk Factors.

    PubMed

    Di Lorenzo, Rosaria; Sagona, Marco; Landi, Giulia; Martire, Lisa; Piemonte, Chiara; Del Giovane, Cinzia

    2016-09-01

    To highlight the revolving door (RD) phenomenon in an acute psychiatric ward, we retrospectively identified the patients hospitalized three or more times in a calendar year from 1/1/2009 to 31/12/2013 as RD patients (RDP). We collected sociodemographic and clinical variables of RDP and statistically analyzed the potential RD risk factors. We divided RDP into "high" and "extremely high" utilizers and evaluated the variables related to more frequent readmissions. RDP represented 5.68% of all patients and their hospitalizations (RDH) 25% of all admissions. The statistically significant risk factors for all RDH were "disability pension," "substance abuse/dependence," "mild/severe aggressiveness," and "psychiatric and social rehabilitative programs". The comparison between "high" and "extremely high" utilizers showed that "manic episodes" and "personality disorders," among the diagnoses, "familial relational conflicts" and "violence/suicidality", among the hospitalization reasons, were statistically significant risk factors for more frequent readmissions. RD phenomenon was greatly affected by severe clinical conditions with social disability. PMID:27227558

  6. Psychiatric emergencies (part I): psychiatric disorders causing organic symptoms.

    PubMed

    Testa, A; Giannuzzi, R; Sollazzo, F; Petrongolo, L; Bernardini, L; Daini, S

    2013-02-01

    Psychiatric emergencies are conditions that mostly destabilize the already frenetic activity of the Emergency Department. Sometimes the emergency is clearly referable to primitive psychiatric illness. Other times, psychiatric and organic symptoms can independently coexist (comorbidity), or develop together in different conditions of substance abuse, including alcohol and prescription drugs. Differentiating between substance induced and pre-existing psychiatric disorder (dual diagnosis) may be difficult, other than controversial issue. Finally, an organic disease can hide behind a psychiatric disorder (pseudopsychiatric emergency). In this review (part I), psychiatric disorders that occur with organic symptoms are discussed. They include: (1) anxiety, conversion and psychosomatic disorders, and (2) simulated diseases. The physiologic mechanisms of the stress reaction, divided into a dual neuro-hormonal response, are reviewed in this section: (1) activation of the sympathetic nervous system and adrenal medulla with catecholamine production (rapid response), and (2) activation of the hypothalamic-pituitary-adrenal axis with cortisol production (slow response). The concept of the fight-or-flight response, its adaptive significance and the potential evolution in paralyzing response, well showing by Yerkes-Dodson curve, is explained. Abnormal short- and long-term reactions to stress evolving toward well codified cluster of trauma and stressor-related disorders, including acute stress disorder, adjustment disorder and post-traumatic stress disorder, are examined. A brief review of major psychiatric disorder and related behaviour abnormalities, vegetative symptoms and cognitive impairment, according to DMS IV-TR classification, are described. Finally, the reactive psychic symptoms and behavioral responses to acute or chronic organic disease, so called "somatopsychic disorders", commonly occurring in elderly and pediatric patients, are presented. The specific conditions of

  7. A replication study of the City nurse intervention: reducing conflict and containment on three acute psychiatric wards.

    PubMed

    Bowers, L; Flood, C; Brennan, G; Allan, T

    2008-11-01

    Conflict and containment on acute inpatient psychiatric wards pose a threat to patient and staff safety, and it is desirable to minimize the frequency of these events. Research has indicated that certain staff attitudes and behaviours might serve to accomplish this, namely, positive appreciation, emotional regulation and effective structure. A previous test of an intervention based on these principles, on two wards, showed a good outcome. In this study, we tested the same intervention on three further wards. Two 'City nurses' were employed to work with three acute wards, assisting with the implementation of changes according to the working model of conflict and containment generation. Evaluation was via before-and-after measures, with parallel data collected from five control wards. While simple before-and-after analysis of the two experimental wards showed significant reductions in conflict and containment, when a comparison with controls was conducted, with control for patient occupancy and clustering of results by ward, no effect of the intervention was found. The results were therefore ambiguous, and neither confirm nor contradict the efficacy of the intervention. A further intervention study may need to be conducted with a larger sample size to achieve adequate statistical power. PMID:18844799

  8. Clinical profile and outcomes of women admitted to a psychiatric mother-baby unit.

    PubMed

    Christl, Bettina; Reilly, Nicole; Yin, Carolyn; Austin, Marie-Paule

    2015-12-01

    This study examines the clinical profile of women admitted to a psychiatric mother-baby unit as well as change in their clinical, parenting, attachment and quality of life outcomes. Data was collected from 191 mothers through self-report measures at admission and discharge. Change was analysed in terms of Edinburgh Postnatal Depression Scale (EPDS) score, parenting confidence, maternal attachment to the infant and overall functioning. Psychosocial factors impacting on symptom severity and recovery were examined. Most women (64.8 %) were admitted in the first 3 months after birth with an ICD-10 unipolar depressive episode (52.3 %) or anxiety disorder (25.7 %), and 47.6 % had comorbid diagnoses. Improvement from admission to discharge was seen with large effect sizes (≥one standard deviation, i.e. μ) in terms of clinical symptoms (EPDS, μ = 1.7), parenting confidence (Karitane Parenting Confidence Scale (KPCS), μ = 1.1) and attachment to their infant (Maternal Postpartum Attachment Scale (MPAS), μ = 0.9) as well as overall level of functioning (SF-14, μ = 1.9). The majority (73.3 %) recovered symptomatically, and this was associated with increasing maternal age (odds ratio (OR) = 1.129, p = 0.002) and lower levels of psychosocial risk at admission (OR = 0.963, p = 0.008). Improvement in parenting confidence was associated with increasing maternal age (OR = 1.17, p = 0.003). No predictive factors were found for improvement in maternal attachment after controlling for admission scores. In the short term, joint admission of mothers with their infants is highly beneficial in terms of clinical, functional and parenting outcomes, but follow up studies are needed to assess the longer term benefits for mother-infant dyads. The use of an observational tool to enhance our assessment of maternal-infant interaction and some measure of maternal emotional dysregulation-both important mediators of development of secure infant

  9. Non-Psychiatric Services Provided in a Mental Health Unit in a County Jail.

    ERIC Educational Resources Information Center

    Young, Diane S.

    2002-01-01

    Examines mental health service provision by social workers in a county jail through a retrospective review of 359 mentally ill jail inmates' health and mental health records. Of the non-psychiatric, mental health services provided beyond initial assessment, housing placement evaluations and follow-up sessions were the most frequent. Suggestions…

  10. Program Learning: Dealing with Common Problems in the Residential Child and Adolescent Psychiatric Unit.

    ERIC Educational Resources Information Center

    Safian-Rush, Donna

    This manual is a programed learning tool for mental health professionals which teaches child and adolescent patient management skills to be used in a residential psychiatric care setting. The introduction to the paper describes the basic differences between adult and child psychiatry; behaviors that are abnormal for adults, such as having…

  11. Geriatric rehabilitation on an acute-care medical unit.

    PubMed

    Jackson, M F

    1984-09-01

    This study examined a geriatric rehabilitation pilot project on an acute-care medical unit. Over a 6-week period, using a 35-item geriatric rating scale and a mental assessment tool, changes in behaviours of 23 patients admitted to the geriatric rehabilitation module were compared to changes in behaviours of 10 elderly patients on a regular medical unit. The patients' demographic characteristics, their nursing and medical diagnoses, and discharge patterns were reviewed. Significant changes in behaviours of patients on the rehabilitation model included: increased ability to care for themselves, to maintain balance, and to communicate with others; decreased restlessness at night; decreased confusion; decreased incidence of incontinence; and improved social skills. The paper describes the geriatric rehabilitation programme and discusses implications for nursing of elderly patients in acute-care hospitals. PMID:6567647

  12. The effects of Snoezelen (multi-sensory behavior therapy) and psychiatric care on agitation, apathy, and activities of daily living in dementia patients on a short term geriatric psychiatric inpatient unit.

    PubMed

    Staal, Jason A; Sacks, Amanda; Matheis, Robert; Collier, Lesley; Calia, Tina; Hanif, Henry; Kofman, Eugene S

    2007-01-01

    A randomized, controlled, single-blinded, between group study of 24 participants with moderate to severe dementia was conducted on a geriatric psychiatric unit. All participants received pharmacological therapy, occupational therapy, structured hospital environment, and were randomized to receive multi sensory behavior therapy (MSBT) or a structured activity session. Greater independence in activities of daily living (ADLs) was observed for the group treated with MSBT and standard psychiatric inpatient care on the Katz Index of Activities of Daily Living (KI-ADL; P = 0.05) than standard psychiatric inpatient care alone. The combination treatment of MSBT and standard psychiatric care also reduced agitation and apathy greater than standard psychiatric inpatient care alone as measured with the Pittsburgh Agitation Scale and the Scale for the Assessment of Negative Symptoms in Alzheimer's Disease (P = 0.05). Multiple regression analysis predicted that within the multi-sensory group, activities of daily living (KI-ADL) increased as apathy and agitation reduced (R2 = 0.42; p = 0.03). These data suggest that utilizing MSBT with standard psychiatric inpatient care may reduce apathy and agitation and additionally improve activities of daily living in hospitalized people with moderate to severe dementia more than standard care alone. PMID:18441625

  13. Analyzing staffing trade-offs on acute care hospital units.

    PubMed

    Berkow, Steven; Vonderhaar, Kate; Stewart, Jennifer; Virkstis, Katherine; Terry, Anne

    2014-10-01

    Given today's resource-limited environment, nurse leaders must make judicious staffing decisions to deliver safe, cost-effective care. Investing in 1 element of staffing often requires scaling back in another. A national cross section of acute care hospital unit leaders was surveyed regarding staffing resources, including nurse workload, education, specialty certification, experience, and level of support staff. The authors report findings from the survey and discuss the trade-offs observed among units regarding nurse-to-patient ratios and the proportion of baccalaureate-prepared nurses. PMID:25208268

  14. Talking therapy groups on acute psychiatric wards: patients' experience of two structured group formats

    PubMed Central

    Radcliffe, Jonathan; Bird, Laura

    2016-01-01

    Aims and method We report the results of a clinical audit of patients' reactions to two types of talking therapy groups facilitated by assistant psychologists and psychology graduates on three acute wards. Patients' experiences of problem-solving and interpersonal group formats were explored via focus groups and structured interviews with 29 group participants. Results Both group formats generated high satisfaction ratings, with benefits related mostly to generic factors. Clinical implications Adequately trained and supported assistant psychologists and psychology graduates can provide supportive talking groups that patients find helpful. PMID:27512586

  15. Talking therapy groups on acute psychiatric wards: patients' experience of two structured group formats.

    PubMed

    Radcliffe, Jonathan; Bird, Laura

    2016-08-01

    Aims and method We report the results of a clinical audit of patients' reactions to two types of talking therapy groups facilitated by assistant psychologists and psychology graduates on three acute wards. Patients' experiences of problem-solving and interpersonal group formats were explored via focus groups and structured interviews with 29 group participants. Results Both group formats generated high satisfaction ratings, with benefits related mostly to generic factors. Clinical implications Adequately trained and supported assistant psychologists and psychology graduates can provide supportive talking groups that patients find helpful. PMID:27512586

  16. Bridging Psychiatric and Anthropological Approaches: The Case of “Nerves” in the United States

    PubMed Central

    Dahlberg, Britt; Barg, Frances K.; Gallo, Joseph J.; Wittink, Marsha N.

    2010-01-01

    Psychiatrists and anthropologists have taken distinct analytic approaches when confronted with differences between emic and etic models for distress: psychiatrists have translated folk models into diagnostic categories whereas anthropologists have emphasized culture-specific meanings of illness. The rift between psychiatric and anthropological research keeps “individual disease” and “culture” disconnected and thus hinders the study of interrelationships between mental health and culture. In this article we bridge psychiatric and anthropological approaches by using cultural models to explore the experience of nerves among 27 older primary care patients from Baltimore, Maryland. We suggest that cultural models of distress arise in response to personal experiences, and in turn, shape those experiences. Shifting research from a focus on comparing content of emic and etic concepts, to examining how these social realities and concepts are coconstructed, may resolve epistemological and ontological debates surrounding differences between emic and etic concepts, and improve understanding of the interrelationships between culture and health. PMID:20428332

  17. Acute Gastroenteritis on Cruise Ships - United States, 2008-2014.

    PubMed

    Freeland, Amy L; Vaughan, George H; Banerjee, Shailendra N

    2016-01-01

    From 1990 to 2004, the reported rates of diarrheal disease (three or more loose stools or a greater than normal frequency in a 24-hour period) on cruise ships decreased 2.4%, from 29.2 cases per 100,000 travel days to 28.5 cases (1,2). Increased rates of acute gastroenteritis illness (diarrhea or vomiting that is associated with loose stools, bloody stools, abdominal cramps, headache, muscle aches, or fever) occurred in years that novel strains of norovirus, the most common etiologic agent in cruise ship outbreaks, emerged (3). To determine recent rates of acute gastroenteritis on cruise ships, CDC analyzed combined data for the period 2008-2014 that were submitted by cruise ships sailing in U.S. jurisdiction (defined as passenger vessels carrying ≥13 passengers and within 15 days of arriving in the United States) (4). CDC also reviewed laboratory data to ascertain the causes of acute gastroenteritis outbreaks and examined trends over time. During the study period, the rates of acute gastroenteritis per 100,000 travel days decreased among passengers from 27.2 cases in 2008 to 22.3 in 2014. Rates for crew members remained essentially unchanged (21.3 cases in 2008 and 21.6 in 2014). However, the rate of acute gastroenteritis was significantly higher in 2012 than in 2011 or 2013 for both passengers and crew members, likely related to the emergence of a novel strain of norovirus, GII.4 Sydney (5). During 2008-2014, a total of 133 cruise ship acute gastroenteritis outbreaks were reported, 95 (71%) of which had specimens available for testing. Among these, 92 (97%) were caused by norovirus, and among 80 norovirus specimens for which a genotype was identified, 59 (73.8%) were GII.4 strains. Cruise ship travelers experiencing diarrhea or vomiting should report to the ship medical center promptly so that symptoms can be assessed, proper treatment provided, and control measures implemented. PMID:26766396

  18. Demographics of acute admissions to a National Spinal Injuries Unit

    PubMed Central

    Boran, S.; Street, J.; Higgins, T.; McCormack, D.; Poynton, A. R.

    2009-01-01

    This prospective demographic study was undertaken to review the epidemiology and demographics of all acute admissions to the National Spinal Injuries Unit in Ireland for the 5 years to 2003. The study was conducted at the National Spinal Injuries Unit, Mater Miscericordiae University Hospital, Dublin, Ireland. Records of all patients admitted to our unit from 1999 to 2003 were compiled from a prospective computerized spinal database. In this 5-year period, 942 patients were acutely hospitalized at the National Spinal Injuries Unit. There were 686 (73%) males and 256 (27%) females, with an average age of 32 years (range 16–84 years). The leading cause of admission with a spinal injury was road traffic accidents (42%), followed by falls (35%), sport (11%), neoplasia (7.5%) and miscellaneous (4.5%). The cervical spine was most commonly affected (51%), followed by lumbar (28%) and thoracic (21%). On admission 38% of patients were ASIA D or worse, of which one-third were AISA A. Understanding of the demographics of spinal column injuries in unique populations can help us to develop preventative and treatment strategies at both national and international levels. PMID:19283414

  19. Computerized patient information system in a psychiatric unit: five-year experience.

    PubMed

    Modai, I; Valevski, A

    1993-10-01

    A computerized psychiatric clinical application based on CLICKS program was developed, consisting of a network of 34 personal computers, run by Novell Netware version 3.11. It includes all clinical records and covers most of the administrative needs of the department; it may be used also in the outpatient clinics. Implementation of the system followed the stages of planning, record structuring, record programming, practice and operation. The system is favorably accepted by the patients, has several important advantages over pencil and paper record keeping, and although it is slightly more time-consuming, it improves record quality and departmental efficiency. PMID:8113635

  20. Psychiatric, neurological, and psychoeducational characteristics of 15 death row inmates in the United States.

    PubMed

    Lewis, D O; Pincus, J H; Feldman, M; Jackson, L; Bard, B

    1986-07-01

    The authors present the results of clinical evaluations of 15 death row inmates, chosen for examination because of the imminence of their executions and not for evidence of neuropsychopathology. All had histories of severe head injury, five had major neurological impairment, and seven others had other, less serious neurological problems (e.g., blackouts, soft signs). Psychoeducational testing provided further evidence of CNS dysfunction. Six subjects had schizophreniform psychoses antedating incarceration and two others were manic-depressive. The authors conclude that many condemned individuals probably suffer unrecognized severe psychiatric, neurological, and cognitive disorders relevant to considerations of mitigation. PMID:3717422

  1. Five-year review of absconding in three acute psychiatric inpatient wards in Australia.

    PubMed

    Gerace, Adam; Oster, Candice; Mosel, Krista; O'Kane, Deb; Ash, David; Muir-Cochrane, Eimear

    2015-02-01

    Absconding, where patients under an involuntary mental health order leave hospital without permission, can result in patient harm and emotional and professional implications for nursing staff. However, Australian data to drive nursing interventions remain sparse. The purpose of this retrospective study was to investigate absconding in three acute care wards from January 2006 to June 2010, in order to determine absconding rates, compare patients who did and did not abscond, and to examine incidents. The absconding rate was 17.22 incidents per 100 involuntary admissions (12.09% of patients), with no significant change over time. Being male, young, diagnosed with a schizophrenia or substance-use disorder, and having a longer hospital stay were predictive of absconding. Aboriginal and Torres Strait Islander patients had higher odds of absconding than Caucasian Australians. Over 25% of absconding patients did so multiple times. Patients absconded early in admission. More incidents occurred earlier in the year, during summer and autumn, and later in the week, and few incidents occurred early in the morning. Almost 60% of incidents lasted ≤24 hours. Formulation of prospective interventions considering population demographic factors and person-specific concerns are required for evidence-based nursing management of the risks of absconding and effective incident handling when they do occur. PMID:25444670

  2. Pragmatism rules: the intervention and prevention strategies used by psychiatric nurses working with non-suicidal self-harming individuals.

    PubMed

    O'Donovan, A

    2007-02-01

    Self harm in the absence of expressed suicidal intent is an under explored area in psychiatric nursing research. This paper reports on findings of a study undertaken in two acute psychiatric inpatient units in Ireland. The purpose of the study was to gain an understanding of the practices of psychiatric nurses in relation to people who self harm, but who are not considered suicidal. Semi structured interviews were held with eight psychiatric nurses. Content analysis revealed several themes. For the purpose of this paper the prevention and intervention strategies psychiatric nurses engage in when working with non-suicidal self harming individuals are presented. Recommendations for further research are offered. PMID:17244007

  3. United States Department of Justice findings letters in psychiatric hospital CRIPA cases: an aid or a distraction?

    PubMed

    Geller, Jeffrey; Lee, Leilani

    2013-01-01

    The Civil Rights of Institutionalized Persons Act (CRIPA) of 1980 allows the United States Department of Justice (DOJ) to investigate and file lawsuits against certain institutions, including state and county psychiatric hospitals, where individuals within may face unconstitutional conditions. Subsequent to an investigation and before negotiations or litigation, the state is provided a Findings Letter generated by the DOJ that generally contains recommended remedial measures. It has never been determined to what extent a Findings Letter provides a state with a recommendation specific to the institution for corrective action before the state enters into negotiations with the DOJ. Three study groups were derived from a sample of 15 Findings Letters written to states concerning their psychiatric hospitals between 2003 and 2009. The individual recommended remedial measures, labeled texts of interest (TOI), were identified, and the degree of overlap among the Findings Letters was determined. To a surprising degree, TOIs overlapped to various extents, from exact copies of text to paraphrased versions, in Findings Letters written between 2003 and 2009 to different states and for multiple state hospitals in the same state. The recommended remedial measures provided in the DOJ's Findings Letters are not specific to each state hospital's deficiencies. The Findings Letters offer limited guidance to the state on how to remedy the deficiencies before negotiating with the DOJ. This lack of specificity causes inefficient and delayed remediation of unconstitutional conditions and other deficiencies in care and treatment in psychiatric hospitals. While the current process most often leads to improvements in state hospitals, it is a costly, inefficient remedy, despite the possibility of alternative remedial processes of less expensive and equal or greater effectiveness. PMID:23771930

  4. Health care professionals implementing a smoke-free policy at inpatient psychiatric units.

    PubMed

    Grant, Lyle G; Oliffe, John L; Johnson, Joy L; Bottorff, Joan L

    2014-12-01

    Smoke-free grounds policies (SFGPs) were introduced to inpatient psychiatric hospital settings to improve health among patients, staff, and visitors. We conducted an ethnographic study in Northern British Columbia, Canada, to describe how the implementation of SFGPs is affected by institutional cultures. Data reported here included participant observation, document review, informal discussions (n = 11), and interviews with health care professionals (HCPs; n = 19) and staff (n = 2) at two hospitals. We used iterative and inductive processes to derive thematic findings. Findings related to HCPs illustrate how local contexts and cultural factors affect SFGP implementation. These factors included individual beliefs and attitudes, the influence of group norms, leadership and consensus building, and locale-specific norms. Strong, consultative leadership, in which leaders solicited input from and long-term support of people most directly responsible for policy implementation, was key to success. PMID:25216860

  5. [Tertiary syphilis diagnosed in a psychiatric unit in Buenos Aires, XXI century].

    PubMed

    Cestaro, Omar A; Calicchio, Ada D; Loidl, Fabián; Presas, Lina

    2012-01-01

    It is a common belief that syphilis, since its effective treatment, is eradicated. However, because of failure prevention and control it is still present. Therefore, we describe what happened in our service with a young patient who was admitted with a presumptive diagnosis of delusional syndrome with a history of multiple symptoms and signs that led him to wander around different specialties in many hospitals. Semiology led us to think of neurosyphilis which was confirmed by laboratory tests on blood and cerebrospinal fluid. Due was then applied in addition to psychiatric treatment for syphilis, but despite this, the patient had a torpid evolution given the lateness of his picture. In this paper we wish to make a warning to doctors about the need to consider when framing neurosyphilis differential diagnosis and thus avoid the progression of the disease. PMID:23979549

  6. Dissociative identity disorder among adolescents: prevalence in a university psychiatric outpatient unit.

    PubMed

    Sar, Vedat; Onder, Canan; Kilincaslan, Ayse; Zoroglu, Süleyman S; Alyanak, Behiye

    2014-01-01

    The aim of this study was to determine the prevalence of dissociative identity disorder (DID) and other dissociative disorders among adolescent psychiatric outpatients. A total of 116 consecutive outpatients between 11 and 17 years of age who were admitted to the child and adolescent psychiatry clinic of a university hospital for the 1st time were evaluated using the Adolescent Dissociative Experiences Scale, adolescent version of the Child Symptom Inventory-4, Childhood Trauma Questionnaire, and McMaster Family Assessment Device. All patients were invited for an interview with the Structured Clinical Interview for DSM-IV Dissociative Disorders (SCID-D) administered by 2 senior psychiatrists in a blind fashion. There was excellent interrater reliability between the 2 clinicians on SCID-D diagnoses and scores. Among 73 participants, 33 (45.2%) had a dissociative disorder: 12 (16.4%) had DID, and 21 (28.8%) had dissociative disorder not otherwise specified. There was no difference in gender distribution, childhood trauma, or family dysfunction scores between the dissociative and nondissociative groups. Childhood emotional abuse and family dysfunction correlated with self-reported dissociation. Of the dissociative adolescents, 93.9% had an additional psychiatric disorder. Among them, only separation anxiety disorder was significantly more prevalent than in controls. Although originally designed for adults, the SCID-D is promising for diagnosing dissociative disorders in adolescents, its modest congruence with self-rated dissociation and lack of relationship between diagnosis and childhood trauma and family dysfunction suggest that the prevalence rates obtained with this instrument originally designed for adults must be replicated. The introduction of diagnostic criteria for adolescent DID in revised versions of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, would refine the assessment of dissociative disorders in this age group. PMID

  7. A randomized trial of a mental health consumer-managed alternative to civil commitment for acute psychiatric crisis.

    PubMed

    Greenfield, Thomas K; Stoneking, Beth C; Humphreys, Keith; Sundby, Evan; Bond, Jason

    2008-09-01

    This experiment compared the effectiveness of an unlocked, mental health consumer-managed, crisis residential program (CRP) to a locked, inpatient psychiatric facility (LIPF) for adults civilly committed for severe psychiatric problems. Following screening and informed consent, participants (n = 393) were randomized to the CRP or the LIPF and interviewed at baseline and at 30-day, 6-month, and 1-year post admission. Outcomes were costs, level of functioning, psychiatric symptoms, self-esteem, enrichment, and service satisfaction. Treatment outcomes were compared using hierarchical linear models. Participants in the CRP experienced significantly greater improvement on interviewer-rated and self-reported psychopathology than did participants in the LIPF condition; service satisfaction was dramatically higher in the CRP condition. CRP-style facilities are a viable alternative to psychiatric hospitalization for many individuals facing civil commitment. PMID:18626766

  8. A Historical Overview of Psychiatric/Mental Health Nursing Education in the United Kingdom: Going around in Circles or on the Straight and Narrow?

    ERIC Educational Resources Information Center

    Cutcliffe, John

    2003-01-01

    Addresses historical issues in psychiatric/mental health nursing in the United Kingdom including attempts to integrate it with general nursing, the balance of theory/research and practice, and tensions over the recent shift to university-level nurse preparation. Discusses needs for the future. (Contains 42 references and commentary by Sheri…

  9. Simple Measures of Hopelessness and Impulsivity are Associated with Acute Suicidal Ideation and Attempts in Patients in Psychiatric Crisis

    PubMed Central

    Williamson, David J.; May, Roberta S.; Bruer, Emily H.; Sheehan, David V.; Alphs, Larry D.

    2014-01-01

    Objective: To explore the authors’ predictions 1) that hopelessness would positively correlate with suicidal ideation and that impulsivity (either transient urges to self-harm or impulsive acting out) would positively correlate with suicidal behavior, and 2) that the recent or long-standing nature of the traits will have corresponding effects on reported histories of suicidal ideation and behavior. Design: Questionnaire validation trial in which each subject received every measure in counterbalanced fashion. Setting: Inpatient and outpatient psychiatric settings associated with a medium-sized medical school in the southeastern United States. Participants: Forty-five subjects presenting with varying levels of suicidal ideation and behavior completed measures providing information about their histories of suicidal ideation and behavior, recent feelings of hopelessness, feelings of general hopelessness, recent feelings of difficulty controlling urges to self-harm, and feeling about general levels of impulsivity. Measurements: The InterSePT Scale for Suicidal Thinking–Plus, the Sheehan-Suicidality Tracking Scale, the Columbia–Suicide Severity Rating Scale, and six additional questions to assess hopelessness and impulsivity. Results: Recent and trait hopelessness correlated positively with suicidal ideation. Patients who reported any suicide attempt endorsed higher levels of general impulsivity than those who did not report a history of at least one suicide attempt. Those enrolled in the study secondary to a very recent suicide attempt reported more difficulties with recent suicidal impulses. Conclusion: Simple measures of hopelessness and impulsivity are associated with suicidal ideation and attempts and may add to determination of suicide risk. PMID:25520888

  10. 'She's manipulative and he's right off': a critical analysis of psychiatric nurses' oral and written language in the acute inpatient setting.

    PubMed

    Hamilton, Bridget; Manias, Elizabeth

    2006-06-01

    Remarks such as 'she's manipulative' and 'he's right off' are familiar to psychiatric nurses. This paper critiques the language nurses use in acute inpatient psychiatry services, highlighting the diverse discourses implicated in nurses' writing and speaking about patients. Based on a review of the literature, this paper examines ethnographic studies and discourse analyses of psychiatric nurses' oral and written language. A prominent debate in the literature surrounds nurses' use of standardized language, which is the use of set terms for symptoms and nursing activities. This review of spoken descriptions of patients highlights nurses' use of informal and local descriptions, incorporating elements of moral judgement, common sense language and empathy. Research into written accounts in patient files and records show nurses' use of objectifying language, the dominance of medicine and the emergence of the language of bureaucracy in health services. Challenges to the language of psychiatry and psychiatric nursing arise from fields as diverse as bioscience, humanism and social theory. Authors who focus on the relationship between language, power and the discipline of nursing disagree in regard to their analysis of particular language as a constructive exercise of power by nurses. Thus, particular language is in some instances endorsed and in other instances censured, by nurses in research and practice. In this paper, a Foucauldian analysis provides further critique of taken-for-granted practices of speech and writing. Rather than censoring language, we recommend that nurses, researchers and educators attend to nurses' everyday language and explore what it produces for nurses, patients and society. PMID:16643343

  11. Hospital Mortality in the United States following Acute Kidney Injury

    PubMed Central

    Rezaee, Michael E.; Marshall, Emily J.; Matheny, Michael E.

    2016-01-01

    Acute kidney injury (AKI) is a common reason for hospital admission and complication of many inpatient procedures. The temporal incidence of AKI and the association of AKI admissions with in-hospital mortality are a growing problem in the world today. In this review, we discuss the epidemiology of AKI and its association with in-hospital mortality in the United States. AKI has been growing at a rate of 14% per year since 2001. However, the in-hospital mortality associated with AKI has been on the decline starting with 21.9% in 2001 to 9.1 in 2011, even though the number of AKI-related in-hospital deaths increased almost twofold from 147,943 to 285,768 deaths. We discuss the importance of the 71% reduction in AKI-related mortality among hospitalized patients in the United States and draw on the discussion of whether or not this is a phenomenon of hospital billing (coding) or improvements to the management of AKI. PMID:27376083

  12. Comparison of assessment and management of suicidal risk for acute psychiatric assessment between two state sponsored hospitals in England and Italy.

    PubMed

    Singh, Ranbir; Verdolini, Norma; Agius, Mark; Moretti, Patrizia; Quartesan, Roberto

    2015-09-01

    The risk of suicide is one of the most important risk factors looked into for acute psychiatric assessments that influences the management plan. The prevalence of suicide is on a rise across European countries; as a consequence, the different countries have created specific guidelines and policies in order to prevent suicides in the acute settings. These guidelines are based on both different cultural aspects as well as the different organization of the mental health system in the different countries. This paper wants to present the comparison between the guidelines of two European countries, England and Italy, in order to evaluate the systems, understand differences and common contact points. The different European countries could learn one from the other and a European shared point of view may be a way forward to create better understanding and preventing the risk of suicide across the population. PMID:26417782

  13. Clay and Anxiety Reduction: A One-Group, Pretest/Posttest Design with Patients on a Psychiatric Unit

    ERIC Educational Resources Information Center

    Kimport, Elizabeth R.; Hartzell, Elizabeth

    2015-01-01

    Little research exists on using clay as an anxiety-reducing intervention with patients in psychiatric hospitals. This article reports on a study that used a one-group, pretest/posttest design with 49 adults in a psychiatric facility who created a clay pinch pot. The State-Trait Anxiety Inventory (STAI) was used as a pre- and posttest measure.…

  14. Improving Sepsis Management in the Acute Admissions Unit

    PubMed Central

    Adcroft, Laura

    2014-01-01

    Sepsis is a common condition with a major impact on healthcare resources and expenditure. We therefore wanted to investigate and improve how the acute admission unit (AAU) at the Great Western Hospital (GWH) is managing patients who present directly to the unit with sepsis. In order to obtain this information, an audit was undertaken against the College of Emergency Medicine standards used by the emergency department within GWH and across the UK. Data was retrospectively collected for 30 patients with a diagnosis of severe sepsis or septic shock. The notes were scrutinized with regard to the implementation of College of Emergency Medicine standards for the management of sepsis. This meant that performance in the AAU was compared against the emergency department at GWH and national figures. The data collected shows performance is below national standards with regard to documentation of high flow oxygen use (AAU: 24%, ED 100%; national median: 50%; CEM standard 95%), crystalloid fluid boluses (AAU: 52%; ED: 90%; national median: 83%; CEM standard 100%), lactate measurements (AAU: 66%, ED: 93%; national median: 80%; CEM standard 95%), and obtainment of blood cultures (AAU: 52%; ED 73%; national median: 77%; CEM standard: 95%). Only 3% of patients received all six parts of the sepsis bundle. Since auditing in 2012/2013 we have introduced a sepsis proforma based on a current proforma being used within Severn Deanery. This proforma uses the ‘Sepsis Six’ bundle appropriate to ward based care. We have raised awareness of sepsis implications and management through the creation of a ‘sepsis working group’ to educate both junior doctors and nurses. In turn, this has led to education through the use of posters, pocket reference cards, and teaching sessions. Re-audit shows significant improvement in administering all parts of the Sepsis Six bundle and an 8% improvement in patients receiving all six of the bundle. PMID:26734269

  15. The periodicities in and biometeorological relationships with bed occupancy of an acute psychiatric ward in Antwerp, Belgium

    NASA Astrophysics Data System (ADS)

    Maes, M.; de Meyer, F.; Peeters, D.; Meltzer, H.; Schotte, C.; Scharpe, S.; Cosyns, P.

    1993-06-01

    Recently, some investigators have established a seasonal pattern in normal human psychology, physiology and behaviour, and in the incidence of psychiatric psychopathology. In an attempt to elucidate the chronopsy and meteotropism in the latter, we have examined the chronograms of, and the biometeorological relationships to bed occupancy of the psychiatric ward of the Antwerp University Hospital during three consecutive calendar years (1987 1989). Weather data for the vicinity were provided by a local meteorological station and comprise mean atmospheric pressure, air temperature, relative humidity, wind speed and minutes of sunlight and precipitation/day. The number of psychiatric beds occupied during the study period exhibited a significant seasonal variation. Peaks in bed occupancy were observed in March and November, with lows in August. An important part of the variability in the number of beds occupied could be explained by the composite effects of weather variables of the preceding weeks. Our results suggest that short-term fluctuations in atmospheric activity may dictate some of the periodicities in psychiatric psychopathology.

  16. Childhood maltreatment among Hispanic women in the United States: an examination of subgroup differences and impact on psychiatric disorder.

    PubMed

    Warner, Lynn A; Alegría, Margarita; Canino, Glorisa

    2012-05-01

    Prevalence rates of childhood maltreatment among Hispanic women in the United States are presented separately for nativity status and ethnic origin subgroups, and the associations between different types of maltreatment and the development of anxiety and depressive disorders are examined. Analyses used self-report data from 1,427 Hispanic women who participated in the National Latino and Asian American Survey. Foreign-born Hispanic women compared to U.S.-born Hispanic women reported significantly lower rates of sexual assault and witnessing interpersonal violence, and a significantly higher rate of being beaten. Ethnic subgroups reported similar rates of maltreatment, with the exception of rape. Bivariate analyses were remarkably consistent in that regardless of nativity status or ethnic subgroup, each type of maltreatment experience increased the risk of psychiatric disorder. In multivariate models controlling for all types of victimization and proxies of acculturation, having been beaten and witnessing interpersonal violence remained significant predictors of both disorders, but sexual abuse increased risk of anxiety only. A significant interaction effect of family cultural conflict and witnessing violence on anxiety provided very limited support for the hypothesis that acculturation moderates the influence of maltreatment on mental health outcomes. Implications for culturally relevant prevention and intervention approaches are presented. PMID:22548893

  17. The Psychosocial Characteristics Associated with NSSI and Suicide Attempt of Youth Admitted to an In-patient Psychiatric Unit

    PubMed Central

    Preyde, Michèle; Vanderkooy, John; Chevalier, Pat; Heintzman, John; Warne, Amanda; Barrick, Kendra

    2014-01-01

    Introduction: The purpose of this study was to explore the prevalence of self-harm and the psychosocial factors associated with self-harming behaviours in youth admitted to an in-patient psychiatric unit. Methods: Cross-sectional surveys of standardized measures were administered to youth and a separate survey to their caregivers while the youth were in hospital. Results: The mean age of the 123 youth who participated was 15.74 (SD 1.51) years, and 90 of 121 (74.38%) reported being female. Of the 115 who completed this question, 101 (87.83%) indicated that they thought of injuring themselves and 89 (77.39%) did engage in NSSI within the past month, and 78 of 116 (67%) reported that they had made an attempt to take their life. Youth who reported that they had attempted suicide (lifetime) reported significantly less difficulty with emotion regulation than youth who engaged in NSSI only, or both NSSI and suicide attempts. Conclusions: These youth reported a very high prevalence of self-harm, and in general substantial difficulty with regulating their emotions, and difficulty with their interpersonal relationships. The psychosocial distinctions evident between groups may have practical utility. PMID:24872825

  18. Differences in Psychopathology Between Immigrant and Native Adolescents Admitted to a Psychiatric Inpatient Unit.

    PubMed

    Blázquez, Ana; Castro-Fornieles, Josefina; Baeza, Inmaculada; Morer, Astrid; Martínez, Esteban; Lázaro, Luisa

    2015-12-01

    It has been postulated that immigrant children are at increased risk of mental health problems. This study examined differences in psychopathology between immigrant and non-immigrant adolescents admitted for the first time to a child and adolescent inpatient psychiatry unit. Participants were 234 adolescents (191 non-immigrants and 43 immigrants). There were significant differences between the two groups in relation to certain stressors: parental separation, family breakdown, being under state custody, physical and/or psychological maltreatment and sexual abuse. Differences between the main diagnoses of the two groups were found in relation to schizophrenia and anorexia nervosa. There are differences between immigrants and natives in terms of diagnosis, and these differences are influenced by ethnicity and stressors. Future studies should seek to identify protective factors in order to prevent mental health disorders in the immigrant population. PMID:25476167

  19. Improving access to competitive employment for service users in forensic psychiatric units

    PubMed Central

    Beck, Charlotte; Wernham, Connie

    2014-01-01

    Employment has been proven to be an effective recovery tool and therapeutic intervention for those with severe and enduring mental health conditions. Aside from monetary reward, employment is a means of structuring time and provides a sense of worth and achievement, which enhances self-esteem and confidence. A social identity is developed through employment, encouraging social support and increasing social networks. Securing employment can bring about improved quality of life and positive change in one's social circumstances; therefore it can reduce symptoms associated with mental illness and potentially prevent re-offending, as the individual develops a sense of independence, self-efficacy, and value. Barriers to employment exist for forensic mental health service users and therefore it is imperative that employment needs are addressed at the earliest possible stage in recovery. An evaluation of employment activities across two forensic mental health units revealed a lack of appropriate employment opportunities for service users, and those roles available were not implemented in line with recommended best practice. In response to this issue several enterprises were established to offer opportunities for service users to engage in meaningful employment and develop skills that a future employer would value. Each enterprise responds to a business need within the units to ensure sustainability of services. The enterprises are essentially micro-businesses with social objectives whose surpluses are reinvested for the purpose of increasing opportunities for service users. The enterprises are underpinned by the philosophy of the Individual Placement and Support (IPS) model; empirical evidence suggests that the IPS model is the most effective intervention, based on the ‘place then train’ philosophy. The model recommends a focus upon rapid job search to achieve competitive employment for those who want to work; opportunities sourced should be consistent with individual

  20. Improving access to competitive employment for service users in forensic psychiatric units.

    PubMed

    Beck, Charlotte; Wernham, Connie

    2014-01-01

    Employment has been proven to be an effective recovery tool and therapeutic intervention for those with severe and enduring mental health conditions. Aside from monetary reward, employment is a means of structuring time and provides a sense of worth and achievement, which enhances self-esteem and confidence. A social identity is developed through employment, encouraging social support and increasing social networks. Securing employment can bring about improved quality of life and positive change in one's social circumstances; therefore it can reduce symptoms associated with mental illness and potentially prevent re-offending, as the individual develops a sense of independence, self-efficacy, and value. Barriers to employment exist for forensic mental health service users and therefore it is imperative that employment needs are addressed at the earliest possible stage in recovery. An evaluation of employment activities across two forensic mental health units revealed a lack of appropriate employment opportunities for service users, and those roles available were not implemented in line with recommended best practice. In response to this issue several enterprises were established to offer opportunities for service users to engage in meaningful employment and develop skills that a future employer would value. Each enterprise responds to a business need within the units to ensure sustainability of services. The enterprises are essentially micro-businesses with social objectives whose surpluses are reinvested for the purpose of increasing opportunities for service users. The enterprises are underpinned by the philosophy of the Individual Placement and Support (IPS) model; empirical evidence suggests that the IPS model is the most effective intervention, based on the 'place then train' philosophy. The model recommends a focus upon rapid job search to achieve competitive employment for those who want to work; opportunities sourced should be consistent with individual

  1. Prescribing patterns and the use of therapeutic drug monitoring of psychotropic medication in a psychiatric high-security unit.

    PubMed

    Castberg, Ingrid; Spigset, Olav

    2008-10-01

    The aim of this study was to investigate the use of psychotropic medication and therapeutic drug monitoring in a high-security psychiatric unit and to compare the doses and serum concentrations both with the recommended intervals and with the doses and serum concentrations in a control group. One hundred thirty-two patients were admitted in the period from January 2000 to December 2005. All available samples were used when comparing serum concentrations and doses with the recommended ranges. For the comparison of doses and serum concentration-to-dose (C:D) ratios with the control group only 1 sample from each patient was used. A total of 459 analyses of 27 different drugs in samples from 8 women and 73 men were included. The median number of therapeutic drug monitoring analyses per patient was 4 (range 1-29). Thirty-seven of the 81 patients (46%) used 2 or more antipsychotics at the same time. Clozapine, lamotrigine, olanzapine, quetiapine, ziprasidone, and zuclopenthixol were often given in doses above the recommended. The serum levels were frequently above those recommended for clozapine, olanzapine, quetiapine, risperidone, ziprasidone, and zuclopenthixol. The serum levels were significantly higher in the study group than in the control group for clozapine, lamotrigine, quetiapine, and zuclopenthixol. The given dose was significantly higher in the study group than in the control group for clozapine, lamotrigine and zuclopenthixol. The C:D ratio was significantly lower in the study group than in the control group for olanzapine but higher for quetiapine. The non-evidence based practice of high-dose polypharmacy with several antipsychotics is widely used in this unit. The use of higher doses in the study group than in the control group was not due to differences in metabolism or adherence to treatment between the 2 groups. The frequent use of therapeutic drug monitoring did not seem to have a great impact on the prescribed doses. PMID:18708990

  2. Impact of the Creation and Implementation of a Clinical Management Guideline for Personality Disorders in Reducing Use of Mechanical Restraints in a Psychiatric Inpatient Unit

    PubMed Central

    Fernandez-Rivas, Aranzazu; Bustamante, Sonia; Rico-Vilademoros, Fernando; Vivanco, Esther; Martinez, Karmele; Angel Vecino, Miguel; Martín, Melba; Herrera, Sonia; Rodriguez, Jorge; Saenz, Carlos

    2014-01-01

    Objective: To evaluate the impact of the implementation of a guideline for the management of personality disorders on reducing the frequency of use of mechanical restraints in a psychiatric inpatient unit. Method: This retrospective study was conducted in a psychiatric inpatient unit with 42 beds, which serves an urban area of 330,000 inhabitants. The sample consisted of all patients with a clinical diagnosis of personality disorder (DSM-IV-TR criteria) who were admitted to the unit from January 2010 to December 2010 and from January 2011 to December 2011 (ie, before and after, respectively, the implementation of the guideline). The guideline focused on cluster B disorders and follows a psychodynamic perspective. Results: Restraint use was reduced from 38 of 87 patients with personality disorders (43.7%) to 3 of 112 (2.7%), for a relative risk of 0.06 (95% CI, 0.02–0.19) and an absolute risk reduction of 41% (95% CI, 29.9%–51.6%). The risk of being discharged against medical advice increased after the intervention, with a relative risk of 1.84 (95% CI, 0.96–3.51). Restraint use in patients with other diagnoses was also reduced to a similar extent. Conclusions: The use of mechanical restraints was dramatically reduced after the implementation of a clinical practice guideline on personality disorders, suggesting that these coercive measures might be decreased in psychiatric inpatient units. PMID:25834763

  3. Seasonality of Admissions for Mania: Results From a General Hospital Psychiatric Unit in Pondicherry, India

    PubMed Central

    Sarkar, Siddharth

    2015-01-01

    Introduction: Bipolar disorder is affected by variables that modulate circadian rhythm, including seasonal variations. There is evidence of a seasonal pattern of admissions of mania in various geographical settings, though its timing varies by region and climate. Variables such as age and gender have been shown to affect seasonality in some studies. Methodology: Data on monthly admission patterns for mania at a general hospital psychiatry unit in Pondicherry, India, were collected for 4 years (2010–2013) and analyzed for seasonality and seasonal peaks. The effects of age and gender were analyzed separately. Results: There was overall evidence of a seasonal pattern of admissions for mania (P < .01, Friedman test for seasonality), with a peak beginning during the rainy season and ending before summer (P < .0.1, Ratchet circular scan test). Male sex (P < .005, Ratchet circular scan test) and age > 25 years (P < .005, Ratchet circular scan test) were specifically associated with this seasonal peak. Discussion: The effect of seasons on mania is complex and is modulated by a variety of variables. Our study is consistent with earlier research findings: a greater degree of seasonality for mania in men. It is possible that climatic and individual variables interact to determine seasonal patterns in bipolar disorder in a given setting. PMID:26644962

  4. Exploring the Needs for Support of Pediatric Nurses Caring for Children with a Mental Health Disorder Hospitalized in Non-Psychiatric Units.

    PubMed

    Vallières-Noël, Marie-Michelle; Garçon, Schnell; Rosmus, Christina; Goulnik, Francoise; Lavoie-Tremblay, Mélanie

    2016-04-01

    This qualitative study explored the experience and the needs for support of pediatric nurses caring for children with a mental health disorder hospitalized in non-psychiatric units in a health organization in Canada. Semi-structured interviews were conducted with 17 nurses. Content analysis revealed two main themes: (a) nurses are challenged by the lack of knowledge, the gap between access to mental health resources and the basic role of only ensuring safety. Amidst these barriers, nurses revealed their feelings of helplessness, frustration and injustice. (b) All participants voiced their willingness to break this powerlessness loop. They identified several strategies to support them: more training in mental health, better collaboration with the mental health team, etc. Further research is needed to evaluate the efficiency of these strategies to improve the delivery of care for children with a mental health disorder hospitalized in non-psychiatric units. PMID:26992867

  5. Co-occurring alcohol, drug, and other psychiatric disorders among Mexican-origin people in the United States.

    PubMed

    Vega, William A; Sribney, William M; Achara-Abrahams, Ijeoma

    2003-07-01

    We examined co-occurrence of (comorbid) alcohol, drug, and non-substance use psychiatric disorders in a population sample of Mexican-origin adults from rural and urban areas of central California. Co-occurring lifetime rates of alcohol or other drug disorders with non-substance use psychiatric disorders, or both, were 8.3% for men and 5.5% for women and were 12.3% for the US born and 3.5% for immigrants. Alcohol abuse or dependence with co-occurring psychiatric disorders is a primary disorder among Mexican-origin adult males (7.5% lifetime prevalence). US-born men and women are almost equally likely to have co-occurring disorders involving substances. Cobormidity is expected to increase in the Mexican-origin population owing to acculturation effects of both sexes. PMID:12835179

  6. Acute Pain Medicine in the United States: A Status Report

    PubMed Central

    Tighe, Patrick; Buckenmaier, Chester C.; Boezaart, Andre P.; Carr, Daniel B.; Clark, Laura L.; Herring, Andrew A.; Kent, Michael; Mackey, Sean; Mariano, Edward R.; Polomano, Rosemary C.; Reisfield, Gary M.

    2015-01-01

    Background Consensus indicates that a comprehensive, multimodal, holistic approach is foundational to the practice of acute pain medicine (APM), but lack of uniform, evidence-based clinical pathways leads to undesirable variability throughout U. S. healthcare systems. Acute pain studies are inconsistently synthesized to guide educational programs. Advanced practice techniques involving regional anesthesia assume the presence of a physician-led, multidisciplinary acute pain service, which is often unavailable or inconsistently applied. This heterogeneity of educational and organizational standards may result in unnecessary patient pain and escalation of healthcare costs. Methods A multidisciplinary panel was nominated through the Acute Pain Medicine Shared Interest Group (APMSIG) of the American Academy of Pain Medicine (AAPM). The panel met in Chicago, Illinois, in July 2014, to identify gaps and set priorities in APM research and education. Results The panel identified 3 areas of critical need: 1) an open-source acute pain data registry and clinical support tool to inform clinical decision making and resource allocation and to enhance research efforts; 2) a strong professional APM identity as an accredited subspecialty; and 3) educational goals targeted toward third-party payers, hospital administrators, and other key stakeholders to convey the importance of APM. Conclusion This report is the first step in a 3-year initiative aimed at creating conditions and incentives for the optimal provision of APM services to facilitate and enhance the quality of patient recovery after surgery, illness, or trauma. The ultimate goal is to reduce the conversion of acute pain to the debilitating disease of chronic pain. PMID:26535424

  7. Reflective Prompts to Guide Termination of the Psychiatric Clinical Student Nursing Experience.

    PubMed

    Hubbard, Grace B

    2016-04-01

    The average length of stay on psychiatric inpatient units has decreased in the past 40 years from 24.9 to 7.2 days. Inpatient psychiatric nurses are challenged to meet the standards and scope of practice despite the changing circumstances of their work environment. The amount of time student nurses spend with a given patient has been affected by changes in acute psychiatric inpatient care and decreased length of stay; however, opportunities exist for effective termination of the nurse-client relationship. Facilitation of students' awareness and understanding of the dynamics inherent in the termination process is an important teaching task for psychiatric nursing clinical instructors. In the current article, a clinically focused learning activity using structured prompts to guide and promote psychiatric nursing students' experiences with the process of termination is described and teaching strategies are discussed. [Journal of Psychosocial Nursing and Mental Health Services, 54(4), 38-43.]. PMID:27042927

  8. Child Rearing Practices and Their Relationship to Psychiatric Disturbances. Unit for Child Studies Selected Papers Number 4.

    ERIC Educational Resources Information Center

    Rickarby, Geoff

    Theories furthering understanding of the effects of child rearing practices on psychiatric disturbance are briefly reviewed. Particular attention is given to family dynamics, the double-bind hypothesis, and the development of schizophrenia and related border line syndromes that lead to psychotic phenomena. The issue of child rearing practices is…

  9. A new model for quality improvement in acute inpatient psychiatry: observational data from an acute assessment unit

    PubMed Central

    Hayes, Joseph; Gibbons, Rachel; Outim, Faizal; Tang, Sylvia; Chakraborty, Apu

    2012-01-01

    Objectives There is little research into the constituents of effective psychiatric inpatient care. The aim of this study was to assess the effectiveness of a newly adopted model of inpatient care; the acute assessment ward. Design Review of data collected over a year-long period. Setting Acute assessment ward in North London. Participants All Admissions between 8 October 2009 and 7 October 2010. Main outcome measures Duration of stay, need for readmission, patient satisfaction and frequency of conflict behaviours. Results A total of 485 admissions over the yearlong study period. The median stay to discharge from the assessment ward was 6 days, whereas in those transferred it was 19 days. Readmission within 28 days following discharge from the assessment ward was 13.9%, whereas those discharged from other wards was 9.2% (P = 0.1). Patient satisfaction was no lower, for all domains, than for other wards in the trust. Frequency of conflict behaviour was equal to previous studies,1 but self harm was significantly less common (P = 0.01). Conclusions Our data show that focusing on the ‘point of entry’ to inpatient services means that some admission times can be reduced without an increase in 28-day readmission rates or conflict behaviours. The acute assessment model attempts to address the need for the NHS to deliver more for less, whilst remaining focused on service-user and staff satisfaction. Research into which areas of this complex intervention are effective is challenging, but we would urge others who run services with novel structures to publish data about their functioning. PMID:23323205

  10. Psychiatric Patients Experiences with Mechanical Restraints: An Interview Study

    PubMed Central

    Lanthén, Klas; Rask, Mikael; Sunnqvist, Charlotta

    2015-01-01

    Objective. To examine psychiatric patients' experience of mechanical restraints and to describe the care the patients received. Background. All around the world, threats and violence perpetrated by patients in psychiatric emergency inpatient units are quite common and are a prevalent factor concerning the application of mechanical restraints, although psychiatric patients' experiences of mechanical restraints are still moderately unknown. Method. A qualitative design with an inductive approach were used, based on interviews with patients who once been in restraints. Results. This study resulted in an overbridging theme: Physical Presence, Instruction and Composed Behaviour Can Reduce Discontent and Trauma, including five categories. These findings implicated the following: information must be given in a calm and sensitive way, staff must be physically present during the whole procedure, and debriefing after the incident must be conducted. Conclusions. When mechanical restraints were unavoidable, the presence of committed staff during mechanical restraint was important, demonstrating the significance of training acute psychiatric nurses correctly so that their presence is meaningful. Nurses in acute psychiatric settings should be required to be genuinely committed, aware of their actions, and fully present in coercive situations where patients are vulnerable. PMID:26199931

  11. Ethnographic research into nursing in acute adult mental health units: a review.

    PubMed

    Cleary, Michelle; Hunt, Glenn E; Horsfall, Jan; Deacon, Maureen

    2011-01-01

    Acute inpatient mental health units are busy and sometimes chaotic settings, with high bed occupancy rates. These settings include acutely unwell patients, busy staff, and a milieu characterised by unpredictable interactions and events. This paper is a report of a literature review conducted to identify, analyse, and synthesize ethnographic research in adult acute inpatient mental health units. Several electronic databases were searched using relevant keywords to identify studies published from 1990-present. Additional searches were conducted using reference lists. Ethnographic studies published in English were included if they investigated acute inpatient care in adult settings. Papers were excluded if the unit under study was not exclusively for patients in the acute phase of their mental illness, or where the original study was not fully ethnographic. Ten research studies meeting our criteria were found (21 papers). Findings were grouped into the following overarching categories: (1) Micro-skills; (2) Collectivity; (3) Pragmatism; and (4) Reframing of nursing activities. The results of this ethnographic review reveal the complexity, patient-orientation, and productivity of some nursing interventions that may not have been observed or understood without the use of this research method. Additional quality research should focus on redefining clinical priorities and philosophies to ensure everyday care is aligned constructively with the expectations of stakeholders and is consistent with policy and the realities of the organisational setting. We have more to learn from each other with regard to the effective nursing care of inpatients who are acutely disturbed. PMID:21736465

  12. Attitudes of clinical staff toward the causes and management of aggression in acute old age psychiatry inpatient units

    PubMed Central

    2014-01-01

    Background In psychiatry, most of the focus on patient aggression has been in adolescent and adult inpatient settings. This behaviour is also common in elderly people with mental illness, but little research has been conducted into this problem in old age psychiatry settings. The attitudes of clinical staff toward aggression may affect the way they manage this behaviour. The purpose of this study was to examine the attitudes of clinical staff toward the causes and management of aggression in acute old age psychiatry inpatient settings. Methods A convenience sample of clinical staff were recruited from three locked acute old age psychiatry inpatient units in Melbourne, Australia. They completed the Management of Aggression and Violence Scale, which assessed the causes and managment of aggression in psychiatric settings. Results Eighty-five staff completed the questionnaire, comprising registered nurses (61.1%, n = 52), enrolled nurses (27.1%, n = 23) and medical and allied health staff (11.8%, n = 10). A range of causative factors contributed to aggression. The respondents had a tendency to disagree that factors directly related to the patient contributed to this behaviour. They agreed patients were aggressive because of the environment they were in, other people contributed to them becoming aggressive, and patients from certain cultural groups were prone to these behaviours. However, there were mixed views about whether patient aggression could be prevented, and this type of behaviour took place because staff did not listen to patients. There was agreement medication was a valuable approach for the management of aggression, negotiation could be used more effectively in such challenging behaviour, and seclusion and physical restraint were sometimes used more than necessary. However, there was disagreement about whether the practice of secluding patients should be discontinued. Conclusions Aggression in acute old age psychiatry inpatient units occurs

  13. A "facilitated" model of inpatient psychiatric care.

    PubMed

    Olden, K W; Johnson, M P

    1993-09-01

    The authors describe a model for an effective partnership between a large health maintenance organization and a fee-for-service acute inpatient psychiatric unit. They present data from five years of experience with the model on a unit serving a catchment area of one million plan members. The model, which is based on "facilitated" care rather than managed care, emphasizes crisis intervention and a strong medical orientation. The HMO contracted with seven psychiatrists to provide treatment and helped develop a value system shared by the physicians and hospital staff. A clinician represented the HMO on the unit and played a key decision-making role in patient care. A total of 4,945 patients were admitted over five years. Costs per admission were reduced 47 percent during this period; the readmission rate was 16.9 percent. Implementation of the model resulted in the delivery of high-quality cost-effective care. PMID:8225303

  14. Genetic analysis of Israel Acute Paralysis Virus: distinct clusters are circulating into the United States.

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Israel acute paralysis virus (IAPV) is associated with colony collapse disorder of honey bees. Nonetheless, its role in the pathogenesis of the disorder and its geographic distribution are unclear. Here, we report phylogenetic analysis of IAPV obtained from bees in the United States, Canada, Austral...

  15. Psychiatric disorders impacting critical illness.

    PubMed

    Struble, Laura M; Sullivan, Barbara J; Hartman, Laurie S

    2014-03-01

    An astounding 30% to 50% of older patients who are hospitalized for a medical condition also have a psychiatric disorder. The intent of this article is to prepare acute care nurses to meet the mental health needs of older adults with a critical illness and prevent untoward sequelae of medical events. The authors discuss the importance of baseline assessment data, issues related to informed consent, manifestations of common psychiatric disorders that may be seen in older adults in the acute care setting, as well as strategies to improve patient outcomes. PMID:24484928

  16. How Patients and Nurses Experience an Open Versus an Enclosed Nursing Station on an Inpatient Psychiatric Unit.

    PubMed

    Shattell, Mona; Bartlett, Robin; Beres, Kyle; Southard, Kelly; Bell, Claire; Judge, Christine A; Duke, Patricia

    2015-01-01

    The inpatient environment is a critical space for nurses and patients in psychiatric settings. In this article, we describe nurses' and patients' perceptions of the inpatient environment both before the removal of a Plexiglas enclosure around a nurses' station and after its removal. Nurses had mixed feelings about the enclosure, reporting that it provided for confidentiality and a concentrated work space but also acknowledged the challenge of the barrier for communication with their patients. Patients unanimously preferred the nurses' station without the barrier, reporting increased feelings of freedom, safety, and connection with the nurses after its removal. It is important to consider the implications of environmental decisions in inpatient settings in order to promote a healthy workplace and healing environment for all community members. PMID:26597907

  17. Patient Factors Associated with Extended Length of Stay in the Psychiatric Inpatient Units of a Large Urban County Hospital.

    PubMed

    Cheng, Jason E; Shumway, Martha; Leary, Mark; Mangurian, Christina V

    2016-08-01

    This case-control study identified patient-specific factors associated with the longest psychiatric inpatient lengths of stay (LOS) at a large urban county hospital. Subjects with LOS ≥ 60 days comprised the extended LOS (ELOS) case cohort. An equally-sized control cohort consisted of a random sample of inpatients with LOS ≤ 30 days. Chi square tests and t tests were conducted to determine differences between groups. Factors associated with ELOS included older age, cognitive impairment, higher number of medical conditions requiring medication, and violence during hospital stay. Initiatives focused on community placement of patients with these characteristics may reduce prolonged LOS at safety-net hospitals. PMID:26883829

  18. Geographic Access to High Capability Severe Acute Respiratory Failure Centers in the United States

    PubMed Central

    Wallace, David J.; Angus, Derek C.; Seymour, Christopher W.; Yealy, Donald M.; Carr, Brendan G.; Kurland, Kristen; Boujoukos, Arthur; Kahn, Jeremy M.

    2014-01-01

    Objective Optimal care of adults with severe acute respiratory failure requires specific resources and expertise. We sought to measure geographic access to these centers in the United States. Design Cross-sectional analysis of geographic access to high capability severe acute respiratory failure centers in the United States. We defined high capability centers using two criteria: (1) provision of adult extracorporeal membrane oxygenation (ECMO), based on either 2008–2013 Extracorporeal Life Support Organization reporting or provision of ECMO to 2010 Medicare beneficiaries; or (2) high annual hospital mechanical ventilation volume, based 2010 Medicare claims. Setting Nonfederal acute care hospitals in the United States. Measurements and Main Results We defined geographic access as the percentage of the state, region and national population with either direct or hospital-transferred access within one or two hours by air or ground transport. Of 4,822 acute care hospitals, 148 hospitals met our ECMO criteria and 447 hospitals met our mechanical ventilation criteria. Geographic access varied substantially across states and regions in the United States, depending on center criteria. Without interhospital transfer, an estimated 58.5% of the national adult population had geographic access to hospitals performing ECMO and 79.0% had geographic access to hospitals performing a high annual volume of mechanical ventilation. With interhospital transfer and under ideal circumstances, an estimated 96.4% of the national adult population had geographic access to hospitals performing ECMO and 98.6% had geographic access to hospitals performing a high annual volume of mechanical ventilation. However, this degree of geographic access required substantial interhospital transfer of patients, including up to two hours by air. Conclusions Geographic access to high capability severe acute respiratory failure centers varies widely across states and regions in the United States. Adequate

  19. Use of Inpatient Psychiatric Services by Children and Youth under Age 18, United States, 1980. Mental Health Statistical Note No. 175.

    ERIC Educational Resources Information Center

    Milazzo-Sayre, Laura J.; And Others

    The report examines data from three sample surveys of admissions during 1980 to the inpatient psychiatric services of state and mental hospitals and private psychiatric hospitals and the separate inpatient psychiatric services of non-federal general hospitals. Findings revealed that an estimated 81,532 persons under 18 years were admitted to…

  20. [Psychiatric rehabilitation].

    PubMed

    Dusek, K

    1990-04-01

    The author presents a brief account of the development of psychiatric rehabilitation during the past two centuries. He draws attention to new trends in rehabilitation of the mentally sick during the post-war period and at present. He describes the system of rehabilitation in the Soviet Union which began to develop as a results of efforts in the Bekhterev Institute in Leningrad. In our country the law on social security in 1964 created conditions for protected workshop and protected work places. In 1973 methodical instructions of the Ministry of Labour and Social Affairs issued instructions which specified the principles of planning, establishment and operation of these facilities. At the end of 1986 the Ministry of Health CSR issued an amendment to the concept of psychiatry which contains the organization of psychiatric rehabilitation not only in in-patient but in particular in out-patient psychiatric facilities. PMID:2194684

  1. Educational Impact of a Psychiatric Liaison in the Medical Intensive Care Unit: Effects on Attitudes and Beliefs of Trainees and Nurses Regarding Delirium

    PubMed Central

    Chen, Donna T.; Huffman, Jeff C.

    2013-01-01

    Objective: Despite high rates and increased risk of mortality, delirium remains underdiagnosed and a minimal focus of formal medical education. This is the first study to examine the educational impact of a psychiatric liaison on beliefs and knowledge about delirium among both nurses and residents. Method: One psychiatrist spent 9 months rounding weekly in the medical intensive care unit, interacting with critical care nurses and internal medicine residents. Preintervention and postintervention surveys were distributed in July 2009 and June 2010, respectively, to staff (critical care nurses: n = 23 and n = 25, respectively; internal medicine residents: n = 31 and n = 23, respectively) and a comparison group (psychiatry residents: n = 29 and n = 23, respectively). Participants responded to 12 statements regarding delirium on a 5-point Likert scale. Results: There were no statistically significant differences between the presurveys and postsurveys for any item when examining all respondents together, as well as psychiatry and internal medicine residents as individual groups. Critical care nurses showed a significant change between surveys for the statements, “Patients with new-onset anxiety or depression in the intensive care unit most commonly have delirium” (17.4% agree presurvey vs 56.0% agree postsurvey, χ2 = 7.62, P = .006) and “Delirium is diagnosed less often than it actually occurs” (100% agree presurvey vs 80% agree postsurvey, χ2 = 5.13, P = .023). Conclusions: Though introduction of a psychiatric liaison was very well received by clinical staff, we did not meaningfully affect the attitudes and beliefs of trainees and nurses regarding delirium. Robust and lasting changes in attitudes regarding delirium may require more intensive efforts involving longer intervention periods, greater rounding frequency, or additional didactic teaching. PMID:24171148

  2. Training in Psychiatric Genomics during Residency: A New Challenge

    ERIC Educational Resources Information Center

    Winner, Joel G.; Goebert, Deborah; Matsu, Courtenay; Mrazek, David A.

    2010-01-01

    Objective: The authors ascertained the amount of training in psychiatric genomics that is provided in North American psychiatric residency programs. Methods: A sample of 217 chief residents in psychiatric residency programs in the United States and Canada were identified by e-mail and surveyed to assess their training in psychiatric genetics and…

  3. The evolution of an acute care hospital unit to a DRG-exempt rehabilitation unit. A preliminary communication.

    PubMed

    Parfenchuck, T A; Parziale, J R; Liberman, J R; Butcher, R P; Ahern, D K

    1990-02-01

    The Health Care Financing Administration's decision to adopt a prospective based payment system has caused many institutions to implement new policies and practices. A recent area of interest for many hospitals has been the creation of diagnosis-related group (DRG) exempt units to maximize reimbursement practices. We analyzed changes which occurred when an eight bed acute care stroke unit (SU) was converted to a DRG exempt eight bed rehabilitation unit (RU). The time period involved was 1 1/2 months before and 1 1/2 months after the transition occurred. Analysis of data from the pre- and posttransition periods revealed that: (1) length of stay increased significantly from 11.7 to 15.3 days (P less than 0.001); (2) functional independence measure (FIM) score improvement was significantly greater (P less than 0.05) for RU patients (0.84/day) than for SU patients (0.39/day); (3) disposition to home v other facilities increased significantly from 50 to 81% (P less than 0.05); (4) the overall occupancy increased from 94 to 100% and all beds were filled with rehabilitation patients; (5) the proportion of patients with Medicare as their primary insurer was comparable before (64%) and after (67%) unit conversion; (6) gross income from rehabilitation patients increased by 43%. Indirect savings via reduction of acute hospital length of stay for Medicare patients increased total income from operation of this unit. We conclude that patients on the RU stayed longer, had greater daily improvements in functional status, and were more likely to be discharged to home. This appears to be due to a more efficient use of rehabilitation beds and a concomitant overall improvement in reimbursement to the hospital.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:2105736

  4. Acute two-photon imaging of the neurovascular unit in the cortex of active mice

    PubMed Central

    Tran, Cam Ha T.; Gordon, Grant R.

    2015-01-01

    In vivo two-photon scanning fluorescence imaging is a powerful technique to observe physiological processes from the millimeter to the micron scale in the intact animal. In neuroscience research, a common approach is to install an acute cranial window and head bar to explore neocortical function under anesthesia before inflammation peaks from the surgery. However, there are few detailed acute protocols for head-restrained and fully awake animal imaging of the neurovascular unit during activity. This is because acutely performed awake experiments are typically untenable when the animal is naïve to the imaging apparatus. Here we detail a method that achieves acute, deep-tissue two-photon imaging of neocortical astrocytes and microvasculature in behaving mice. A week prior to experimentation, implantation of the head bar alone allows mice to train for head-immobilization on an easy-to-learn air-supported ball treadmill. Following just two brief familiarization sessions to the treadmill on separate days, an acute cranial window can subsequently be installed for immediate imaging. We demonstrate how running and whisking data can be captured simultaneously with two-photon fluorescence signals with acceptable movement artifacts during active motion. We also show possible applications of this technique by (1) monitoring dynamic changes to microvascular diameter and red blood cells in response to vibrissa sensory stimulation, (2) examining responses of the cerebral microcirculation to the systemic delivery of pharmacological agents using a tail artery cannula during awake imaging, and (3) measuring Ca2+ signals from synthetic and genetically encoded Ca2+ indicators in astrocytes. This method will facilitate acute two-photon fluorescence imaging in awake, active mice and help link cellular events within the neurovascular unit to behavior. PMID:25698926

  5. [Inpatient Dialectical Behavioral Therapy for Adolescents (DBT-A) - 10 years of experience on the psychiatric inpatient unit "wellenreiter"].

    PubMed

    von Auer, Anne Kristin; Kleindienst, Nikolaus; Ludewig, Sonia; Soyka, Oliver; Bohus, Martin; Ludäscher, Petra

    2015-09-01

    In April 2004 the inpatient unit "Wellenreiter" at the Vorwerker Clinic for Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy in Lubeck (Germany) opened its doors. Despite reservations by the therapeutic community, we implemented a specialized treatment for female adolescents with symptoms of borderline personality disorder - the I;>ialectical Behavior Therapy for Adolescents (DBT-A). In this article we present the concept, our experiences, and data from the past 10 years of clinical work in this specialized unit. PMID:26373383

  6. Psychiatric emergencies.

    PubMed

    Cavanaugh, S V

    1986-09-01

    Psychiatric disorders are common in medical inpatient and outpatient populations. As a result, internists commonly are the first to see psychiatric emergencies. As with all medical problems, a good history, including a collateral history from relatives and friends, physical and mental status examination, and appropriate laboratory tests help establish a preliminary diagnosis and treatment plan. Patients with suicidal ideation usually have multiple stressors in the environment and/or a psychiatric disorder (i.e., a major affective disorder, dysthymic disorder, anxiety or panic disorder, psychotic disorder, alcohol or drug abuse, a personality disorder, and/or an adjustment disorder). Of all patients who commit suicide, 70% have a major depressive disorder, schizophrenia, psychotic organic mental disorder, alcoholism, drug abuse, and borderline personality disorder. Patients who are at great risk have minimal supports, a history of previous suicide attempts, a plan with high lethality, hopelessness, psychosis, paranoia, and/or command self-destructive hallucinations. Treatment is directed toward placing the patient in a protected environment and providing psychotropic medication and/or psychotherapy for the underlying psychiatric problem. Other psychiatric emergencies include psychotic and violent patients. Psychotic disorders fall into two categories etiologically: those that have an identifiable organic factor causing the psychosis and those that have an underlying psychiatric disorder. Initially, it is essential to rule out organic pathology that is life-threatening or could cause irreversible brain damage. After such organic causes are ruled out, neuroleptic medication is indicated. If the patient is not agitated or combative, he or she may be placed on oral divided doses of neuroleptics in the antipsychotic range. Patients who are agitated or psychotic need rapid tranquilization with an intramuscular neuroleptic every half hour to 1 hour until the agitation and

  7. Establishing an acute care nursing bed unit size: employing a decision matrix framework.

    PubMed

    Ritchey, Terry; Pati, Debajyoti

    2008-01-01

    Determining the number of patient rooms for an acute care (medical-surgical) patient unit is a challenge for both healthcare architects and hospital administrators when renovating or designing a new patient tower or wing. Discussions on unit bed size and its impact on hospital operations in healthcare design literature are isolated, and clearly there is opportunity for more extensive research. Finding the optimal solution for unit bed size involves many factors, including the dynamics of the site and existing structures. This opinion paper was developed using a "balanced scorecard" concept to provide decision makers a framework for assessing and choosing a customized solution during the early planning and conceptual design phases. The context of a healthcare balanced scorecard with the quadrants of quality, finance, provider outcomes, and patient outcomes is used to compare the impact of these variables on unit bed size. PMID:22973617

  8. Psychiatric wards: places of safety?

    PubMed

    Jones, J; Nolan, P; Bowers, L; Simpson, A; Whittington, R; Hackney, D; Bhui, K

    2010-03-01

    In recent years, the purpose and quality of provision delivered in acute inpatient psychiatric settings have been increasingly questioned. Studies from a service user perspective have reported that while some psychiatric inpatients feel safe and cared for, others feel their time in hospital is neither safe nor therapeutic. This paper explores the experiences of service users on acute inpatient psychiatric wards in England, with a particular focus on their feelings of safety and security. Interviews were conducted with 60 psychiatric inpatients in England. The majority of service users felt safe in hospital and felt supported by staff and other service users. However, anything that threatened their sense of security such as aggression, bullying, theft, racism and the use of alcohol and drugs on the ward, made some respondents feel insecure and unsafe. Psychiatric wards are still perceived by many as volatile environments, where service users feel forced to devise personal security strategies in order to protect themselves and their property. It would appear that there remains much to do before research findings and policies are implemented in ways that facilitate all service users to derive the maximum benefit from their inpatient experience. PMID:20465757

  9. Leadership-organizational culture relationship in nursing units of acute care hospitals.

    PubMed

    Casida, Jesus; Pinto-Zipp, Genevieve

    2008-01-01

    The phenomena of leadership and organizational culture (OC) has been defined as the driving forces in the success or failure of an organization. Today, nurse managers must demonstrate leadership behaviors or styles that are appropriate for the constantly changing, complex, and turbulent health care delivery system. In this study, researchers explored the relationship between nurse managers' leadership styles and OC of nursing units within an acute care hospital that had achieved excellent organizational performance as demonstrated by a consistent increase in patient satisfaction ratings. The data from this study support that transformational and transactional contingent reward leaderships as nurse manager leadership styles that are associated with nursing unit OC that have the ability to balance the dynamics of flexibility and stability within their nursing units and are essential for maintaining organizational effectiveness. It is essential for first-line nursing leaders to acquire knowledge and skills on organizational cultural competence. PMID:18389837

  10. Prolonged stays in hospital acute geriatric care units: identification and analysis of causes.

    PubMed

    Parent, Vivien; Ludwig-Béal, Stéphanie; Sordet-Guépet, Hélène; Popitéan, Laura; Camus, Agnès; Da Silva, Sofia; Lubrano, Anne; Laissus, Frederick; Vaillard, Laurence; Manckoundia, Patrick

    2016-06-01

    In France, the population of very old frail patients, who require appropriate high-quality care, is increasing. Given the current economic climate, the mean duration of hospitalization (MDH) needs to be optimized. This prospective study analyzed the causes of prolonged hospitalization in an acute geriatric care unit. Over 6 months, all patients admitted to the target acute geriatric care unit were included and distributed into two groups according to a threshold stay of 14 days: long MDH group (LMDHG) and short MDH group (SMDHG). These two groups were compared. 757 patients were included. The LMDHG comprised 442 with a mean age of 86.7 years, of whom 67.65% were women and the SMDHG comprised 315 with a mean age of 86.6 years, of whom 63.2% were women. The two groups were statistically similar for age, sex, living conditions at home (alone or not, help), medical history and number of drugs. Patients in the LMDHG were more dependent (p=0.005), and were more likely to be hospitalized for social reasons (p=0.024) and to have come from their homes (p=0.011) than those in the SMDHG. The reasons for the prolonged stay, more frequent in the LMDHG than the SMDHG (p<0.05), were principally: waiting for imaging examinations, medical complications, and waiting for discharge solutions, assistance from social workers and/or specialist consultations. In order to reduce the MDH in acute geriatric care unit, it is necessary to consider the particularities of the patients who are admitted, their medico-socio-psychological management, access to technical facilities/consultations and post-discharge accommodation. PMID:27277146

  11. The Evolving Role of the Acute Assessment Unit - from inpatient to outpatient care.

    PubMed

    Connolly, V; Hamad, M; Scott, Y; Bramble, M

    2005-01-01

    Acute Assessment Units (AAUs) have been developed to meet the demand for emergency care. Traditionally, AAUs have been an admission route to secondary care but the role is now evolving to assessment. AAUs are complex and have many interactions both in hospitals and the community. The effective functioning of an AAU requires excellent clinical leadership, appropriate facilities, timely access to diagnostics and input from the multi-disciplinary team. Increasingly, AAUs will have to develop services which are not dependent on using hospital beds. A variety of emergency medical presentations can, with the appropriate resources, be delivered in an out-patient setting. PMID:21655513

  12. Incidence and risk factors of workplace violence on psychiatric staff

    PubMed Central

    Ridenour, Marilyn; Lanza, Marilyn; Hendricks, Scott; Hartley, Dan; Rierdan, Jill; Zeiss, Robert; Amandus, Harlan

    2015-01-01

    BACKGROUND A study by Hesketh et al. found that 20% of psychiatric nurses were physically assaulted, 43% were threatened with physical assault, and 55% were verbally assaulted at least once during the equivalent of a single work week. From 2005 through 2009, the U.S. Department of Justice reported that mental health occupations had the second highest average annual rate of workplace violence, 21 violent crimes per 1,000 employed persons aged 16 or older. OBJECTIVE An evaluation of risk factors associated with patient aggression towards nursing staff at eight locked psychiatric units. PARTICIPANTS Two-hundred eighty-four nurses in eight acute locked psychiatric units of the Veterans Health Administration throughout the United States between September 2007 and September 2010. METHODS Rates were calculated by dividing the number of incidents by the total number of hours worked by all nurses, then multiplying by 40 (units of incidents per nurse per 40-hour work week). Risk factors associated with these rates were analyzed using generalized estimating equations with a Poisson model. RESULTS Combining the data across all hospitals and weeks, the overall rate was 0.60 for verbal aggression incidents and 0.19 for physical aggression, per nurse per week. For physical incidents, the evening shift (3 pm – 11 pm) demonstrated a significantly higher rate of aggression than the day shift (7 am – 3 pm). Weeks that had a case-mix with a higher percentage of patients with personality disorders were significantly associated with a higher risk of verbal and physical aggression. CONCLUSION Healthcare workers in psychiatric settings are at high risk for aggression from patients. PMID:24894691

  13. Clinical Frailty Scale in an Acute Medicine Unit: a Simple Tool That Predicts Length of Stay

    PubMed Central

    Juma, Salina; Taabazuing, Mary-Margaret; Montero-Odasso, Manuel

    2016-01-01

    Background Frailty is characterized by increased vulnerability to external stressors. When frail older adults are admitted to hospital, they are at increased risk of adverse events including falls, delirium, and disability. The Clinical Frailty Scale (CFS) is a practical and efficient tool for assessing frailty; however, its ability to predict outcomes has not been well studied within the acute medical service. Objective To examine the CFS in elderly patients admitted to the acute medical ward and its association with length of stay. Design Prospective cohort study in an acute care university hospital in London, Ontario, Canada, involving 75 patients over age 65, admitted to the general internal medicine clinical teaching units (CTU). Measurements Patient demographics were collected through chart review, and CFS score was assigned to each patient after brief clinician assessment. The CFS ranges from 1 (very fit) to 9 (terminally ill) based on descriptors and pictographs of activity and functional status. The CFS was collapsed into three categories: non-frail (CFS 1–4), mild-to-moderately frail (CFS 5–6), and severely frail (CFS 7–8). Outcomes of length of stay and 90-day readmission were gathered through the LHSC electronic patient record. Results Severe frailty was associated with longer lengths of stay (Mean = 12.6 ± 12.7 days) compared to mild-to-moderate frailty (mean = 11.2 ± 10.8 days), and non-frailty (mean = 4.1 ± 2.1 days, p = .014). This finding was significant after adjusting for age, sex, and number of medications. Participants with higher frailty scores showed higher readmission rates when compared with those with no frailty (31.2% for severely frail, vs. 34.2% for mild-to-moderately frail vs. 19% for non-frail) although there was no significant difference in the adjusted analysis. Conclusion The CFS helped identify patients that are more likely to have prolonged hospital stays on the acute medical ward. The CFS is an easy to use tool which

  14. Outcomes associated with nesiritide administration for acute decompensated heart failure in the emergency department observation unit: a single center experience.

    PubMed

    Styron, Joseph F; Jois-Bilowich, Preeti; Tallman, Thomas; Emerman, Charles; Starling, Randall C; Frank Peacock, W

    2009-01-01

    The authors' purpose was to determine 30- and 180-day readmission and mortality rates for acutely decompensated heart failure patients receiving nesiritide in the emergency department observation unit. The authors conducted a retrospective evaluation of all patients admitted to the emergency department observation unit, stratified by nesiritide administration, from January 2002 to January 2004. Eligible patients had a primary diagnosis of acutely decompensated heart failure. Observation unit treatment was by previously published protocols, except for nesiritide administration, which was per attending physician choice. Of 595 patients, 196 (33%) received nesiritide. The crude and adjusted odds ratios comparing readmission rates and mortality rates of the nesiritide group with the control group failed to demonstrate significant differences at either the 30- or the 180-day endpoints. The use of nesiritide for acute decompensated heart failure in the emergency department observation unit is not associated with mortality or readmission differences compared with standard therapy alone. PMID:19522957

  15. Diagnostic accuracy of acute vestibular syndrome at the bedside in a stroke unit.

    PubMed

    Chen, L; Lee, W; Chambers, B R; Dewey, H M

    2011-05-01

    Acute vestibular syndrome may be due to vestibular neuritis (VN) or posterior circulation strokes. Bedside ocular motor testing performed by experts is superior to early MRI in excluding strokes. We sought to demonstrate that differentiation of strokes from VN in our stroke unit is reliable. During a prospective study at a tertiary hospital over 1 year, patients with AVS were evaluated in the emergency department (ED) and underwent admission with targeted examination: gait, gaze-holding, horizontal head impulse test (hHIT), testing for skew deviation (SD) and vertical smooth pursuit (vSP). Neuroimaging included CT, transcranial Doppler (TCD) and MRI with MR angiogram (MRA). VN was diagnosed with normal diffusion-weighted images (DWI) and absence of neurological deficits on follow-up. Acute strokes were confirmed with DWI. A total of 24 patients with AVS were enrolled and divided in two groups. In the pure vestibular group (n = 20), all VN (n = 10/10) had positive hHIT and unidirectional nystagmus, but 1 patient had SD and abnormal vertical smooth pursuit (SP). In all the strokes (n = 10/10), one of the following signs suggestive of central lesion was present: negative hHIT, central-type nystagmus, SD or abnormal vSP. Finding one of these was 100% sensitive and 90% specific for stroke. In the cochleovestibular group (n = 4) all had normal DWI, but 3 patients had central ocular motor signs (abnormal vertical SP and SD). Whilst the study is small, classification of AVS in our stroke unit is reliable. The sensitivity and specificity of bedside ocular motor testing are comparable to those previously reported by expert neuro-otologists. Acute cochleovestibular loss and normal DWI may signify a labyrinthine infarct but differentiating between different causes of inner ear dysfunction is not possible with bedside testing. PMID:21153732

  16. Caregivers' perceptions of coercion in psychiatric hospital admission.

    PubMed

    Ranieri, Veronica; Madigan, Kevin; Roche, Eric; Bainbridge, Emma; McGuinness, David; Tierney, Kevin; Feeney, Larkin; Hallahan, Brian; McDonald, Colm; O'Donoghue, Brian

    2015-08-30

    While knowledge on service users' perspective on their admissions to psychiatric wards has improved substantially in the last decade, there is a paucity of knowledge of the perspectives of caregivers. This study aimed to determine caregiver's perception of the levels of perceived coercion, perceived pressures and procedural justice experienced by service users during their admission to acute psychiatric in-patient units. The perspective of caregivers were then compared to the perspectives of their related service users, who had been admitted to five psychiatric units in Ireland. Caregivers were interviewed using an adapted version of the MacArthur admission experience interview. Sixty-six caregivers participated in this study and the majority were parents. Seventy one percent of service users were admitted involuntarily and nearly half had a diagnosis of schizophrenia or schizoaffective disorder. Caregivers of involuntarily admitted individuals perceived the service users' admission as less coercive than reported by the service users. Caregivers also perceived a higher level of procedural justice in comparison to the level reported by service users. Reducing the disparity of perceptions between caregivers and service users could result in caregivers having a greater understanding of the admission process and why some service users may be reluctant to be admitted. PMID:26163727

  17. Working as a doctor when acutely ill: comments made by doctors responding to United Kingdom surveys

    PubMed Central

    Smith, Fay; Goldacre, Michael J

    2016-01-01

    Summary Objectives We undertook multi-purpose surveys of doctors who qualified in the United Kingdom between 1993 and 2012. Doctors were asked specific questions about their careers and were asked to comment about any aspect of their training or work. We report doctors’ comments about working whilst acutely ill. Design Self-completed questionnaire surveys. Setting United Kingdom. Participants Nine cohorts of doctors, comprising all United Kingdom medical qualifiers of 1993, 1996, 1999, 2000, 2002, 2005, 2008, 2009 and 2012. Main outcome measures Comments made by doctors about working when ill, in surveys one, five and 10 years after graduation. Results The response rate, overall, was 57.4% (38,613/67,224 doctors). Free-text comments were provided by 30.7% (11,859/38,613). Three-hundred and twenty one doctors (2.7% of those who wrote comments) wrote about working when feeling acutely ill. Working with Exhaustion/fatigue was the most frequent topic raised (195 doctors), followed by problems with Taking time off for illness (112), and general comments on Physical/mental health problems (66). Other topics raised included Support from others, Leaving or adapting/coping with the situation, Bullying, the Doctor’s ability to care for patients and Death/bereavement. Arrangements for cover due to illness were regarded as insufficient by some respondents; some wrote that doctors were expected to work harder and longer to cover for colleagues absent because of illness. Conclusions We recommend that employers ensure that it is not unduly difficult for doctors to take time off work when ill, and that employers review their strategies for covering ill doctors who are off work. PMID:27066264

  18. Work-Time Exposure and Acute Injuries in Inshore Lobstermen of the Northeast United States.

    PubMed

    Fulmer, Scott; Buchholz, Bryan; Jenkins, Paul; Scribani, Melissa

    2016-01-01

    The objective of this study was to inform efforts to reduce risk for musculoskeletal disorders among commercial lobstermen by characterizing and quantifying injuries that occur to people while harvesting lobsters commercially in the Northeast United States. This study aimed to estimate a denominator of exposure to lobstering in full-time equivalents (FTE), to estimate a fatality rate, and to calculate incidence rates for acute injuries within the sample population. Captains were randomly selected from those licensed to fish in Maine and Massachusetts. Data on work exposure and injuries with rapid onset that occurred on the boat ("acute injuries") were collected using a survey, which was administered quarterly via phone or face-to-face interview with the captain. The quarterly survey assessed the number of weeks worked during the quarter, average crew size, number of trips per week, and average trip length in hours. In addition, this survey captured relevant information (body segment affected, type of injury, and whether treatment was received) on all acute injuries occurring during the quarter. FTE were estimated using fishermen days and fishermen hours. The annual FTE estimated using days was 2,557 and using hours was 2,855. As expected, the summer months (3rd quarter) had the highest FTE and the winter (1st quarter) the lowest FTE. Fall (4th quarter) and spring (2nd quarter) ranked second and third, respectively. The incidence rates for all injuries (49.7/100 FTE) and injuries requiring treatment (15.0/100 FTE) were much higher than those reported in other studies of fishing that used Coast Guard data. PMID:26788780

  19. 1H NMR global metabolic phenotyping of acute pancreatitis in the emergency unit.

    PubMed

    Villaseñor, Alma; Kinross, James M; Li, Jia V; Penney, Nicholas; Barton, Richard H; Nicholson, Jeremy K; Darzi, Ara; Barbas, Coral; Holmes, Elaine

    2014-12-01

    We have investigated the urinary and plasma metabolic phenotype of acute pancreatitis (AP) patients presenting to the emergency room at a single center London teaching hospital with acute abdominal pain using (1)H NMR spectroscopy and multivariate modeling. Patients were allocated to either the AP (n = 15) or non-AP patients group (all other causes of abdominal pain, n = 21) on the basis of the national guidelines. Patients were assessed for three clinical outcomes: (1) diagnosis of AP, (2) etiology of AP caused by alcohol consumption and cholelithiasis, and (3) AP severity based on the Glasgow score. Samples from AP patients were characterized by high levels of urinary ketone bodies, glucose, plasma choline and lipid, and relatively low levels of urinary hippurate, creatine and plasma-branched chain amino acids. AP could be reliably identified with a high degree of sensitivity and specificity (OPLS-DA model R(2) = 0.76 and Q(2)Y = 0.59) using panel of discriminatory biomarkers consisting of guanine, hippurate and creatine (urine), and valine, alanine and lipoproteins (plasma). Metabolic phenotyping was also able to distinguish between cholelithiasis and colonic inflammation among the heterogeneous non-AP group. This work has demonstrated that combinatorial biomarkers have a strong diagnostic and prognostic potential in AP with relevance to clinical decision making in the emergency unit. PMID:25160714

  20. Acute kidney injury among HIV-infected patients admitted to the intensive care unit.

    PubMed

    Randall, D W; Brima, N; Walker, D; Connolly, J; Laing, C; Copas, A J; Edwards, S G; Batson, S; Miller, R F

    2015-11-01

    We describe the incidence, associations and outcomes of acute kidney injury (AKI) among HIV-infected patients admitted to the intensive care unit (ICU). We retrospectively analysed 223 admissions to an inner-London, University-affiliated ICU between 1999 and 2012, and identified those with AKI and performed multivariate analysis to determine associations with AKI. Of all admissions, 66% were affected by AKI of any severity and 35% developed stage 3 AKI. In multivariate analysis, AKI was associated with chronic kidney disease (odds ratio [OR] = 3.19; p = 0.014), a previous AIDS-defining illness (OR = 1.93; p = 0.039) and the Acute Physiology and Chronic Health Evaluation (APACHE) II score, (OR = 3.49; p = 0.018, if > 30). No associations were demonstrated with use of anti-retroviral medication (including tenofovir), or an individual's HIV viral load or CD4 count. AKI was associated with higher inpatient mortality and longer duration of ICU admission. Among patients with stage 3 AKI, only 41% were alive 90 days after ICU admission. Among survivors, 74% regained good renal function, the remainder were dependent on renal replacement therapy or were left with significant ongoing renal dysfunction. Of note, many patients had baseline serum creatinine concentrations well below published reference ranges. AKI among HIV-infected patients admitted to ICU carries a poor prognosis. PMID:25411349

  1. Detection of airborne severe acute respiratory syndrome (SARS) coronavirus and environmental contamination in SARS outbreak units.

    PubMed

    Booth, Timothy F; Kournikakis, Bill; Bastien, Nathalie; Ho, Jim; Kobasa, Darwyn; Stadnyk, Laurie; Li, Yan; Spence, Mel; Paton, Shirley; Henry, Bonnie; Mederski, Barbara; White, Diane; Low, Donald E; McGeer, Allison; Simor, Andrew; Vearncombe, Mary; Downey, James; Jamieson, Frances B; Tang, Patrick; Plummer, Frank

    2005-05-01

    Severe acute respiratory syndrome (SARS) is characterized by a risk of nosocomial transmission; however, the risk of airborne transmission of SARS is unknown. During the Toronto outbreaks of SARS, we investigated environmental contamination in SARS units, by employing novel air sampling and conventional surface swabbing. Two polymerase chain reaction (PCR)-positive air samples were obtained from a room occupied by a patient with SARS, indicating the presence of the virus in the air of the room. In addition, several PCR-positive swab samples were recovered from frequently touched surfaces in rooms occupied by patients with SARS (a bed table and a television remote control) and in a nurses' station used by staff (a medication refrigerator door). These data provide the first experimental confirmation of viral aerosol generation by a patient with SARS, indicating the possibility of airborne droplet transmission, which emphasizes the need for adequate respiratory protection, as well as for strict surface hygiene practices. PMID:15809906

  2. A creative alternative for providing constant observation on an acute-brain-injury unit.

    PubMed

    Bailey, Marci; Amato, Shelly; Mouhlas, Christopher

    2009-01-01

    A performance improvement project to explore creative alternatives to improve the efficiency of constant observation was performed on an acute-brain-injury rehabilitation unit. The goals of the project were to increase opportunities for therapeutic cognitive stimulation among patients, increase nursing satisfaction regarding efficient use of resources to deliver rehabilitative care, decrease constant-observation salary costs, and maintain fall and restraint rates within 10% of baseline. Implementing the project involved developing a new job description (rehabilitation patient companion) and creating a day room where patients receiving constant observation could go between therapies to receive therapeutic cognitive stimulation. The program benefited patients, staff and the hospital. This project illustrates how a creative alternative to constant observation proves beneficial on many levels and improves the delivery of rehabilitative care to patients with traumatic brain injury. PMID:19160919

  3. Practice of Acute and Maintenance Electroconvulsive Therapy in the Psychiatric Clinic of a University Hospital from Turkey: between 2007 and 2013

    PubMed Central

    Sengul, Melike Ceyhan Balci; Kenar, Ayse Nur Inci; Hanci, Ezgi; Sendur, İbrahim; Sengul, Cem; Herken, Hasan

    2016-01-01

    Objective Electroconvulsive therapy (ECT) can be given as the form of acute, continuation or maintenance ECT according to the process of administration. We report our 7 years’ observation with acute and maintenance ECT in a university hospital in Turkey. Methods The medical records of the hospitalized patients treated with acute or maintenance ECT between the years 2007 and 2013 was retrospectively analyzed. The sociodemographic characteristics, diagnosis, data of ECT and the co-administered psychotropic drugs were recorded. The frequency of ECT was calculated by identifying the total number of the hospitalized patients during the study period from the hospital records. Results A total number of 1,432 female and 1,141 male patients hospitalized in a period of 7 years, with a total number of 111 patients treated with ECT. The ratio of ECT was 4%, maintenance/acute ECT 11%. For acute ECT, affective disorders (65.3%) and psychotic disorders (21.6%) were among the leading diagnoses. Maintenance ECT, the diagnosis was; 6 affective disorders, 4 psychotic disorders and 1 obsessive compulsive disorder. There was a significant difference between the patients receiving acute and maintenance ECT in terms of age, duration of illness, and number of previous hospitalizations and ECTs. Conclusion The percentage of patients treated with acute ECT is lower in our institution than that in many other institutions from our country. Acute and maintenance ECT should be considered as an important treatment option particularly for patients with long disease duration, a high number of hospitalizations and a history of benefiting from previous ECTs. PMID:26792041

  4. Factors associated with variations in hospital expenditures for acute heart failure in the United States

    PubMed Central

    Ziaeian, Boback; Sharma, Puza P.; Yu, Tzy-Chyi; Johnson, Katherine Waltman; Fonarow, Gregg C.

    2015-01-01

    Background Relatively little contemporary data are available that describe differences in acute heart failure (AHF) hospitalization expenditures as a function of patient and hospital characteristics, especially from a population-based investigation. This study aimed to evaluate factors associated with variations in hospital expenditures for AHF in the United States. Methods A cross-sectional analysis using discharge data from the 2011 Nationwide Inpatient Sample, Healthcare Cost and Utilization Project, was conducted. Discharges with primary International Classification of Diseases, Ninth Revision, Clinical Modification, diagnosis codes for AHF in adults were included. Costs were estimated by converting Nationwide Inpatient Sample charge data using the Healthcare Cost and Utilization Project Cost-to-Charge Ratio File. Discharges with highest (≥80th percentile) versus lowest (≤20th percentile) costs were compared for patient characteristics, hospital characteristics, utilization of procedures, and outcomes. Results Of the estimated 1 million AHF hospital discharges, the mean cost estimates were $10,775 per episode. Younger age, higher percentage of obesity, atrial fibrillation, pulmonary disease, fluid/electrolyte disturbances, renal insufficiency, and greater number of cardiac/noncardiac procedures were observed in stays with highest versus lowest costs. Highest-cost discharges were more likely to be observed in urban and teaching hospitals. Highest-cost AHF discharges also had 5 times longer length of stay, were 9 times more costly, and had higher in-hospital mortality (5.6% vs 3.5%) compared with discharges with lowest costs (all P < .001). Conclusions Acute heart failure hospitalizations are costly. Expenditures vary markedly among AHF hospitalizations in the United States, with substantial differences in patient and hospital characteristics, procedures, and in-hospital outcomes among discharges with highest compared with lowest costs. PMID:25641538

  5. Accessing Inpatient Rehabilitation after Acute Severe Stroke: Age, Mobility, Prestroke Function and Hospital Unit Are Associated with Discharge to Inpatient Rehabilitation

    ERIC Educational Resources Information Center

    Hakkennes, Sharon; Hill, Keith D.; Brock, Kim; Bernhardt, Julie; Churilov, Leonid

    2012-01-01

    The objective of this study was to identify the variables associated with discharge to inpatient rehabilitation following acute severe stroke and to determine whether hospital unit contributed to access. Five acute hospitals in Victoria, Australia participated in this study. Patients were eligible for inclusion if they had suffered an acute severe…

  6. Acute retinal necrosis in the United Kingdom: results of a prospective surveillance study

    PubMed Central

    Cochrane, T F; Silvestri, G; McDowell, C; Foot, B; McAvoy, C E

    2012-01-01

    Background To determine the incidence of acute retinal necrosis (ARN) in the United Kingdom and to describe the demographics, management, and visual outcome in these patients. Methods This was a prospective study carried out by the British Ophthalmological Surveillance Unit (BOSU) between September 2007 and October 2008. Initial and 6-month questionnaires were sent to UK ophthalmologists who reported cases of ARN via the monthly BOSU report card system. Results In all, 45 confirmed cases (52 eyes) of ARN were reported in the 14-month study period, giving a minimum incidence of 0.63 cases per million population per year. There were 20 females and 25 males. Age ranged from 10 to 94 years. Eight patients had a history of herpetic CNS disease. Aqueous sampling was carried out in 13 patients, vitreous in 27, and cerebrospinal fluid (CSF) in 4. Varicella-zoster virus followed by herpes simplex were the most common causative agents. Treatment in 76% of the cases was with intravenous antivirals; however, 24% received only oral antivirals. In all, 47% of patients had intravitreal antiviral therapy. Visual outcome at 6 months was <6/60 in 48% of the affected eyes. Conclusion The minimum incidence of ARN in the UK is 0.63 cases per million. Patients with a history of herpetic CNS disease should be warned to immediately report any visual symptoms. There is increased use of oral and intravitreal antivirals in initial treatment. PMID:22281865

  7. Characterization of patients treated by rehabilitation service after establishing of an acute stroke unit in a Brazilian hospital

    PubMed Central

    Luvizutto, Gustavo José; Gameiro, Mônica de Oliveira Orsi; Schelp, Arthur Oscar; Braga, Gabriel Pereira; Ribeiro, Priscila Watson; Bazan, Rodrigo

    2015-01-01

    [Purpose] The study aimed to characterize patients treated by rehabilitation section after establishment of an acute stroke unit. [Subjects and Methods] Medical consultation records of individuals with ischemic stroke were studied retrospectively, excluding individuals with hemorrhagic stroke, thrombolysis, previous Modified Rankin Scale ≥ 1, prior stroke, structural bone deformities, associated neurological disease, and prior cognitive deficit. The data evaluated were age, gender, etiology, localization, treatment received, ictus onset, hospitalization time, discharge date, and date of first evaluation at the rehabilitation center. The Modified Rankin Scale in 90 days after ictus was utilized to measure functional incapacity with the individuals divided into two groups, before and after acute stroke unit implementation (2010). Functional incapacity was compared between before and after acute stroke unit implementation by the Mann-Whitney test, χ2 test and Fisher’s exact test. [Results] The medical records of 170 patients were evaluated. In the group evaluated after 2010, the patients were significantly older and presented a shorter time between hospitalization and discharge, shorter time until the first evaluation in rehabilitation, and increased percentage of mild incapacity (Modified Rankin Scale = 0 to 2). [Conclusion] After acute stroke unit implementation, the patients treated in the rehabilitation section presented a shorter hospitalization time and rehabilitation delay and less functional incapacity. PMID:26355915

  8. Elements of Successful School Reentry after Psychiatric Hospitalization

    ERIC Educational Resources Information Center

    Clemens, Elysia V.; Welfare, Laura E.; Williams, Amy M.

    2011-01-01

    Psychiatric hospitalization is an intensive intervention designed to stabilize adolescents who are experiencing an acute mental health crisis. Reintegrating to school after discharge from psychiatric hospitalization can be overwhelming for many adolescents (E. V. Clemens, L. E. Welfare, & A. M. Williams, 2010). The authors used a consensual…

  9. Patients with Acute Myeloid Leukemia Admitted to Intensive Care Units: Outcome Analysis and Risk Prediction

    PubMed Central

    Braess, Jan; Thudium, Johannes; Schmid, Christoph; Kochanek, Matthias; Kreuzer, Karl-Anton; Lebiedz, Pia; Görlich, Dennis; Gerth, Hans U.; Rohde, Christian; Kessler, Torsten; Müller-Tidow, Carsten; Stelljes, Matthias; Büchner, Thomas; Schlimok, Günter; Hallek, Michael; Waltenberger, Johannes; Hiddemann, Wolfgang; Berdel, Wolfgang E.; Heilmeier, Bernhard; Krug, Utz

    2016-01-01

    Background This retrospective, multicenter study aimed to reveal risk predictors for mortality in the intensive care unit (ICU) as well as survival after ICU discharge in patients with acute myeloid leukemia (AML) requiring treatment in the ICU. Methods and Results Multivariate analysis of data for 187 adults with AML treated in the ICU in one institution revealed the following as independent prognostic factors for death in the ICU: arterial oxygen partial pressure below 72 mmHg, active AML and systemic inflammatory response syndrome upon ICU admission, and need for hemodialysis and mechanical ventilation in the ICU. Based on these variables, we developed an ICU mortality score and validated the score in an independent cohort of 264 patients treated in the ICU in three additional tertiary hospitals. Compared with the Simplified Acute Physiology Score (SAPS) II, the Logistic Organ Dysfunction (LOD) score, and the Sequential Organ Failure Assessment (SOFA) score, our score yielded a better prediction of ICU mortality in the receiver operator characteristics (ROC) analysis (AUC = 0.913 vs. AUC = 0.710 [SAPS II], AUC = 0.708 [LOD], and 0.770 [SOFA] in the training cohort; AUC = 0.841 for the developed score vs. AUC = 0.730 [SAPSII], AUC = 0.773 [LOD], and 0.783 [SOFA] in the validation cohort). Factors predicting decreased survival after ICU discharge were as follows: relapse or refractory disease, previous allogeneic stem cell transplantation, time between hospital admission and ICU admission, time spent in ICU, impaired diuresis, Glasgow Coma Scale <8 and hematocrit of ≥25% at ICU admission. Based on these factors, an ICU survival score was created and used for risk stratification into three risk groups. This stratification discriminated distinct survival rates after ICU discharge. Conclusions Our data emphasize that although individual risks differ widely depending on the patient and disease status, a substantial portion of critically ill patients with AML benefit

  10. Acute HIV-1 infection in the Southeastern United States: a cohort study.

    PubMed

    McKellar, Mehri S; Cope, Anna B; Gay, Cynthia L; McGee, Kara S; Kuruc, Joann D; Kerkau, Melissa G; Hurt, Christopher B; Fiscus, Susan A; Ferrari, Guido; Margolis, David M; Eron, Joseph J; Hicks, Charles B

    2013-01-01

    In 1998 a collaboration between Duke University and the University of North Carolina, Chapel Hill (UNC) was founded to enhance identification of persons with acute HIV-1 infection (AHI). The Duke-UNC AHI Research Consortium Cohort consists of patients ≥18 years old with a positive nucleic acid amplification test (NAAT) and either a negative enzyme immunoassay (EIA) test or a positive EIA with a negative/indeterminate Western blot. Patients were referred to the cohort from acute care settings and state-funded HIV testing sites that use NAAT testing on pooled HIV-1 antibody-negative samples. Between 1998 and 2010, 155 patients with AHI were enrolled: 81 (52%) African-Americans, 63 (41%) white, non-Hispanics, 137 (88%) males, 108 (70%) men who have sex with men (MSM), and 18 (12%) females. The median age was 27 years (IQR 22-38). Most (n=138/155) reported symptoms with a median duration of 17.5 days. The median nadir CD4 count was 408 cells/mm(3) (IQR 289-563); the median observed peak HIV-1 level was 726,859 copies/ml (IQR 167,585-3,565,728). The emergency department was the most frequent site of initial presentation (n=55/152; 3 missing data). AHI diagnosis was made at time of first contact in 62/137 (45%; 18 missing data) patients. This prospectively enrolled cohort is the largest group of patients with AHI reported from the Southeastern United States. The demographics reflect the epidemic of this geographic area with a high proportion of African-Americans, including young black MSM. Highlighting the challenges of diagnosing AHI, less than half of the patients were diagnosed at the first healthcare visit. Women made up a small proportion despite increasing numbers in our clinics. PMID:22839749

  11. Psychiatric home care: a new tool for crisis intervention.

    PubMed

    Spiro, A H

    1994-03-01

    The cost of psychiatric care has been rapidly increasing in recent years. Between 1984 and 1987, there was a 46 percent increase in psychiatric hospitals beds and a 60 percent increase in psychiatric units in general hospitals. This reflected a recognition by many health care systems that psychiatric patients were a good source of revenue. With this push toward more and more inpatient programs, crucial aspects of psychiatric care were left behind. Specifically, the limitations of inpatient therapy have not been recognized. Within the past five years, a new program has been developed and pioneered to use home care to prevent psychiatric hospitalizations and to also prevent the difficult transitions for psychiatric patients. Over a two-year period, this program was studied for its impact on the quality and cost of psychiatric care. PMID:10132548

  12. [Psychiatric complications of alcoholism: alcohol withdrawal syndrome and other psychiatric disorders].

    PubMed

    Maciel, Cláudia; Kerr-Corrêa, Florence

    2004-05-01

    Alcohol withdrawal syndrome is an acute condition secondary to total or partial reduction of alcohol consumption, characterized by self limited signs and symptoms and different degrees of severity. It can be complicated by several clinical and/or other psychiatric related problems. The objective of this article is to review the most important psychiatric complications to alcohol withdrawal syndrome as well as other psychiatric disorders associated with alcohol dependence as Wernicke Korsakoff and Marchiava Bignami syndromes. We aim to promote early diagnosis and treatment of these conditions, minimizing morbidity and mortality associated with them. PMID:15729445

  13. Psychiatric Rehabilitation in a Community Center.

    ERIC Educational Resources Information Center

    Goveia, Leonard H.; Tutko, Thomas A.

    A research project was designed to compare the therapeutic effectiveness of treatment in a state hospital with treatment in a supportive, residential halfway-house facility involving patients in the acute initial stages of a psychiatric episode. Psychological tests were administered to randomly assigned patients at admission to the two facilities,…

  14. Regional anesthesia for management of acute pain in the intensive care unit

    PubMed Central

    De Pinto, Mario; Dagal, Armagan; O’Donnell, Brendan; Stogicza, Agnes; Chiu, Sheila; Edwards, William Thomas

    2015-01-01

    Pain is a major problem for Intensive Care Unit (ICU) patients. Despite numerous improvements it is estimated that as many as 70% of the patients experience moderate-to-severe postoperative pain during their stay in the ICU. Effective pain management means not only decreasing pain intensity, but also reducing the opioids’ side effects. Minimizing nausea, vomiting, urinary retention, and sedation may indeed facilitate patient recovery and it is likely to shorten the ICU and hospital stay. Adequate postoperative and post-trauma pain management is also crucial for the achievement of effective rehabilitation. Furthermore, recent studies suggest that effective acute pain management may be helpful in reducing the development of chronic pain. When used appropriately, and in combination with other treatment modalities, regional analgesia techniques (neuraxial and peripheral nerve blocks) have the potential to reduce or eliminate the physiological stress response to surgery and trauma, decreasing the possibility of surgical complications and improving the outcomes. Also they may reduce the total amount of opioid analgesics necessary to achieve adequate pain control and the development of potentially dangerous side effects. PMID:26557482

  15. Regional anesthesia for management of acute pain in the intensive care unit.

    PubMed

    De Pinto, Mario; Dagal, Armagan; O'Donnell, Brendan; Stogicza, Agnes; Chiu, Sheila; Edwards, William Thomas

    2015-01-01

    Pain is a major problem for Intensive Care Unit (ICU) patients. Despite numerous improvements it is estimated that as many as 70% of the patients experience moderate-to-severe postoperative pain during their stay in the ICU. Effective pain management means not only decreasing pain intensity, but also reducing the opioids' side effects. Minimizing nausea, vomiting, urinary retention, and sedation may indeed facilitate patient recovery and it is likely to shorten the ICU and hospital stay. Adequate postoperative and post-trauma pain management is also crucial for the achievement of effective rehabilitation. Furthermore, recent studies suggest that effective acute pain management may be helpful in reducing the development of chronic pain. When used appropriately, and in combination with other treatment modalities, regional analgesia techniques (neuraxial and peripheral nerve blocks) have the potential to reduce or eliminate the physiological stress response to surgery and trauma, decreasing the possibility of surgical complications and improving the outcomes. Also they may reduce the total amount of opioid analgesics necessary to achieve adequate pain control and the development of potentially dangerous side effects. PMID:26557482

  16. Frequency and Factors Associated with Unexpected Death in an Acute Palliative Care Unit: Expect the Unexpected

    PubMed Central

    Bruera, Sebastian; Chisholm, Gary; Santos, Renata Dos; Bruera, Eduardo; Hui, David

    2015-01-01

    Context Few studies have examined the frequency of unexpected death and its associated factors in a palliative care setting. Objectives To determine the frequency of unexpected death in two acute palliative care units (APCUs); to compare the frequency of signs of impending death between expected and unexpected deaths; and to determine the predictors associated with unexpected death. Methods In this prospective, longitudinal, observational study, consecutive patients admitted to two APCUs were enrolled and physical signs of impending death were documented twice daily until discharge or death. Physicians were asked to complete a survey within 24 hours of APCU death. The death was considered unexpected if the physician answered “yes” to the question “Were you surprised by the timing of the death?” Results In total, 193 of 203 after-death assessments (95%) were collected for analysis. Nineteen of 193 patients died unexpectedly (10%). Signs of impending death, including nonreactive pupils, inability to close eyelids, decreased response to verbal stimuli, drooping of nasolabial folds, peripheral cyanosis, pulselessness of the radial artery, and respiration with mandibular movement, were documented more frequently in expected deaths than unexpected deaths (P < 0.05). Longer disease duration was associated with unexpected death (33 months vs. 12 months, P=0.009). Conclusion Unexpected death occurred in an unexpectedly high proportion of patients in the APCU setting, and was associated with fewer signs of impending death. Our findings highlight the need for palliative care teams to be prepared for the unexpected. PMID:25499421

  17. Acute coronary syndrome registry from four large centres in United Arab Emirates (UAE-ACS Registry)

    PubMed Central

    Yusufali, Afzalhussein M; AlMahmeed, Wael; Tabatabai, Sadeq; Rao, Kabad; Binbrek, Azan

    2010-01-01

    Objective To identify the characteristics, treatments and hospital outcomes of patients diagnosed as having acute coronary syndrome (ACS) in the United Arab Emirates (UAE). Design A 3-year prospective registry. Setting Four tertiary care hospitals in three major cities of UAE from December 2003 to December 2006. Patients 1842 eligible consecutive patients with suspected ACS. Interventions None. Main outcome measures Characteristics, treatments and in-hospital outcomes were recorded. Results The mean age was 50.8±10.0 years, and 93.1% were male. More than half (51%) had ST elevation myocardial infarction (STEMI). The smoking rate was 46.4%, and diabetes was present in 38.9%. Only a minority (17.3%) used the ambulance services. For patients with STEMI, the median symptom to hospital time was 127 (IQR 60–256) min, and the median diagnostic ECG to thrombolysis time was 28 (IQR 16–50) min. Reperfusion in STEMI was in 81.4% (64.8% thrombolysis and 16.6% primary percutaneous coronary intervention). During hospitalisation, only a minority of the patients did not receive antiplatelets, anticoagulants, beta-blockers, ACE inhibitors and statin therapy. In-hospital complications were not common in our registry cohort. In-hospital mortality was 1.68%. Conclusions ACS patients in UAE are young but have higher risk factors such as smoking and diabetes. Almost half present as STEMI. Only a minority use ambulance services.

  18. Quality Improvement on the Acute Inpatient Psychiatry Unit Using the Model for Improvement

    PubMed Central

    Singh, Kuldeep; Sanderson, Joshua; Galarneau, David; Keister, Thomas; Hickman, Dean

    2013-01-01

    Background A need exists for constant evaluation and modification of processes within healthcare systems to achieve quality improvement. One common approach is the Model for Improvement that can be used to clearly define aims, measures, and changes that are then implemented through a plan-do-study-act (PDSA) cycle. This approach is a commonly used method for improving quality in a wide range of fields. The Model for Improvement allows for a systematic process that can be revised at set time intervals to achieve a desired result. Methods We used the Model for Improvement in an acute psychiatry unit (APU) to improve the screening incidence of abnormal involuntary movements in eligible patients—those starting or continuing on standing neuroleptics—with the Abnormal Involuntary Movement Scale (AIMS). Results After 8 weeks of using the Model for Improvement, both of the participating inpatient services in the APU showed substantial overall improvement in screening for abnormal involuntary movements using the AIMS. Conclusion Crucial aspects of a successful quality improvement initiative based on the Model for Improvement are well-defined goals, process measures, and structured PDSA cycles. Success also requires communication, organization, and participation of the entire team. PMID:24052768

  19. Psychiatric Morbidity and Functional Impairments in Survivors of Burns, Traumatic Injuries, and ICU Stays for Other Critical Illnesses: A Review of the Literature

    PubMed Central

    Davydow, Dimitry S.; Katon, Wayne J.; Zatzick, Douglas F.

    2010-01-01

    Severe burns, traumatic injuries and other critical illnesses are a substantial source of morbidity in the United States. As more patients survive these conditions, there has been increasing interest in psychiatric and functional outcomes of these individuals. In this article, we reviewed the literature on the prevalence of psychiatric conditions, with particular emphasis on posttraumatic stress disorder (PTSD) and depression, as well as functional impairments, in adult and pediatric survivors of burns, trauma and intensive care unit stays for other critical illnesses. We found that PTSD and depressive symptoms are quite prevalent in these patient groups. We also examined potential risk factors for psychiatric morbidity and impaired function in all three patient groups, and conclude that patient-specific and acute care factors, in addition to early post-acute care psychiatric symptoms, may convey risk for subsequent psychopathology and diminished function. Finally, we discussed limitations in the literature as well as possible directions for future research, particularly in clarifying risk factors for psychiatric disorders as well as potential preventative and treatment interventions that may improve outcomes. PMID:19919206

  20. Occupational stress in psychiatric nursing.

    PubMed

    Sullivan, P J

    1993-04-01

    Psychiatric nursing is invariably assumed to be a stressful area of nursing practice. Empirical evidence to support this proposition is limited, however, due to the lack of research in this field. The purpose of this project was to examine occupational stress in a specified area of psychiatric nursing. The research was exploratory and therefore the concern was discovery and description rather than the testing of clear hypotheses and the development of causal relationships. The study has four main objectives. First, to describe the various stressors present in the work of the psychiatric nurse in the acute admission wards of two district health authorities. Secondly, to measure the effects of stress using a recognized and well-validated instrument for recording levels of burnout. Thirdly, through the use of a particular theoretical framework to identify the types of coping strategy used by the participants in the study. Fourthly, to note any clear associations between the stressors, the effects of stress and the ways of coping identified in the study. The conceptual basis for the project was Lazarus's cognitive theory of stress and coping and Maslach's model of burnout. PMID:8496507

  1. Impact of dialysis practice patterns on outcomes in acute kidney injury in Intensive Care Unit

    PubMed Central

    Annigeri, Rajeev A.; Nandeesh, Venkatappa; Karuniya, Ramanathan; Rajalakshmi, Sasikumar; Venkataraman, Ramesh; Ramakrishnan, Nagarajan

    2016-01-01

    Aim: Recent advances in dialysis therapy have made an impact on the clinical practice of renal replacement therapy (RRT) in acute kidney injury (AKI) in Intensive Care Unit (ICU). We studied the impact of RRT practice changes on outcomes in AKI in ICU over a period of 8 years. Subjects and Methods: AKI patients requiring RRT in ICU referred to a nephrologist during two different periods (period-1: Between May 2004 and May 2007, n = 69; period-2: Between August 2008 and May 2011, n = 93) were studied. The major changes in the dialysis practice during the period-2, compared to period-1 were introduction of prolonged intermittent RRT (PIRRT), early dialysis for metabolic acidosis, early initiation of RRT for anuria and positive fluid balance and use of bicarbonate-based fluids for continuous RRT (CRRT) instead of lactate buffer. The primary study outcome was 28-day hospital mortality. Results: The mean age was 53.8 ± 16.1 years and 72.6% were male. Introduction of PIRRT resulted in 37% reduction in utilization of CRRT during period-2 (from 85.5% to 53.7%). The overall mortality was high (68%) but was significantly reduced during period-2 compared to period-1 (59% vs. 79.7%, P = 0.006). Metabolic acidosis but not the mode of RRT, was the significant factor which influenced mortality. Conclusions: Adaption of PIRRT resulted in 37% reduction of utilization of CRRT. The mortality rate was significantly reduced during the period of adaption of PIRRT, possibly due to early initiation of RRT in the latter period for indications such as anuria and metabolic acidosis. PMID:26955212

  2. Urinary Biomarkers Improve the Diagnosis of Intrinsic Acute Kidney Injury in Coronary Care Units

    PubMed Central

    Chang, Chih-Hsiang; Yang, Chia-Hung; Yang, Huang-Yu; Chen, Tien-Hsing; Lin, Chan-Yu; Chang, Su-Wei; Chen, Yi-Ting; Hung, Cheng-Chieh; Fang, Ji-Tseng; Yang, Chih-Wei; Chen, Yung-Chang

    2015-01-01

    Abstract Acute kidney injury (AKI) is associated with increased morbidity and mortality and is frequently encountered in coronary care units (CCUs). Its clinical presentation differs considerably from that of prerenal or intrinsic AKI. We used the biomarkers calprotectin and neutrophil gelatinase-associated lipocalin (NGAL) and compared their utility in predicting and differentiating intrinsic AKI. This was a prospective observational study conducted in a CCU of a tertiary care university hospital. Patients who exhibited any comorbidity and a kidney stressor were enrolled. Urinary samples of the enrolled patients collected between September 2012 and August 2013 were tested for calprotectin and NGAL. The definition of AKI was based on Kidney Disease Improving Global Outcomes classification. All prospective demographic, clinical, and laboratory data were evaluated as predictors of AKI. A total of 147 adult patients with a mean age of 67 years were investigated. AKI was diagnosed in 71 (50.3%) patients, whereas intrinsic AKI was diagnosed in 43 (60.5%) of them. Multivariate logistic regression analysis revealed urinary calprotectin and serum albumin as independent risk factors for intrinsic AKI. For predicting intrinsic AKI, both urinary NGAL and calprotectin displayed excellent areas under the receiver operating characteristic curve (AUROC) (0.918 and 0.946, respectively). A combination of these markers revealed an AUROC of 0.946. Our result revealed that calprotectin and NGAL had considerable discriminative powers for predicting intrinsic AKI in CCU patients. Accordingly, careful inspection for medication, choice of therapy, and early intervention in patients exhibiting increased biomarker levels might improve the outcomes of kidney injury. PMID:26448023

  3. Dial a Doctor: Improving lines of communication on the acute admissions unit

    PubMed Central

    Schwartz, Fionnuala

    2014-01-01

    The Royal London Hospital operates a system of ‘specialty take triage’, meaning that multiple teams provide patient care on the hospital's Acute Admission Unit (AAU). The aim of this project is to ensure the medical team for each patient can be promptly and easily contacted. An initial staff survey and engagement with key stakeholders assessed the baseline situation and guided a series of interventions, including the creation of ward whiteboards and funding for more portable phones. During further improvement cycles representatives from each profession were recruited to promote the new system, working groups held, and presentations made at staff meetings. The staff survey was repeated to gauge improvement. The initial survey of 33 staff revealed that there was no reliable system for ascertaining the specialty team to which a patient had been allocated or information on how to contact them. 39% of respondents reported experiencing a situation they felt was unsafe. Following the initial interventions, 25 staff responded to a second survey. 96% responded that the new system had made it easier to contact the correct medical team. The percentage of staff reporting difficulty knowing which medical team to contact most or everyday reduced from 66% to 32%. The percentage of those reporting difficulty contacting that team most or everyday reduced from 36% to 12%. There were 22 respondents to the survey following the second round of intervention. Less than 5% of staff reported difficulty most or everyday in both identifying the correct medical team and contacting them. There has been marked improvement in the ease of identifying and contacting the medical teams. This project is ongoing, recognising that further progress is required to ensure patient safety.

  4. Temporal Trends in Hospitalization for Acute Decompensated Heart Failure in the United States, 1998-2011.

    PubMed

    Agarwal, Sunil K; Wruck, Lisa; Quibrera, Miguel; Matsushita, Kunihiro; Loehr, Laura R; Chang, Patricia P; Rosamond, Wayne D; Wright, Jacqueline; Heiss, Gerardo; Coresh, Josef

    2016-03-01

    Estimates of the numbers and rates of acute decompensated heart failure (ADHF) hospitalization are central to understanding health-care utilization and efforts to improve patient care. We comprehensively estimated the frequency, rate, and trends of ADHF hospitalization in the United States. Based on Atherosclerosis Risk in Communities (ARIC) Study surveillance adjudicating 12,450 eligible hospitalizations during 2005-2010, we developed prediction models for ADHF separately for 3 International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) code 428 discharge diagnosis groups: 428 primary, 428 nonprimary, or 428 absent. We applied the models to data from the National Inpatient Sample (11.5 million hospitalizations of persons aged ≥55 years with eligible ICD-9-CM codes), an all-payer, 20% probability sample of US community hospitals. The average estimated number of ADHF hospitalizations per year was 1.76 million (428 primary, 0.80 million; 428 nonprimary, 0.83 million; 428 absent, 0.13 million). During 1998-2004, the rate of ADHF hospitalization increased by 2.0%/year (95% confidence interval (CI): 1.8, 2.5) versus a 1.4%/year (95% CI: 0.8, 2.1) increase in code 428 primary hospitalizations (P < 0.001). In contrast, during 2005-2011, numbers of ADHF hospitalizations were stable (-0.5%/year; 95% CI: -1.4, 0.3), while the numbers of 428-primary hospitalizations decreased by -1.5%/year (95% CI: -2.2, -0.8) (P for contrast = 0.03). In conclusion, the estimated number of hospitalizations with ADHF is approximately 2 times higher than the number of hospitalizations with ICD-9-CM code 428 in the primary position. The trend increased more steeply prior to 2005 and was relatively flat after 2005. PMID:26895710

  5. Acute kidney injury in asphyxiated neonates admitted to a tertiary neonatal unit in Sudan

    PubMed Central

    Medani, Safaa A; Kheir, Abdelmoneim E M; Mohamed, Mazahir B

    2014-01-01

    Acute kidney injury (AKI) is a recognized complication of birth asphyxia. Early recognition of AKI is important in asphyxiated neonates as it helps in early intervention and appropriate management. The aim of this study was to determine the pattern of AKI in asphyxiated neonates and its relation to the grade of Hypoxic Ischemic Encephalopathy (HIE). This was a prospective hospital based study, conducted in the neonatal intensive care unit (NICU) at Gafaar Ibn Auf Children’s Specialized Hospital during the period between January 2013 and December 2013. A total of 85 full term asphyxiated neonates who were admitted in NICU and diagnosed as HIE were enrolled in this study. with 50 (58.8%) less than 7 days of age, 31(36.5%) between (8–15) days and 4(4.7%) between (16–28) days. Males were found to be more affected than females (58.9% and 41.1%) respectively. Spontaneous vaginal delivery was the mode of delivery in 48(56.4%), assisted vaginal delivery in 14(16.5%), emergency caesarian in 19(22.4%) and elective caesarian section in. Percentage of AKI in those babies was 54.1%(46). With 30(65%) from those had non-oliguric type. Ten babies (21.7%) had serum creatinine between (1.5 – 2mg/dl), 29 (63.04%) between (2 – 3mg/dl) and 7(15.22%) between (3–4mg/ dl). This means that the majority of patients presented in injury stage. Hyperkalemia was found in (37.6%), hyponatremia in (27.1%) and hypocalceamia in (25.8%). Most of the babies with AKI had stage (ii) HIE. All babies were treated conservatively and 4(8.6%) died. In conclusion AKI was observed to be a common complication in asphyxiated neonates.

  6. Acute Transfusion Reactions (ATRs) in Intensive Care Unit (ICU): A Retrospective Study

    PubMed Central

    Kumar, Rajesh; Gupta, Manvi; Gupta, Varun; Kaur, Amarjit; Gupta, Sonia

    2014-01-01

    Background: Blood transfusion is a frequent and integral part of critical care. Although life saving, it can occasionally be unsafe and result in a spectrum of adverse events. Acute transfusion reactions (ATRs) are probably under diagnosed in critically ill patients due to confusion of the symptoms with the underlying disease. Aim: To analyze the incidence and spectrum of ATRs occuring in critically ill patients. Materials and Methods: This was a retrospective review conducted from 1st April 2011 till 31st March 2013. The ATRs related to the administration of blood components in the patients admitted in various Intensive Care Units (ICUs) were recorded, analyzed and classified on the basis of their clinical features and laboratory tests. Results: During the study period 98651 blood components were issued. Out of these 21971 were issued to various ICUs. A total of 225 transfusion reactions were reported from the various critical care departments during this period. The most frequent were Febrile Non Hemolytic Transfusion Reactions (FNHTR) 136 (60.4%), allergic reactions 70 (31.2%), hemolytic reactions 1(0.4%) and non specific reactions 18 (8%). The incidence of ATRs in our study was found to be 1.09% in adult ICUs and 0.36% in pediatric ICUs. Conclusions: Blood transfusion is a vital therapeutic procedure with a potential risk to already critical patients. So a strict vigilance has to be kept and each transfusion has to be monitored carefully with prompt recognition and treatment of ATRs. A rational use of these products considering their deleterious effects can decrease transfusion related morbidity and mortality in the critically ill patients. PMID:24701502

  7. Gender differences in the roles and functions of inpatient psychiatric nurses.

    PubMed

    Torkelson, Diane J; Seed, Mary S

    2011-03-01

    This study explored the difference between male and female psychiatric nurses' job performance and job satisfaction levels on an acute care inpatient unit. The amount of time male (n = 28) and female (n = 45) nurses spent on 10 specific functions and roles during a shift were observed and recorded. The nurses also self-rated the amount of time they spent on these specific functions and roles. The observed and self-rated functions were then correlated with job satisfaction. Female nurses were observed and self-rated as spending significantly more time on patient care activities, and these activities were significantly correlated with higher job satisfaction levels. Male nurses who self-rated spending more time on patient care activities had significantly lower job satisfaction scores. Findings confirm the concepts from social role theory that gender identity and expectations influence job performance in psychiatric nursing. The results offer insight for increasing job satisfaction and recruitment/retention efforts. PMID:21323265

  8. Psychiatric inpatient services in general hospitals.

    PubMed

    HUME, P B; RUDIN, E

    1960-10-01

    Traditional asylum care of psychiatric patients leads to the isolation, confinement, and restraint of the patients, and to isolation of psychiatric practice from the rest of medicine. Modern psychiatric advances have demonstrated the disadvantages to both patients and their families of such isolation, confinement and restraint. It is in the best interests of patients and professional workers that inpatient psychiatric services be continuous with, and contiguous to, other medical services and to rehabilitation services of all kinds. Examination of currently available information reveals a shortage of psychiatric beds in California, particularly for diagnosis and brief treatment. Thus, not only is there a need to develop psychiatric inpatient facilities, but also an opportunity to develop them along several different lines. Since both the Hill-Burton Act (federal) and the Short-Doyle Act (state) give financial assistance to only those psychiatric services established in general hospitals or affiliated with general hospitals, this requirement calls for examination in the light of experience with services so operated. At first, the Short-Doyle Act was perceived as a panacea for the psychiatric ills of the state. Now it is beginning to be recognized as one method of providing additional mental health resources, rather than the exclusive method. As more short-term cases are treated in local, tax-supported, psychiatric units in general hospitals, an impact can be expected on the state hospital program. In its administration of the Short-Doyle Act, the Department of Mental Hygiene attempts to respond to community needs as locally determined. It tries to insure local option and encourage local responsibility while furthering high standards of staffing and of service. PMID:13716797

  9. Psychopathy in women: Prediction of criminality and violence in UK and USA psychiatric patients resident in the community.

    PubMed

    Gray, Nicola S; Snowden, Robert J

    2016-03-30

    Psychopathy is an important clinical construct often used in the assessment and management of psychiatric patients and offenders. This, in part, is due to the strong association between psychopathy, crime, and particularly violent crime. However, there are few studies of these associations in women. These relationships were examined using information from two large databases. The Partnerships in Care database contains data from a sample of forensic psychiatric patients (154 women and 777 men) in the UK that were discharged from secure psychiatric units. Follow-up was via official conviction data within the next 2 years. The MacArthur study examined violence and aggression in a sample of civil psychiatric patients (367 women and 496 men) in the USA following discharge from an acute psychiatric hospital. Follow-up was via a mixture of self-report, informant report and official records. Psychopathy in both samples was measured via the PCL:SV prior to discharge. Psychopathy was a good predictor of target events for the women in both samples and for all time intervals used. No significant gender differences in the PCL:SV's predictive efficacy were found. The results provide a strong evidence-base for the use of psychopathy in women when considering future community behaviour and reoffending. PMID:26833281

  10. Getting in and getting out whole: nurse-patient connections in the psychiatric setting.

    PubMed

    Van Sant, Judith E; Patterson, Barbara J

    2013-01-01

    As a strong component in patient healing, interpersonal connection in the psychiatric/mental health setting can threaten nurses' health. Participant observation on four behavioral health and addiction units revealed a process of connecting with patients' emotional pain, delineating strategies applicable to nurses' multiple world views and practice styles. Findings from 12 nurses highlighted connectedness as a process and personal decision that, with self-awareness and individualized self-protective/self-separating strategies, can enhance patient healing as well as nurse satisfaction and growth. The evolved model may help nurses ease emotional labor, combat compassion fatigue, enhance performance, and preserve their self in today's complex acute care setting. PMID:23301568

  11. Psychiatric Effects of Military Deployment on Children and Families

    PubMed Central

    James, Trenton

    2012-01-01

    Deployments in the United States military have increased greatly in the past 10 years. Families and children are psychiatrically affected by these deployments, and recent studies are clarifying these effects. This article focuses on the psychiatric effects of deployment on children and uses a composite case example to review the use of play therapy to treat children who are having psychiatric issues related to the deployment of one or both parents. PMID:22468239

  12. Emergency room referral to internal medicine wards or to coronary care units of patients with first acute myocardial infarction. Israel Study Group on First Acute Myocardial Infarction.

    PubMed

    Drory, Y; Shapira, I; Goldbourt, U; Fisman, E Z; Villa, Y; Tenenbaum, A; Pines, A

    2000-01-01

    The objective of the study was to assess factors associated with ward assignment in the emergency room for patients < or = 65 years old with first acute myocardial infarction. We analysed uni- and multivariate predictors for ward assignment (coronary care unit versus internal ward). Eight major centrally located Israeli hospitals provided data during one year. The study population included 1252 patients, of whom 83% were men, 37% were hypertensives, 22% were diabetics, and 14% had previous anginal syndrome. Most patients (83%) were admitted to the coronary care unit. Internal medicine ward assignment was significantly associated with advanced age, history of hypertension or diabetes, a longer time from appearance of symptoms to arrival at the hospital, and myocardial infarction type (non-Q-wave or non-anterior). The likelihood of medical ward referral increased stepwise with the increasing number of a patient's predictive factors: those with > or = 4 factors had a > 30% chance of being assigned to a medical ward compared to a < 10% chance when there were 0-3 risk factors. Exclusion of patients with thrombolysis had no effect on the results. The shortage of cardiac care unit beds apparently leads to emergency room selection acting in detriment of patients with poorest prognoses. Clear guidelines for decision making in the emergency room are needed to resolve this paradoxical situation. PMID:10998758

  13. Tobacco and psychiatric dual disorders.

    PubMed

    Graham, Noni A; Frost-Pineda, Kimberly; Gold, Mark S

    2007-01-01

    Smoking is a leading cause of morbidity and premature mortality in the United States. The relationship between tobacco smoking and several forms of cancer, heart disease, stroke, chronic lung disease, and other medical diseases is well recognized and accepted. Recent epidemiological studies are now focusing on the link between tobacco use and psychiatric diseases. Experts now suggest that in the differential diagnosis of "smoker," depression, alcohol dependence, and schizophrenia are highest on the list. Studies are also focusing on the role of secondhand tobacco exposure, either in utero or during childhood, in the risk of dual disorders. Prenatal exposure may alter gene expression and change the risk for a variety of life-long psychiatric diseases, e.g., ADD/ADHD, antisocial personality disorders, substance use disorders, and major depression. Considerable time and effort have been devoted to studying the link between smoking and depression and also schizophrenia. We will focus on less well-studied areas in tobacco use and psychiatric dual disorders (including eating disorders), prenatal and early childhood secondhand smoke (SHS) exposure, and the relationship to the genesis of these dual disorders. PMID:19283970

  14. Predicting Length of Psychiatric Hospital Stay in Children and Adolescents.

    ERIC Educational Resources Information Center

    Leininger, Michele; Stephenson, Laura A.

    Length of stay in psychiatric inpatient units has received increasing attention with the external pressures for treatment cost-effectiveness and evidence that longer hospital stays do not appear to have significant advantages over shorter hospital stays. This study examined the relationship between length of psychiatric hospital stay and…

  15. Delayed psychiatric sequelae among Falklands war veterans

    PubMed Central

    Jones, Gareth H.; Lovett, Jonathan W.T.

    1987-01-01

    The only published account to date of psychiatric complications among Falklands war veterans suggests that acute reactions are rare. Reported here are three cases of severe delayed reactions in Falklands veterans from South Wales. All three cases demonstrate a common pattern similar to that shown by Vietnam war veterans. Possible aetiological factors and prevention are discussed. It seems likely that relatives of combatants will also be affected and general practitioners are in a unique position to recognize and treat these problems. PMID:3668924

  16. Neuroinflammation and psychiatric illness

    PubMed Central

    2013-01-01

    Multiple lines of evidence support the pathogenic role of neuroinflammation in psychiatric illness. While systemic autoimmune diseases are well-documented causes of neuropsychiatric disorders, synaptic autoimmune encephalitides with psychotic symptoms often go under-recognized. Parallel to the link between psychiatric symptoms and autoimmunity in autoimmune diseases, neuroimmunological abnormalities occur in classical psychiatric disorders (for example, major depressive, bipolar, schizophrenia, and obsessive-compulsive disorders). Investigations into the pathophysiology of these conditions traditionally stressed dysregulation of the glutamatergic and monoaminergic systems, but the mechanisms causing these neurotransmitter abnormalities remained elusive. We review the link between autoimmunity and neuropsychiatric disorders, and the human and experimental evidence supporting the pathogenic role of neuroinflammation in selected classical psychiatric disorders. Understanding how psychosocial, genetic, immunological and neurotransmitter systems interact can reveal pathogenic clues and help target new preventive and symptomatic therapies. PMID:23547920

  17. Comprehensive Psychiatric Evaluation

    MedlinePlus

    ... for Families Guide Skip breadcrumb navigation Comprehensive Psychiatric Evaluation Quick Links Facts For Families Guide Facts For ... Families Guide - Search No. 52; Updated November 2012 Evaluation by a child and adolescent psychiatrist is appropriate ...

  18. Outcome of Acute Kidney Injury in Sudanese Children — An Experience from a Sub-Saharan African Unit

    PubMed Central

    Abdelraheem, Mohamed; Ali, El-Tigani; Osman, Rania; Ellidir, Rashid; Bushara, Amna; Hussein, Rasha; Elgailany, Shiraz; Bakhit, Yassir; Karrar, Mohamed; Watson, Alan; Abu-Aisha, Hasan

    2014-01-01

    ♦ Background: Acute Kidney Injury (AKI) is an important cause of morbidity and mortality in developing countries. Although continuous renal replacement therapy is gaining more popularity worldwide, peritoneal dialysis (PD) in children remains an appropriate therapy for AKI in children for all age groups including neonates. ♦ Methodology: We retrospectively reviewed all children who have been admitted with AKI at the pediatric nephrology unit, Soba University Hospital, Khartoum, during the period from January 2005 to December 2011. ♦ Results: Over 7 years we recorded 659 children of whom 362 (54.9%) were male. The spectrum of age was variable with the majority being neonates, 178 (27.1%). The average patient admission rate was 94 patients per year, with an estimated incidence of 9.8 patients/million population/year. Common causes of AKI were sepsis 202 (30.8%), acute glomerulonephritis 75 (11.5%) and obstructive uropathy due to stones 56 (8.5%). The most common dialysis modality used was PD, 343 (52.4%), and peritonitis was reported in 53 (15.4%) patients. Recovery from AKI was achieved in 450 (68.9%) children, 37 (5.7%) went into chronic kidney disease (CKD), 33 (5.1%) referred to the pediatric surgery and 194 (29.7%) died. ♦ Conclusion: In the setting of developing countries where AKI is a common cause of morbidity and mortality, reasonably equipped renal units with adequately trained medical staff may save many lives. International funding programs for communicable diseases and charity organizations should include AKI management in their programs. Acute PD remains the treatment modality of choice for AKI in developing countries. PMID:24584611

  19. Acute intermittent porphyria associated with respiratory failure: a multidisciplinary approach.

    PubMed

    Menegueti, Mayra Gonçalves; Gil Cezar, Alkmim-Teixeira; Casarini, Karin Aparecida; Muniz Cordeiro, Kátia Simone; Basile-Filho, Anibal; Martins-Filho, Olindo Assis; Auxiliadora-Martins, Maria

    2011-01-01

    Despite being challenging, delivery of effective nursing care to patients with acute intermittent porphyria is a matter of utmost importance. In this paper, the diversity of symptoms and the difficult diagnosis of this condition are emphasized, and details concerning the treatment of this disorder in the intensive care unit are presented. We believe that acute intermittent porphyria should be borne in mind during performance of differential diagnosis of neurological, psychiatric, and gastroenterological disorders on patients whose routine investigation tests are normal, especially when precipitating factors exist. Intensive care measures and a multidisciplinary team approach are essential. PMID:21687623

  20. Acute Intermittent Porphyria Associated with Respiratory Failure: A Multidisciplinary Approach

    PubMed Central

    Menegueti, Mayra Gonçalves; Gil Cezar, Alkmim-Teixeira; Casarini, Karin Aparecida; Muniz Cordeiro, Kátia Simone; Basile-Filho, Anibal; Martins-Filho, Olindo Assis; Auxiliadora-Martins, Maria

    2011-01-01

    Despite being challenging, delivery of effective nursing care to patients with acute intermittent porphyria is a matter of utmost importance. In this paper, the diversity of symptoms and the difficult diagnosis of this condition are emphasized, and details concerning the treatment of this disorder in the intensive care unit are presented. We believe that acute intermittent porphyria should be borne in mind during performance of differential diagnosis of neurological, psychiatric, and gastroenterological disorders on patients whose routine investigation tests are normal, especially when precipitating factors exist. Intensive care measures and a multidisciplinary team approach are essential. PMID:21687623

  1. A cluster of acute hepatitis E infection in United Nations Bangladeshi peacekeepers in Haiti.

    PubMed

    Drabick, J J; Gambel, J M; Gouvea, V S; Caudill, J D; Sun, W; Hoke, C H; Innis, B L

    1997-10-01

    In the fall of 1995, within a month of deployment to Haiti for peacekeeping duty, four Bangladeshi soldiers developed acute icteric hepatitis in rapid succession. Hepatitis E virus (HEV) was found to be the etiology by demonstrating HEV genomic sequences in serum samples by the polymerase chain reaction (PCR) and serologically by the detection of elevated IgM titers to HEV. No case had serologic evidence of acute hepatitis A or C infection. The soldiers had probably acquired their infection while living in a cantonment area outside Dhaka, Bangladesh for one month prior to deployment. Cloning and sequencing of amplified PCR products demonstrated a single strain suggestive of a common source of infection. Furthermore, high genomic identity with Asian strains of HEV and dissimilarity with the Mexican strain was demonstrated, verifying that the strain had indeed been imported. Human waste management from the Bangladesh camp in Haiti was strictly controlled and no secondary cases were observed. A convenience sample of 105 (12%) soldiers from the Bangladesh battalion (850 men) revealed anicteric or asymptomatic HEV infection in seven (7%) of 105. This report contains the first demonstration of acute hepatitis E in natives of Bangladesh and demonstrates the power of the PCR in the rapid diagnosis and epidemiologic analysis of HEV infection. More importantly, this cluster demonstrates the importation of an important infectious disease by multinational peacekeepers to a potentially susceptible host country. PMID:9347962

  2. Current management of acute ischemic stroke. Part 2: Antithrombotics, neuroprotectives, and stroke units.

    PubMed Central

    Herd, A. M.

    2001-01-01

    OBJECTIVE: To help family physicians who care for patients with acute stroke or who are involved in planning service delivery or resource allocation to understand recent developments in acute stroke care. QUALITY OF EVIDENCE: A MEDLINE search indicated that most data were derived from well designed, randomized, double-blind, placebo-controlled trials, including all the largest international studies and large systematic reviews. MAIN MESSAGE: Routine anticoagulation is not recommended except for circumstances such as cardioembolic stroke or deep vein thrombosis prophylaxis. Antiplatelet therapy with low-dose acetylsalicylic acid (or another antiplatelet agent if ASA is contraindicated) should be initiated within 48 hours of stroke onset, although benefit is modest. Dedicated care for stroke patients reduces morbidity and mortality and can be cost effective. Recent research into defibrinogenating and neuroprotective agents suggests some benefit, although none are currently licensed for use. Combination therapy might be the answer. CONCLUSION: Management of acute stroke is an emerging discipline; many potential therapies are still experimental. PMID:11570305

  3. Long term prognosis of acute coronary syndrome with chronic renal dysfunction treated in different therapy units at department of cardiology: a retrospective cohort study

    PubMed Central

    Fu, Cong; Sheng, Zulong; Yao, Yuyu; Wang, Xin; Yu, Chaojun; Ma, Genshan

    2015-01-01

    Coronary care unit is common in hospitals and clinical centers which offer intensive care and therapy for severe coronary artery disease patients. However, if coronary care unit could improve the long term prognosis of acute coronary syndrome patients with renal dysfunction remain unknown. Accordingly, we designed this study to evaluate the differences of incidence of major adverse cardiovascular events for acute coronary syndromes patients with renal dysfunction who treated in coronary care unit or normal unit. The primary end point was all cause mortality. A total of 414 acute coronary syndromes patients with renal dysfunction involved in the study. The results showed that during 12-48 months follow-up, death of any cause occurred in 1.8% patients (4 of 247) in coronary care unit group, as compared with 1.8% in the normal group (3 of 167) (hazard ratio, 1.098; 95% confidence interval, 0.246 to 4.904; P=0.903). Kaplan-Meier survival analysis showed that there were no significant differences between the two groups with respect to the risk of death (P=0.903), revascularization (P=0.948), stroke (P=0.542), heart failure (P=0.198). This trial firstly revealed that acute coronary syndromes patients with renal dysfunction treated in coronary care unit and normal units. Our study showed that acute coronary syndromes patients with renal dysfunction treated in coronary care unit obtained no significant benefits compared with patients in normal units, although there was a declining tendency of the risk of major adverse cardiovascular effectswith patients in coronary care unit. PMID:26770436

  4. Psychiatric morbidity among prisoners

    PubMed Central

    Ayirolimeethal, Anithakumari; Ragesh, G.; Ramanujam, Jayanthi M.; George, Biju

    2014-01-01

    Background: There is a considerable lack of scientific estimate of psychiatric morbidity among Indian prisoners. Objective: The objective of the following study is to study the prevalence of psychiatric morbidity among prisoners. Settings and Design: A cross-sectional study at District Jail, Kozhikode, Kerala. Materials and Methods: A total of 255 prisoners who were inmates during the period from mid-April to mid-July 2011 participated in the study. The study subjects included both male and female remand or convict prisoners. Socio-demographic data, clinical history and criminological history were collected from each individual. Psychiatric morbidity was assessed using MINI-Plus. Statistical Analysis: Done by using SPSS version 16 (SPSS Inc, Chicago, USA). Results: A total of 175 subjects (68.6%) had a current mental illness. Substance use disorder was the most common diagnosis (47.1%). Antisocial personality disorder was diagnosed in 19.2%, adjustment disorder in 13.7%, mood disorder in 4.3% and psychosis in another 6.3% of prisoners. A high rate of a current psychiatric disorder was seen in male (69.7%) prisoners. A significant association was noticed for the different nature of crimes with psychiatric diagnoses and previous imprisonment. Nearly 4% of prisoners reported a moderate to high suicide risk. Conclusion: Mental health problems among prisoners were quite high. Mentally ill prisoners are at high risk for repeated incarceration. The increased rate of psychiatric disorders should be a concern for mental health professionals and the policy makers. PMID:24891702

  5. Acute effects of dynamic exercises on the relationship between the motor unit firing rate and the recruitment threshold.

    PubMed

    Ye, Xin; Beck, Travis W; DeFreitas, Jason M; Wages, Nathan P

    2015-04-01

    The aim of this study was to compare the acute effects of concentric versus eccentric exercise on motor control strategies. Fifteen men performed six sets of 10 repetitions of maximal concentric exercises or eccentric isokinetic exercises with their dominant elbow flexors on separate experimental visits. Before and after the exercise, maximal strength testing and submaximal trapezoid isometric contractions (40% of the maximal force) were performed. Both exercise conditions caused significant strength loss in the elbow flexors, but the loss was greater following the eccentric exercise (t=2.401, P=.031). The surface electromyographic signals obtained from the submaximal trapezoid isometric contractions were decomposed into individual motor unit action potential trains. For each submaximal trapezoid isometric contraction, the relationship between the average motor unit firing rate and the recruitment threshold was examined using linear regression analysis. In contrast to the concentric exercise, which did not cause significant changes in the mean linear slope coefficient and y-intercept of the linear regression line, the eccentric exercise resulted in a lower mean linear slope and an increased mean y-intercept, thereby indicating that increasing the firing rates of low-threshold motor units may be more important than recruiting high-threshold motor units to compensate for eccentric exercise-induced strength loss. PMID:25514631

  6. Critical Behaviors in Psychiatric-Mental Health Nursing. Volume 3: Behavior of Attendants.

    ERIC Educational Resources Information Center

    Jacobs, Angeline Marchese; And Others

    Part of a three-volume document, this volume is concerned with providing source data about the activities of mental health nursing personnel as the activities relate to patient care and contains abstracts of more than 4,000 critical behaviors of psychiatric attendants in 50 psychiatric hospitals, general hospitals with psychiatric units, and…

  7. Urgent Psychiatric Services: A Scoping Review

    PubMed Central

    Sunderji, Nadiya; de Bibiana, Jason Tan; Stergiopoulos, Vicky

    2015-01-01

    Objective: Urgent psychiatric services can provide timely access to ambulatory psychiatric assessment and short-term treatment for patients experiencing a mental health crisis or risk of rapid deterioration requiring hospitalization, yet little is known about how best to organize mental health service delivery for this population. Our scoping review was conducted to identify knowledge gaps and inform program development and quality improvement. Method: We searched MEDLINE, PsycINFO, CINAHL, Embase, and EBM Reviews for English-language articles, published from January 1993 to June 2014, using relevant key words and subject headings. Reverse and forward citations were manually searched using reference lists and Google Scholar. Articles were included if they described programs providing ambulatory psychiatric assessment (with or without treatment) within 2 weeks of referral. Results: We identified 10 programs providing urgent psychiatric services. Programs targeted a diagnostically heterogeneous population with acute risks and intensive needs. Most programs included a structured process for triage, strategies to improve accessibility and attendance, interprofessional staffing, short-term treatment, and efforts to improve continuity of care. Despite substantial methodological limitations, studies reported improvements in symptom severity, distress, psychosocial functioning, mental health–related quality of life, subjective well-being, and satisfaction with care, as well as decreased wait times for post-emergency department (ED) ambulatory care, and averted ED visits and admissions. Conclusions: Urgent psychiatric services may be an important part of the continuum of mental health services. Further work is needed to clarify the role of urgent psychiatric services, develop standards or best practices, and evaluate outcomes using rigorous methodologies. PMID:26454727

  8. Recovery education: a tool for psychiatric nurses.

    PubMed

    Knutson, M B; Newberry, S; Schaper, A

    2013-12-01

    Patient teaching is vital for nursing care of psychiatric patients. This paper describes the process of developing Recovery Education as a tool for nurses who lead daily patient education groups. Gundersen Lutheran's Recovery Model developed for the Inpatient Psychiatric Unit includes seven Elements of Recovery--Hope, Security, Support/Managing Symptoms, Empowerment, Relationships, Coping and Finding Meaning. Concepts of cognitive behavioural therapy, mindfulness and case-based education were woven through recovery lessons in ready-to-use folders. Statistics on patient satisfaction and patient outcome data were positive. Education for self-management can move patients forward to improve health and healing on their recovery journey. PMID:23445505

  9. OLDER ADULT PSYCHIATRIC INPATIENTS WITH NON-COGNITIVE DISORDERS SHOULD BE SCREENED FOR VITAMIN B12 DEFICIENCY

    PubMed Central

    LACHNER, C.; MARTIN, C.; JOHN, D.; NEKKALAPU, S.; SASAN, A.; STEINLE, N.; REGENOLD, W.T.

    2016-01-01

    Objective Vitamin B12 (B12) deficiency is most prevalent among older adults. Practice guidelines recommend screening older adults with symptoms of cognitive disorder for B12 deficiency. However, guidelines for non-cognitive psychiatric disorders typically do not mention screening older adults for B12 deficiency. The purpose of this study was to determine whether routine screening of older adult psychiatric inpatients for B12 deficiency, regardless of cognitive symptoms, is clinically justified. Design We conducted a retrospective chart-review study of consecutive inpatient admissions. Setting Older Adult Acute Psychiatric Inpatient Unit at the University of Maryland Medical Center from 10/2007-4/2010. Participants Acute psychiatric inpatients aged ≥50 years who met inclusion criteria (N=374). Measurements Mean (SD) B12 levels and percentages of probable (<180pg/mL) and possible (180–350pg/mL) B12 deficiency as well as characteristics of patients with probable and possible B12 deficiency compared to patients with optimal B12 levels. Results Mean (SD) B12 levels and percentages of probable and possible B12 deficiency, respectively, for cognitive disorder patients [468 (284) pg/mL, 7.8 % (n=5) and 29.7% (n=19)] and for non-cognitive disorder patients [481(268) pg/mL, 4.8 %(n=15) and 33.2%(n=103)] were not significantly different (t=0.339, df=372, P=0.735; χ2=1.084, df=2, P=0.582, respectively). Conclusion Considering the potential benefits and low costs of screening and treatment, we conclude that it is justified to routinely screen older adult psychiatric inpatients for B12 deficiency whether or not cognitive disorder symptoms are present. PMID:24522476

  10. [Dichotomy of psychiatric and somatic emergency care; fundamental flaw should be addressed].

    PubMed

    Tuerlings, Joep H A M; Pelger, E C M Noor; de Pont, Boudewijn J H B; van Waarde, Jeroen A

    2015-01-01

    In the Netherlands, acute psychiatric care is characterised by mind-body dualism. For acute psychiatric patients, the first port of call is the general practitioner (GP); after-hour care is provided by the out-of-hours GP service. In contrast to patients with other medical illnesses, the out-of-hours GP service does not usually refer patients with acute psychiatric issues to the accident and emergency (A&E) department of the general hospital, but to the local ambulant psychiatric 'crisis' service. However, some of these patients still end up at the A&E department, as our three cases demonstrate. Integration of the out-of-hours GP service, A&E and acute psychiatric care, therefore, would enable elimination of the current partitioning of somatic and psychiatric medicine in acute emergency care. This solution would not only improve acute emergency care, but would also ensure a targeted and efficient implementation of services and might even lead to a decreased stigmatisation of psychiatric patients in general. PMID:26230348

  11. Regionalization of psychiatric services for the elderly.

    PubMed

    Shulman, K I

    1991-02-01

    This overview addresses issues related to psychiatric services for the elderly in Canada. The author reviews the developments in the United Kingdom that have led to the establishment of guiding principles which may be applied to the Canadian health care system. These include the clear definition of a target population, a comprehensive approach to services, availability and accessibility, and clear accountability. A model for the establishment of regionalized psychiatric services is proposed, including the integration of hospital-based and community-based services with clearly defined areas of responsibility. In light of the changing demographics in Canada and the prevalence of psychiatric illness in the elderly, this is a matter of growing urgency for the health care system. PMID:2029681

  12. Negative rumor: contagion of a psychiatric department.

    PubMed

    Novac, Andrei; McEwan, Stephanie; Bota, Robert G

    2014-01-01

    Over the past few decades, a sizable body of literature on the effects of rumors and gossip has emerged. Addressing rumors in the workplace is an important subject, as rumors have a direct impact on the quality of the work environment and also on the productivity and creativity of the employees. To date, little has been written on the effect of rumors and gossip in psychiatric hospitals. This article presents case vignettes of rumors spread in psychiatric hospitals and the impact on team cohesion and morale among the staff implicated in these, too often, neglected occurrences. Dynamic aspects with particular focus on rumors in psychiatric units and suggestions for remedy and treatment are presented. PMID:25133051

  13. Negative Rumor: Contagion of a Psychiatric Department

    PubMed Central

    McEwan, Stephanie; Bota, Robert G.

    2014-01-01

    Over the past few decades, a sizable body of literature on the effects of rumors and gossip has emerged. Addressing rumors in the workplace is an important subject, as rumors have a direct impact on the quality of the work environment and also on the productivity and creativity of the employees. To date, little has been written on the effect of rumors and gossip in psychiatric hospitals. This article presents case vignettes of rumors spread in psychiatric hospitals and the impact on team cohesion and morale among the staff implicated in these, too often, neglected occurrences. Dynamic aspects with particular focus on rumors in psychiatric units and suggestions for remedy and treatment are presented. PMID:25133051

  14. Psychiatric comorbidity in veterans with psychogenic seizures.

    PubMed

    Salinsky, Martin; Evrard, Collette; Storzbach, Daniel; Pugh, Mary Jo

    2012-11-01

    Psychogenic non-epileptic seizures (PNES) are frequently encountered in epilepsy monitoring units (EMU) at Veterans Affairs Medical Centers (VAMCs) and cause significant long-term disability. An understanding of psychiatric factors associated with PNES could aid in earlier diagnosis and treatment. We studied 50 consecutive veterans diagnosed with PNES and 37 veterans diagnosed with epileptic seizures (ES), evaluated at a VAMC EMU. We reviewed all available mental health evaluations prior to EMU evaluation. Univariate comparisons included axis I diagnoses, axis II diagnoses, and psychiatric hospitalizations. Predictive models of seizure classification were evaluated by logistic regression. A diagnosis of post-traumatic stress disorder (PTSD) preceded the diagnosis of PNES in 58% of patients and the diagnosis of ES in 13.5% (p<0.001). On logistic regression, PTSD was the only significant psychiatric diagnosis (odds ratio 9.2). Major depression and alcohol abuse were common diagnoses but did not differentiate PNES and ES groups. PMID:23103308

  15. Abortion and psychiatric practice.

    PubMed

    Stotland, Nada L

    2003-03-01

    The subject of abortion is fraught with politics, emotions, and misinformation. A widespread practice reaching far back in history, abortion is again in the news. Psychiatry sits at the intersection of the religious, ethical, psychological, sociological, medical, and legal facets of the abortion issue. Although the religions that forbid abortion are more prominent in the media, many religions have more liberal approaches. While the basic right to abortion has been upheld by the U.S. Supreme Court, several limitations have been permitted, including parental notification or consent (with the possibility of judicial bypass) for minors, waiting periods, and mandatory provision of certain, sometimes biased, information. Before the Roe v. Wade decision legalizing abortion in 1973, many women were maimed or killed by illegal abortions, and psychiatrists were sometimes asked to certify that abortions were justified on psychiatric grounds. Currently, there are active attempts to convince the public and women considering abortion that abortion frequently has negative psychiatric consequences. This assertion is not borne out by the literature: the vast majority of women tolerate abortion without psychiatric sequelae. The psychiatric outcome of abortion is best when patients are able to make autonomous, supported decisions. Psychiatrists need to know the medical and psychiatric facts about abortion. Psychiatrists can then help patients prevent unwanted pregnancies, make informed decisions consonant with their own values and circumstances when they become pregnant, and find appropriate social and medical resources whatever their decisions may be. PMID:15985924

  16. Transporting Forensic Psychiatric Patients.

    PubMed

    Dike, Charles C; Nicholson, Elizabeth; Young, John L

    2015-12-01

    Patients in a forensic psychiatric facility often require escorted transport to medical facilities for investigations or treatments of physical health ailments. Transporting these patients presents significant safety and custody challenges because of the nature of patients housed in forensic psychiatric facilities. A significant proportion of these patients may be transfers from the Department of Corrections (DOC) under legal mandates for psychiatric evaluation and treatment better provided in a hospital setting, and most of them will return to the DOC. Although departments of correction have protocols for escorting these potentially dangerous individuals, it is unclear whether receiving psychiatric hospitals have established procedures for maintaining the safety of others and custody of these individuals during transportation outside the hospital facility. The literature is sparse on precautions to be observed when transporting dangerous forensic psychiatric patients, including those with high escape risk. In this article, we describe one forensic inpatient facility's procedure for determining the appropriate level needed to transport these individuals outside of the forensic facility. We also describe the risk assessment procedure for determining level of transport. These are quality improvement measures resulting from a critical review of an incident of escape from the forensic facility several years ago. PMID:26668224

  17. Burden and viral aetiology of influenza-like illness and acute respiratory infection in intensive care units.

    PubMed

    Tramuto, Fabio; Maida, Carmelo Massimo; Napoli, Giuseppe; Mammina, Caterina; Casuccio, Alessandra; Cala', Cinzia; Amodio, Emanuele; Vitale, Francesco

    2016-04-01

    The purpose of this investigation was to study the viral aetiology of influenza-like illness (ILI) and acute respiratory tract infection (ARTI) among patients requiring intensive care unit admission. A cross-sectional retrospective study was carried out in Sicily over a 4-year period. A total of 233 respiratory samples of patients with ILI/ARTI admitted to intensive care units were molecularly analyzed for the detection of a comprehensive panel of aetiologic agents of viral respiratory infections. About 45% of patients was positive for at least one pathogen. Single aetiology occurred in 75.2% of infected patients, while polymicrobial infection was found in 24.8% of positive subjects. Influenza was the most common aetiologic agent (55.7%), especially among adults. Most of patients with multiple aetiology (76.9%) were adults and elderly. Mortality rates among patients with negative or positive aetiology did not significantly differ (52.4% and 47.6%, respectively). Highly transmissible respiratory pathogens are frequently detected among patients with ILI/ARTI admitted in intensive care units, showing the occurrence of concurrent infections by different viruses. The knowledge of the circulation of several types of microorganisms is of crucial importance in terms of appropriateness of therapies, but also for the implication in prevention strategies and hospital epidemiology. PMID:26706819

  18. Psychiatric consultation to the postpartum mother.

    PubMed

    Anderson, Eleanor A; Kim, Deborah R

    2015-04-01

    The immediate postpartum period is a time of acute vulnerability to mental illness, which presents unique challenges for the psychiatric consultant. Because the postpartum hospital stay is typically brief, the consultant must have a working knowledge of postpartum physiology and the myriad forms of mental illness that may emerge in this vulnerable time, in order to quickly make a diagnosis and formulate a treatment plan. This review aims to characterize the most common reasons for postpartum consultation, review postpartum physiology and psychiatric conditions, and propose an evidence-based, practical approach to treatment. A literature search using the terms "postpartum," "obstetric," "consultation," and "psychiatry" yielded six studies that identified reasons for psychiatric consultation to the obstetrics and gynecology services. These studies informed the structure of the article such that we review the most common reasons for consultation and how to approach each issue. The most common reason for consultation is past psychiatric history, often in the absence of current symptoms. For each clinical situation, including depression, adverse birth events, and psychosis, we present a differential diagnosis, as well as risk factors, clinical signs, and recommended treatment. PMID:25764006

  19. Comparison of Unit-Level Patient Turnover Measures in Acute Care Hospital Settings.

    PubMed

    Park, Shin Hye; Dunton, Nancy; Blegen, Mary A

    2016-06-01

    High patient turnover is a critical factor increasing nursing workload. Despite the growing number of studies on patient turnover, no consensus about how to measure turnover has been achieved. This study was designed to assess the correlation among patient turnover measures commonly used in recent studies and to examine the degree of agreement among the measures for classifying units with different levels of patient turnover. Using unit-level data collected for this study from 292 units in 88 hospitals participating in the National Database of Nursing Quality Indicators®, we compared four patient turnover measures: the inverse of length of stay (1/LOS), admissions, discharges, and transfers per daily census (ADTC), ADTC with short-stay adjustment, and the number of ADTs and short-stay patients divided by the total number of treated patients, or Unit Activity Index (UAI). We assessed the measures' agreement on turnover quartile classifications, using percent agreement and Cohen's kappa statistic (weighted and unweighted). Pearson correlation coefficients also were calculated. ADTC with or without adjustment for short-stay patients had high correlations and substantial agreement with the measure of 1/LOS (κ = .62 to .91; r = .90 to .95). The UAI measure required data less commonly collected by participating hospital units and showed only moderate correlations and fair agreement with the other measures (κ = .23 to .39; r = .41 to .45). The UAI may not be comparable and interchangeable with other patient turnover measures when data are obtained from multiple units and hospitals. © 2016 Wiley Periodicals, Inc. PMID:26998744

  20. Outcomes After Acute Ischemic Stroke in the United States: Does Residential ZIP Code Matter?

    PubMed Central

    Agarwal, Shikhar; Menon, Venu; Jaber, Wael A.

    2015-01-01

    Background We sought to analyze the impact of socioeconomic status (SES) on in‐hospital outcomes, cost of hospitalization, and resource use after acute ischemic stroke. Methods and Results We used the 2003–2011 Nationwide Inpatient Sample database for this analysis. All admissions with a principal diagnosis of acute ischemic stroke were identified by using International Classification of Diseases, Ninth Revision codes. SES was assessed by using median household income of the residential ZIP code for each patient. Quartile 1 and quartile 4 reflect the lowest‐income and highest‐income SES quartile, respectively. During a 9‐year period, 775 905 discharges with acute ischemic stroke were analyzed. There was a progressive increase in the incidence of reperfusion on the first admission day across the SES quartiles (P‐trend<0.001). In addition, we observed a significant reduction in discharge to nursing facility, across the SES quartiles (P‐trend<0.001). Although we did not observe a significant difference in in‐hospital mortality across the SES quartiles in the overall cohort (P‐trend=0.22), there was a significant trend toward reduced in‐hospital mortality across the SES quartiles in younger patients (<75 years) (P‐trend<0.001). The mean length of stay in the lowest‐income quartile was 5.75 days, which was significantly higher compared with other SES quartiles. Furthermore, the mean adjusted cost of hospitalization among quartiles 2, 3, and 4, compared with quartile 1, was significantly higher by $621, $1238, and $2577, respectively. Compared with the lowest‐income quartile, there was a significantly higher use of echocardiography, invasive angiography, and operative procedures, including carotid endarterectomy, in the highest‐income quartile. Conclusions Patients from lower‐income quartiles had decreased reperfusion on the first admission day, compared with patients from higher‐income quartiles. The cost of hospitalization of patients

  1. Psychiatric services in China: or, Mao versus Freud.

    PubMed

    Allodi, F; Dukszta, J

    1978-10-01

    Reportedly, the People's Republic of China has made great progress in health care services, particularly at preventive, primary and community levels. Information on their psychiatric services is still scarce. A group of 12 health professionals visited the country for three weeks in July 1977. This paper provides a description and an analysis of the network of mental health services using a sample of one mental hospital, six general hospitals and a number of health units in cities, factories and communes. The basic principles of policy and administration are those of a collective socialism with strong central guidelines and considerable local administrative initiative. Admissions to the mental hospital in Shanghai reveal that 83% are young acute schizophrenic cases and very few are neurotic or non-psychotic. This distribution stands in great contrast with admissions to mental hospitals in the West, as is the case in Canada, where schizophrenics represent only 12% of all first admissions to mental hospitals and non-psychotic or minor conditions amount to two-thirds. An impressionistic survey of Chinese traditional medicine rooms in general hospitals revealed that a good proportion of their cases (60-70%) are diagnosed as suffering from minor organic or vague organic conditions without evidence of organic pathology and which in the West would be considered as neurotic or psychosomatic conditions. Outside the institutions, in the communes of the rural and urban areas behavioural, interpersonal and family problems are not defined specifically as mental health problems, but handled within the moral and political ideology prevalent in the country. None of the general hospitals visited had a psychiatric unit, but every patient in every hospital or health unit in the cities and countryside received a combination of traditional Chinese medicine (herbal preparations, acupuncture and moxibustion) besides the Western or modern type of treatment. Officially mental illness is not

  2. Prognostic value of plasma neuropeptide-Y in coronary care unit patients with and without acute myocardial infarction.

    PubMed

    Ullman, B; Hulting, J; Lundberg, J M

    1994-04-01

    Plasma neuropeptide Y-like immunoreactivity (NPY-LI) is elevated in patients with acute myocardial ischaemia and congestive heart failure (CHF) owing to increased activity of the sympathetic nervous system. The prognostic value of plasma NPY-LI with regard to mortality was studied in 324 random patients admitted to a coronary care unit. The one-year mortality was 37% in 113 patients with acute myocardial infarction (AMI) and 18% in those without AMI. Several factors were tested by multiple logistical regression analysis to predict the one-year mortality. Plasma NPY-LI > 60 pmol.l-1, advanced age and previous CHF were independent prognostic factors for an increased risk of mortality in patients without AMI. The mortality rate after one year in non-AMI patients with plasma NPY-LI < or = 60 pmol.l-1 was 14% compared to 69% in those with plasma NPY-LI > 60 pmol.l-1. Increased heart rate was the only independent prognostic factor for increased mortality in AMI patients. Plasma NPY-LI on admission was an independent predictor of mortality in CCU patients without AMI and thus resembles plasma noradrenaline. PMID:8070470

  3. [The RUTA project (Registro UTIC Triveneto ANMCO). An e-network for the coronary care units for acute myocardial infarction].

    PubMed

    Di Chiara, Antonio; Zonzin, Pietro; Pavoni, Daisy; Fioretti, Paolo Maria

    2003-06-01

    In the era of evidence-based medicine, the monitoring of the adherence to the guidelines is fundamental, in order to verify the diagnostic and therapeutic processes. Informatic paperless databases allow a higher data quality, lower costs and timely analysis with overall advantages over the traditional surveys. The RUTA project (acronym of Triveneto Registry of ANMCO CCUs) was designed in 1999, aiming at creating an informatic network among the coronary care units of a large Italian region, for a permanent survey of patients admitted for acute myocardial infarction. Information ranges from the pre-hospital phase to discharge, including all relevant clinical and management variables. The database uses DBMS Personal Oracle and Power-Builder as user interface, on Windows platform. Anonymous data are sent to a central server. PMID:19400054

  4. Scrub Typhus with Acute Respiratory Distress Syndrome (ARDS) and its Management in Intensive Care Unit: A Case Report.

    PubMed

    Sankuratri, Srinivas; Kalagara, Pavani; Samala, Kartika Balaji; Veledandi, Prabhakar Krishna; Atiketi, Srinadh Babu

    2015-05-01

    Scrub typhus is zoonotic disease caused by Orientia tsutsugamushi (O tsutsugamushi). It is transmitted to humans by the bite of trombiculid mite larvae (chiggers). It is a re-emerging infectious disease in India. Clinical manifestations include fever, headache, anorexia, myalgia, eschar, adenopathy and maculopapular rash. Complications of Scrub typhus develop after first week of illness. Complications include meningoencephalitis, jaundice, myocarditis, ARDS and renal failure. Eschar and rash may be unnoticed or absent. Thorough physical examination, identification of eschar/rash throws light in thinking about scrub typhus, treating and preventing further complications. Here, we report a case of scrub typhus with Acute Respiratory Distress Syndrome (ARDS) and its management with non invasive ventilation in the intensive care unit. PMID:26155511

  5. Psychiatric advance directives: potential challenges in India.

    PubMed

    Sarin, Alok; Murthy, Pratima; Chatterjee, Sudipto

    2012-01-01

    The advance directive is a statement of an individual's preference for future treatment. The concept initially evolved in the context of end-of-life treatment decision making. Subsequently, in some countries, advance directives have been promoted in the care and treatment of people with serious mental disorders. They have recently been endorsed by the United Nations Convention for the Rights of Persons with Disability. In India, the legal framework related to the care of persons with mental illness is currently being reappraised, and significant changes are being contemplated. Thus, this is an appropriate time to review the existing evidence on psychiatric advance directives and examine the potential challenges involved in making them legally binding. A wide spectrum of mental health 'advance statements' have been developed and implemented in some high-resource countries. Of special interest to mental health contexts is the complex Ulysses contract to accommodate situations where the advance directive can be overridden during phases of acute illness or relapse. There have been mixed experiences with advance directives in the last couple of decades and there is scant evidence to suggest that they are effective in improving actual care. There has been almost no discourse in India on the issue of mental health advance directives. Yet this feature is being considered for implementation in the revised legal framework for the care of persons with mental illness. There are significant barriers to the feasibility and acceptability of legally mandated advance directives. There are logistical barriers to operationalising them in a manner that guarantees quality assurance of the process, and minimises the possibility of misuse. Thus, while the advance directive is a highly desirable clinical tool for collaborative decision making between the person with mental illness and the treatment provider, at this time, more needs to be done before legal enforcement is considered in

  6. Psychiatric patient and anaesthesia

    PubMed Central

    Attri, Joginder Pal; Bala, Neeru; Chatrath, Veena

    2012-01-01

    Many patients with psychiatric illnesses are prescribed long-term drug treatment, and the anaesthesiologist must be aware of potential interactions with anaesthetic agents. Psychotropic drugs often given in combination with each other or with other non-psychiatric drugs generally exert profound effects on the central and peripheral neurotransmitter and ionic mechanisms. Hence, prior intake of these drugs is an important consideration in the management of the patient about to undergo anaesthesia and surgery. This article highlights the effects of anaesthetics on patients taking antipsychotics, tricyclic antidepressants, monoamine oxidase inhibitors and lithium carbonate. The risk that should be considered in the perioperative period are the extent of surgery, the patient's physical state, anaesthesia, the direct and indirect effects of psychotropics, risk of withdrawal symptoms and risk of psychiatric recurrence and relapse. PMID:22529413

  7. Community-acquired pneumonia and survival of critically ill acute exacerbation of COPD patients in respiratory intensive care units

    PubMed Central

    Lu, Zhiwei; Cheng, Yusheng; Tu, Xiongwen; Chen, Liang; Chen, Hu; Yang, Jian; Wang, Jinyan; Zhang, Liqin

    2016-01-01

    Purpose The aim of this study was to appraise the effect of community-acquired pneumonia (CAP) on inhospital mortality in critically ill acute exacerbation of COPD (AECOPD) patients admitted to a respiratory intensive care unit. Patients and methods A retrospective observational study was performed. Consecutive critically ill AECOPD patients receiving treatment in a respiratory intensive care unit were reviewed from September 1, 2012, to August 31, 2015. Categorical variables were analyzed using chi-square tests, and continuous variables were analyzed by Mann–Whitney U-test. Kaplan–Meier analysis was used to assess the association of CAP with survival of critically ill AECOPD patients for univariate analysis. Cox’s proportional hazards regression model was performed to identify risk factors for multivariate analysis. Results A total of 80 consecutive eligible individuals were reviewed. These included 38 patients with CAP and 42 patients without CAP. Patients with CAP had a higher inhospital rate of mortality than patients without CAP (42% vs 33.3%, P<0.05). Kaplan–Meier survival analysis showed that patients with CAP had a worse survival rate than patients without CAP (P<0.05). Clinical characteristics, including Acute Physiology and Chronic Health Evaluation II (APACHE II) score, C-reactive protein, and CAP, were found to be closely associated with survival of AECOPD individuals. Further multivariate Cox regression analysis confirmed that CAP and APACHE II were independent risk factors for inhospital mortality in critically ill AECOPD patients (CAP: hazard ratio, 5.29; 95% CI, 1.50–18.47, P<0.01 and APACHE II: hazard ratio, 1.20; 95% CI, 1.06–1.37, P<0.01). Conclusion CAP may be an independent risk factor for higher inhospital mortality in critically ill AECOPD patients. PMID:27563239

  8. Pharmacogenomics in Psychiatric Practice.

    PubMed

    El-Mallakh, Rif S; Roberts, R Jeannie; El-Mallakh, Peggy L; Findlay, Lillian Jan; Reynolds, Kristen K

    2016-09-01

    Pharmacogenomic testing in psychiatry is becoming an established clinical procedure. Several vendors provide clinical interpretation of combinatorial pharmacogenomic testing of gene variants that have documented predictive implications regarding either pharmacologic response or adverse effects in depression and other psychiatric conditions. Such gene profiles have demonstrated improvements in outcome in depression, and reduction of cost of care of patients with inadequate clinical response. Additionally, several new gene variants are being studied to predict specific response in individuals. Many of these genes have demonstrated a role in the pathophysiology of depression or specific depressive symptoms. This article reviews the current state-of-the-art application of psychiatric pharmacogenomics. PMID:27514465

  9. Postoperative hospital course of patients with history of severe psychiatric illness.

    PubMed

    Solomon, S; McCartney, J R; Saravay, S M; Katz, E

    1987-09-01

    The postoperative hospital course of 54 patients with a past history of psychiatric illness was studied through chart review. Both chronic schizophrenics and chronic depressives tolerated surgical procedures well, without any unusual difficulties or exacerbation of psychiatric illness. They represented no management problems. Patients with acute, severe upset in the preoperative period (regardless of diagnosis) presented most of the management problems postoperatively. PMID:3678811

  10. Adolescents and Dual Diagnosis in a Psychiatric Emergency Service.

    PubMed

    Matali, José Luis; Andión, Oscar; Pardo, Marta; Iniesta, Raquel; Serrano, Eduard; San, Luis

    2016-01-01

    In recent years, both the prevalence of drug use and related child and adolescent psychiatric emergencies have risen sharply. There are few studies about the impact on child and adolescent emergency services. This study has a twofold aim. The first is to describe the prevalence of substance use disorders, mental disorders and dual diagnosis (substance use problems plus mental disorder) in adolescents in psychiatric emergency service. The second is to analyze clinical and healthcare differences between patients with dual diagnosis and patients with a mental disorder without substance use disorder.We retrospectively reviewed 4012 discharge forms for emergencies treated at the psychiatric emergency department during the period 2007-2009. We obtained a sample of 1795 visits. This sample was divided into two groups: the dual diagnosis group (n = 477) and the psychiatric disorder group (n = 1318).The dual diagnosis group accounted for 26.5% of psychiatric emergencies analyzed. Compared to the psychiatric disorder group,the dual diagnosis group had significantly more conduct disorders, social problems, involuntariness in the visit, less hospital admissions and less connection with the healthcare network.Adolescents with a dual diagnosis account for a high percentage of visits at child and adolescent psychiatric emergency services. This patient group requires specialized care both at emergency services and in specific units. Accordingly, these units should play a triple role when handling dual diagnosis: detection, brief treatment and referral to a specialised unit. PMID:26990268

  11. Early Clinical Outcome of Acute Poisoning Cases Treated in Intensive Care Unit

    PubMed Central

    Sulaj, Zihni; Prifti, Edvin; Demiraj, Aurel; Strakosha, Arjana

    2015-01-01

    Introduction: A variety of factors have influenced the significant incidence of morbidity and mortality of acute poisoning and the timely recognition and properly management of critically ill poisoned patients is a key component. The aim of this study is to reveal the reasons for ICU admission of acutely poisoned patients, the main factors influencing the course and outcome of patients in relation with clinical approaches applied, available resources and infrastructure of treatment. Materials and Methods: This is a retrospective study based on most reachable variables extracted from patients’ medical records and ED registers of patients admitted at the medical ICU of “Mother Teresa” University Hospital in Tirana over two (2012-2013) years. Demography, time of exposure, etiology and circumstances of poisonings, assessment and treatment, reasons for ICU admission, course and outcome were duly obtained. Results: The number of ICU treated patients was 118, consisting in 47.4% (56) males and 52.5% (62) females which represented 10.2% of poisoned patients admitted during this two-year-period in ED and 9.2% of other etiology ICU admitted patients. Mean was 42.6 years for males, and 38 years for females. About 55.9% were urban residents and 44% rural ones. The elapsed time from toxic exposure to treatment initiation had varied between 2-6 hours, 44% arrived in the hospital <4 hours. The toxic exposures were intentional in 87.2% of cases, with a male:female ratio was 0.8:1. Agrochemicals such as Aluminum phosphide and organophosphates were involved in 77.1% of cases. Cardiovascular collapse and respiratory failure were the main clinical syndromes encountered. Mechanical ventilation was required in 31.4% of patients. The length of ICU stay was 2.73 (0.96) days and the mortality was 54.2%. Conclusion: This study evidenced that highly lethal toxicants used in poisoning acts such as agrochemicals, high rate of suicide, notwithstanding the infrastructure and resources

  12. Psychiatric Advance Directives: Getting Started

    MedlinePlus

    ... Getting Started State by State Info FAQs Educational Webcasts Links Current Research In the News Legal Issues ... How to write a Psychiatric Advance Directive?" View webcast (15:04) What are Psychiatric Advance Directives? View ...

  13. Migraine and its psychiatric comorbidities.

    PubMed

    Minen, Mia Tova; Begasse De Dhaem, Olivia; Kroon Van Diest, Ashley; Powers, Scott; Schwedt, Todd J; Lipton, Richard; Silbersweig, David

    2016-07-01

    Migraine is a highly prevalent and disabling neurological disorder associated with a wide range of psychiatric comorbidities. In this manuscript, we provide an overview of the link between migraine and several comorbid psychiatric disorders, including depression, anxiety and post-traumatic stress disorder. We present data on psychiatric risk factors for migraine chronification. We discuss the evidence, theories and methods, such as brain functional imaging, to explain the pathophysiological links between migraine and psychiatric disorders. Finally, we provide an overview of the treatment considerations for treating migraine with psychiatric comorbidities. In conclusion, a review of the literature demonstrates the wide variety of psychiatric comorbidities with migraine. However, more research is needed to elucidate the neurocircuitry underlying the association between migraine and the comorbid psychiatric conditions and to determine the most effective treatment for migraine with psychiatric comorbidity. PMID:26733600

  14. Outcomes and Predictors of Mortality for Patients with Acute Leukemia Admitted to the Intensive Care Unit

    PubMed Central

    Croucher, Danielle; Christian, Michael; Ibrahimova, Narmin; Kumar, Vikram; Jacob, Gabriella; Kiss, Alex

    2016-01-01

    Purpose. The objectives were to describe the management and outcomes of acute leukemia (AL) patients admitted to the ICU and to identify predictors of ICU mortality. Methods. Data was retrospectively collected from the medical records of all patients with AML or ALL admitted to the Mount Sinai Hospital ICU from August 2009 to December 2012. Results. 151 AL patients (117 AML, 34 ALL) were admitted to the ICU. Mean age was 54 (SD 15) years, median APACHE II score was 27 (IQR 22–33), and 50% were female. While in ICU, 128 (85%) patients had sepsis and 56 (37%) had ARDS. The majority of patients required invasive organ support: 94 (62%) required mechanical ventilation while 23 (15%) received renal replacement therapy. Multivariable analysis identified SOFA score (OR 1.18, 95% CI 1.01–1.38) and invasive ventilation (OR 9.64, 95% CI 3.39–27.4) as independent predictors of ICU mortality. Ninety-four (62%) patients survived to ICU discharge. Only 39% of these 94 patients discharged were alive 12 months after ICU admission. Conclusions. AL patients admitted to the ICU had a 62% ICU survival rate; yet only 25% of cohort patients were alive 12 months after ICU admission. Higher admission SOFA scores and invasive ventilation are independently associated with a greater risk of dying in the ICU. PMID:27445524

  15. Acute kidney injury in the perioperative period and in intensive care units (excluding renal replacement therapies).

    PubMed

    Ichai, Carole; Vinsonneau, Christophe; Souweine, Bertrand; Armando, Fabien; Canet, Emmanuel; Clec'h, Christophe; Constantin, Jean-Michel; Darmon, Michaël; Duranteau, Jacques; Gaillot, Théophille; Garnier, Arnaud; Jacob, Laurent; Joannes-Boyau, Olivier; Juillard, Laurent; Journois, Didier; Lautrette, Alexandre; Muller, Laurent; Legrand, Matthieu; Lerolle, Nicolas; Rimmelé, Thomas; Rondeau, Eric; Tamion, Fabienne; Walrave, Yannick; Velly, Lionel

    2016-12-01

    Acute kidney injury (AKI) is a syndrome that has progressed a great deal over the last 20 years. The decrease in urine output and the increase in classical renal biomarkers, such as blood urea nitrogen and serum creatinine, have largely been used as surrogate markers for decreased glomerular filtration rate (GFR), which defines AKI. However, using such markers of GFR as criteria for diagnosing AKI has several limits including the difficult diagnosis of non-organic AKI, also called "functional renal insufficiency" or "pre-renal insufficiency". This situation is characterized by an oliguria and an increase in creatininemia as a consequence of a reduction in renal blood flow related to systemic haemodynamic abnormalities. In this situation, "renal insufficiency" seems rather inappropriate as kidney function is not impaired. On the contrary, the kidney delivers an appropriate response aiming to recover optimal systemic physiological haemodynamic conditions. Considering the kidney as insufficient is erroneous because this suggests that it does not work correctly, whereas the opposite is occurring, because the kidney is healthy even in a threatening situation. With current definitions of AKI, normalization of volaemia is needed before defining AKI in order to avoid this pitfall. PMID:27230984

  16. Excited delirium: Consideration of selected medical and psychiatric issues

    PubMed Central

    Samuel, Edith; Williams, Robert B; Ferrell, Richard B

    2009-01-01

    Excited delirium, sometimes referred to as agitated or excited delirium, is the label assigned to the state of acute behavioral disinhibition manifested in a cluster of behaviors that may include bizarreness, aggressiveness, agitation, ranting, hyperactivity, paranoia, panic, violence, public disturbance, surprising physical strength, profuse sweating due to hyperthermia, respiratory arrest, and death. Excited delirium is reported to result from substance intoxication, psychiatric illness, alcohol withdrawal, head trauma, or a combination of these. This communication reviews the history of the origins of excited delirium, selected research related to its causes, symptoms, management, and the links noted between it and selected medical and psychiatric conditions. Excited delirium involves behavioral and physical symptoms that are also observed in medical and psychiatric conditions such as rhabdomyolysis, neuroleptic malignant syndrome, and catatonia. A useful contribution of this communication is that it links the state of excited delirium to conditions for which there are known and effective medical and psychiatric interventions. PMID:19557101

  17. Pathological Gambling: Psychiatric Models

    ERIC Educational Resources Information Center

    Westphal, James R.

    2008-01-01

    Three psychiatric conceptual models: addictive, obsessive-compulsive spectrum and mood spectrum disorder have been proposed for pathological gambling. The objectives of this paper are to (1) evaluate the evidence base from the most recent reviews of each model, (2) update the evidence through 2007 and (3) summarize the status of the evidence for…

  18. Culture and Psychiatric Diagnosis

    PubMed Central

    Lewis-Fernández, Roberto; Aggarwal, Neil Krishan

    2015-01-01

    Since the publication of DSM-IV in 1994, a number of components related to psychiatric diagnosis have come under criticism for their inaccuracies and inadequacies. Neurobiologists and anthropologists have particularly criticized the rigidity of DSM-IV diagnostic criteria that appear to exclude whole classes of alternate illness presentations as well as the lack of attention in contemporary psychiatric nosology to the role of contextual factors in the emergence and characteristics of psychopathology. Experts in culture and mental health have responded to these criticisms by revising the very process of diagnosis for DSM-5. Specifically, the DSM-5 Cultural Issues Subgroup has recommended that concepts of culture be included more prominently in several areas: an introductory chapter on Cultural Aspects of Psychiatric Diagnosis –composed of a conceptual introduction, a revised Outline for Cultural Formulation, a Cultural Formulation Interview that operationalizes this Outline, and a glossary on cultural concepts of distress—as well as material directly related to culture that is incorporated into the description of each disorder. This chapter surveys these recommendations to demonstrate how culture and context interact with psychiatric diagnosis at multiple levels. A greater appreciation of the interplay between culture, context, and biology can help clinicians improve diagnostic and treatment planning. PMID:23816860

  19. Comparison of acute physiology and chronic health evaluation II and acute physiology and chronic health evaluation IV to predict intensive care unit mortality

    PubMed Central

    Parajuli, Bashu Dev; Shrestha, Gentle S.; Pradhan, Bishwas; Amatya, Roshana

    2015-01-01

    Context: Clinical assessment of severity of illness is an essential component of medical practice to predict the outcome of critically ill-patient. Acute Physiology and Chronic Health Evaluation (APACHE) model is one of the widely used scoring systems. Aims: This study was designed to evaluate the Performance of APACHE II and IV scoring systems in our Intensive Care Unit (ICU). Settings and Design: A prospective study in 6 bedded ICU, including 76 patients all above 15 years. Subjects and Methods: APACHE II and APACHE IV scores were calculated based on the worst values in the first 24 h of admission. All enrolled patients were followed, and outcome was recorded as survivors or nonsurvivors. Statistical Analysis Used: SPSS version 17. Results: The mean APACHE score was significantly higher among nonsurvivors than survivors (P < 0.005). Discrimination for APACHE II and APACHE IV was fair with area under receiver operating characteristic curve of 0.73 and 0.79 respectively. The cut-off point with best Youden index for APACHE II was 17 and for APACHE IV was 85. Above cut-off point, mortality was higher for both models (P < 0.005). Hosmer–Lemeshow Chi-square coefficient test showed better calibration for APACHE II than APACHE IV. A positive correlation was seen between the models with Spearman's correlation coefficient of 0.748 (P < 0.01). Conclusions: Discrimination was better for APACHE IV than APACHE II model however Calibration was better for APACHE II than APACHE IV model in our study. There was good correlation between the two models observed in our study. PMID:25722550

  20. Psychiatric-Mental Health Nursing.

    ERIC Educational Resources Information Center

    Reighley, Joan

    A description is provided of a course, "Psychiatric-Mental Health Nursing," designed to teach students at Level 3 of a two-year college nursing program about the role of the nurse in a psychiatric setting and about concepts of mental health and psychiatric disorders, using both classroom and clinical instruction. The first section of the course…

  1. [Psychiatric effects of cardiac surgery].

    PubMed

    Imbert, D; Daubech, M J; Tignol, J; Bourgeois, M

    1976-11-01

    The authors report three cases of psychotic complications of cardiac surgery. A review is made from literature and an inventory of psychological and organic factors implicated in this pathology. These complications are still frequent (up to 50% for Braceland, and 70% for Rabiner and al.). For Blacher there is an almost universal "psychosis" in by-pass surgery and frequent "hidden psychosis" (they are ignored and denied both by the staff and the patient). They are caused by the emotional stress, intensive care unit syndrome, or personal vulnerability. The symbolism of the heart and the personality of the cardiac patient are also in cause. Neurologic accidents, hypoxy, embolisms, are now less frequent. The collaboration of a psychiatrist with the cardiologic staff is mandatory. With this collaboration not only psychiatric complications but also somatic morbidity and mortality would be reduced. PMID:1020860

  2. Health Policy Considerations in Treating Mental and Behavioral Health Emergencies in the United States.

    PubMed

    Halmer, Thiago C; Beall, Rakel C; Shah, Asim A; Dark, Cedric

    2015-11-01

    In recent years, health care providers have sounded the call that the US mental health system is in crisis. With decreases in funding and eroding access to care, the availability of psychiatric services has become increasingly limited, failing to meet growing needs. This article provides a brief history of mental health services in the United States and describes the current landscape of US psychiatric care; it touches upon some of the most important policy considerations, describing some of the glaring issues in US mental health care today. Last, it offers some potential remedies to improve care in acute behavioral emergencies. PMID:26493530

  3. Development and Pilot of a Checklist for Management of Acute Liver Failure in the Intensive Care Unit

    PubMed Central

    Liou, Iris; Karvellas, Constantine J.; Ganger, Daniel R.; Forde, Kimberly A.; Subramanian, Ram M.; Boylan, Alice; Hanje, James; Stravitz, R. Todd; Lee, William M.

    2016-01-01

    Introduction Acute liver failure (ALF) is an ideal condition for use of a checklist. Our aims were to develop a checklist for the management of ALF in the intensive care unit (ICU) and assess the usability of the checklist among multiple providers. Methods The initial checklist was developed from published guidelines and expert opinion. The checklist underwent pilot testing at 11 academic liver transplant centers in the US and Canada. An anonymous, written survey was used to assess the usability and quality of the checklist. Written comments were used to improve the checklist following the pilot testing period. Results We received 81 surveys involving the management of 116 patients during the pilot testing period. The overall quality of the checklist was judged to be above average to excellent by 94% of users. On a 5-point Likert scale, the majority of survey respondents agreed or agreed strongly with the following checklist characteristics: the checklist was easy to read (99% agreed/agreed strongly), easy to use (97%), items are categorized logically (98%), time to complete the checklist did not interfere with delivery of appropriate and safe patient care (94%) and was not excessively burdensome (92%), the checklist allowed the user the freedom to use his or her clinical judgment (80%), it is a useful tool in the management of acute liver failure (98%). Web-based and mobile apps were developed for use of the checklist at the point of care. Conclusion The checklist for the management of ALF in the ICU was shown in this pilot study to be easy to use, helpful and accepted by a wide variety of practitioners at multiple sites in the US and Canada. PMID:27176033

  4. Acute Poisonings Admitted to a Tertiary Level Intensive Care Unit in Northern India: Patient Profile and Outcomes

    PubMed Central

    Mathai, Ashu Sara; Pannu, Aman; Arora, Rohit

    2015-01-01

    Background Poisoning is becoming a real health care burden for developing countries like India. An improved knowledge of the patterns of poisonings, as well as the clinical course and outcomes of these cases can help to formulate better preventive and management strategies. Aim To study the demographic and clinical profiles of patients admitted to the ICU with acute poisoning and to study the factors that predict their mortality. Materials and Methods Retrospective two years (September 1, 2010 to August 31, 2012) study of all consecutive patients admitted to the Intensive Care Unit (ICU) with acute poisoning at a tertiary care hospital in Northern India. Results Out of the 67 patients admitted to the ICU during the study period, the majority were young (median age 29 years) males (69%) who had consumed poison intentionally. Pesticides were the most commonly employed poison, notably organophosphorus compounds (22 patients, 32.8%) and aluminium phosphide (14 patients, 20.9%). While the overall mortality from all poisonings was low (18%), aluminium phosphide was highly toxic, with a mortality rate of 35%. The factors at ICU admission that were found to be associated with a significant risk of death were, high APACHE II and SOFA scores (p =0.0001 and p=0.006, respectively), as well as the need for mechanical ventilation and drugs for vasoactive support (p=0.012 and p= 0.0001, respectively). Conclusion Use of pesticides for intentional poisoning continues to be rampant in Northern India, with many patients presenting in a critical condition to tertiary level hospitals. Pesticide regulations laws, educational awareness, counseling and poison information centers will help to curtail this public health problem. PMID:26557594

  5. Trends in Outcome and Hospitalization Cost among Adult Patients with Acute Ischemic Stroke in the United States

    PubMed Central

    Yacoub, Hussam A.; Al-Qudah, Zaid A.; Khan, Hafiz M. R.; Farhad, Khosro; Ji, Andrew Bo-Hua; Souayah, Nizar

    2015-01-01

    Introduction New treatments for acute ischemic stroke (AIS) have been introduced and are expected to improve patients’ overall outcomes. We assessed the impact of new therapeutic strategies on outcome and cost of hospitalization among adult patients with AIS in the United States. Methods Patients with AIS admitted in the United States in 1993–1994 and 2006–2007 were listed using the Nationwide Inpatient Survey database. We determined the rates of occurrence, hospitalization outcomes, and mean hospital charges for all patients. We further analyzed these variables in the ventilated and nonventilated patients. Results We identified 386,043 patients with AIS admitted in the United States in 1993–1994 and 749,766 patients in 2006–2007. The length of hospitalization was significantly higher in 1993–1994 compared with 2006–2007: 6.9 ± 4.2 days versus 4.66 ± 3 days, respectively. In-hospital mortality rate was 8.9% in 1993–1994 and 5.6% in 2006–2007 (P < 0.0001). There was a significant increase in mean hospital charges in 2006–2007 compared with 1993–1994 ($21,916 ± $14,117 versus $9,646 ± $5,727). The length of hospitalization was significantly shorter in 2006–2007 in nonventilated patients. There was a significant increase in mean hospital charges in 2006–2007 compared with 1993–1994 in both ventilated ($81,528 ± $64,526 versus $25,143 ± $17,172, P<0.0001) and nonventilated patients ($21,085 ± $13,042 versus $10,000 ± $6,300, P<0.0001). The mortality rate was significantly lower in 2006–2007 in both subgroups: 46.5% versus 59.8% in ventilated patients and 4.2% versus 8.2% in nonventilated patients (P < 0.0001). Conclusion Our study suggests that new therapeutic strategies have improved outcomes and increased cost of hospitalization among adult patients with AIS in the United States over a period of 13 years. The hospitalization cost was significantly higher in the ventilated and nonventilated patients in 2006–2007, which may

  6. [Acute cholangitis in interstenosis space accompanied by two-component unit of the main bile duct].

    PubMed

    Yurchenko, V V

    2016-02-01

    Palliative treatment of obstructive jaundice with the help of biliary endoprosthesis due to the possible complication of post-intervention in the form of insolvency stent deformation or dislocation. The study features in the postoperative period of the main bile duct endoprosthesis about their two-component unit, described the syndrome of the closed space of the bile ducts. On the basis of observation of 14 patients with the given anatomical feature of endoscopic, who were underwent stenting, was assessed frequency of the syndrome and possibilities of its prevention. Interstenosis space expansion of the main bile duct can be a reason for local cholangitis. For the prevention of cholangitis, it should be carried out a separate drainage of interstenosis space with the help of endoprosthesis or by proximal supra-stenotic extension of two or more stents. PMID:27263209

  7. [Interest of ambulatory simplified acute physiology score (ASAPS) applied to patients admitted in an intensive care unit of an infectious diseases unit in Dakar].

    PubMed

    Dia, N M; Diallo, I; Manga, N M; Diop, S A; Fortes-Deguenonvo, L; Lakhe, N A; Ka, D; Seydi, M; Diop, B M; Sow, P S

    2015-08-01

    The evaluation of patients by a scale of gravity allows a better categorization of patients admitted in intensive care unit (ICU). Our study had for objective to estimate interest of Ambulatory Simplified Acute Physiologic Score (ASAPS) applied to patients admitted in ICU of infectious diseases department of FANN hospital. It was about a descriptive and analytical retrospective study, made from the data found in patients' files admitted into the USI infectious diseases department of FANN hospital in Dakar, from January 1(st), 2009 till December 31st, 2009.The data of 354 patients' files were analyzed. The sex-ratio was 1.77 with an average age of 37.6 years ± 19.4 years old [5-94 years]. The majority of the patients were unemployed paid (39.6%). The most frequent failures were the following ones: neurological (80.5%), cardio-respiratory (16.7%). The average duration of stay was 6.2 days ± 8.2 days going of less than 24 hours to more than 10 weeks. The deaths arose much more at night (53.1%) than in the daytime (46.9%) and the strongest rate of death was recorded in January (61.5%), most low in October (26.7%). The global mortality was 48.3%. The rate of lethality according to the highest main diagnosis was allocated to the AIDS (80.5%). The average ambulatory simplified acute physiology score was 5.3 ± 3.6 with extremes of 0 and 18. The deaths in our series increased with this index (p = 0.000005). The female patients had a rate of lethality higher than that of the men people, 55.5% against 44.2% (p = 0.03). In spite of a predictive score of a high survival (ASAPS < 8), certain number of patients died (n = 105) that is 61.4% of the deaths. The metabolic disturbances, hyperleukocytosis or leukopenia when realised, the presence of a chronic disease, seemed also to influence this lethality. ASAPS only, although interesting, would not good estimate the gravity of patients, where from the necessity thus of a minimum biological balance sheet. It seems better adapted

  8. Exploring the Influence of Environment on the Spatial Behavior of Older Adults in a Purpose-Built Acute Care Dementia Unit.

    PubMed

    Mazzei, Francesco; Gillan, Roslyn; Cloutier, Denise

    2014-06-01

    Limited research explores the experience of individuals with dementia in acute care geriatric psychiatry units. This observational case study examines the influence of the physical environment on behavior (wandering, pacing, door testing, congregation and seclusions) among residents in a traditional geriatric psychiatry unit who were then relocated to a purpose-built acute care unit. Purpose-built environments should be well suited to the needs of residents with dementia. Observed trends revealed differences in spatial behaviors in the pre- and post- environments attributable to the physical environment. Person-centred modifications to the current environment including concerted efforts to know residents are meaningful in fostering quality of life. Color coded environments (rooms vs dining areas etc.) to improve wayfinding and opportunities to personalize rooms that address the `hominess' of the setting also have potential. Future research could also seek the opinions of staff about the impact of the environment on them as well as residents. PMID:24381136

  9. Psychiatric hospital challenges for healthcare security officers.

    PubMed

    White, Donald E

    2003-01-01

    Security and Safety managers in today's healthcare facilities need to use creative thinking and resourcefulness, to juggle competing issues in psychiatric hospitals, wards, or units. Using a 3-step process of accountability, access control, and scenario exercises, these managers can mitigate the real-world risk assessment discoveries that might not be evident in well-documented facility policies, staff training, or even written surveys. PMID:12629788

  10. A predictive instrument to improve coronary-care-unit admission practices in acute ischemic heart disease. A prospective multicenter clinical trial.

    PubMed

    Pozen, M W; D'Agostino, R B; Selker, H P; Sytkowski, P A; Hood, W B

    1984-05-17

    Each year 1.5 million patients are admitted to coronary-care units (CCUs) for suspected acute ischemic heart disease; for half of these, the diagnosis is ultimately "ruled out." In this study, conducted in the emergency rooms of six New England hospitals ranging in type from urban teaching centers to rural nonteaching hospitals, we sought to develop a diagnostic aid to help emergency room physicians reduce the number of their CCU admissions of patients without acute cardiac ischemia. From data on 2801 patients, we developed a predictive instrument for use in a hand-held programmable calculator, which requires only 20 seconds to compute a patient's probability of having acute cardiac ischemia. In a prospective trial that included 2320 patients in the six hospitals, physicians' diagnostic specificity for acute ischemia increased when the probability value determined by the instrument was made available to them. Rates of false-positive diagnosis decreased without any increase in rates of false-negative diagnosis. Among study patients with a final diagnosis of "not acute ischemia," the number of CCU admissions decreased 30 per cent, without any increase in missed diagnoses of ischemia. The proportion of CCU admissions that represented patients without acute ischemia dropped from 44 to 33 per cent. Widespread use of this predictive instrument could reduce the number of CCU admissions in this country by more than 250,000 per year. PMID:6371525

  11. The acute effect of stretching on the passive stiffness of the human gastrocnemius muscle tendon unit

    PubMed Central

    Morse, C I; Degens, H; Seynnes, O R; Maganaris, C N; Jones, D A

    2008-01-01

    Passive stretching is commonly used to increase limb range of movement prior to athletic performance but it is unclear which component of the muscle–tendon unit (MTU) is affected by this procedure. Movement of the myotendinous junction (MTJ) of the gastrocnemius medialis muscle was measured by ultrasonography in eight male participants (20.5 ± 0.9 years) during a standard stretch in which the ankle was passively dorsiflexed at 1 deg s−1 from 0 deg (the foot at right angles to the tibia) to the participants' volitional end range of motion (ROM). Passive torque, muscle fascicle length and pennation angle were also measured. Standard stretch measurements were made before (pre-) and after (post-) five passive conditioning stretches. During each conditioning stretch the MTU was taken to the end ROM and held for 1 min. Pre-conditioning the extension of the MTU during stretch was taken up almost equally by muscle and tendon. Following conditioning, ROM increased by 4.6 ± 1.5 deg (17%) and the passive stiffness of the MTU was reduced (between 20 and 25 deg) by 47% from 16.0 ± 3.6 to 10.2 ± 2.0 Nm deg−1. Distal MTJ displacement (between 0 and 25 deg) increased from 0.92 ± 0.06 to 1.16 ± 0.05 cm, accounting for all the additional MTU elongation and indicating that there was no change in tendon properties. Muscle extension pre-conditioning was explicable by change in length and pennation angle of the fascicles but post-conditioning this was not the case suggesting that at least part of the change in muscle with conditioning stretches was due to altered properties of connective tissue. PMID:17884924

  12. CQUIN audit for prescription of antibiotics for urinary tract infections in an acute medical assessment unit.

    PubMed

    Oppenheimer, Maylin; Rezwan, Nivin

    2015-01-01

    Urinary tract infections (UTI) are a common presentation in a medical assessment unit, and we wanted to check compliance with hospital guidelines for antibiotic prescribing in patients presenting to hospital with urinary tract infection. The guidelines are based on local organisms and sensitivities. A retrospective audit of 40 patient records with positive urine cultures from July to August 2013 showed that 20% of patients with culture confirmed UTI were not given antibiotics at all. Of those prescribed antibiotics, 25% were non-compliant with local policy, and nearly one in two patients received more than one antibiotic. Furthermore, stop dates were not stated on 77% of the drug charts and duration of treatment ranged from one to 11 days. Interventions were then introduced in the form of group teaching sessions, proactive checks by Trust pharmacists and widely distributed posters, and the same data sets collected for April to March 2014 to assess for efficacy of the interventions. On re-auditing, 35% patients were not prescribed any antibiotics. However, compliance with local policy was 100%, including 100% drug charts having a stop/review date stated. The overall duration of treatment now ranged from one to seven days, and fewer than one in four patients had more than one antibiotic. Our results showed that improvement was needed in antibiotic stewardship, in particular with regards to compliance with the local guidelines and documentation of prescription. We have demonstrated that it is possible to improve compliance through teaching, by displaying information prominently, and vigilance by the clinical team. The outcome of this is a decreased number and duration of antibiotics prescribed, which has benefits for the patients, the hospital, and the community as a whole. Further work would include interventions to improve the number of patients who are missing antibiotic prescriptions altogether. PMID:26734357

  13. [Indications for central veinous catheterism in psychiatric patients (author's transl)].

    PubMed

    König, P; Strickner, M

    1978-03-01

    Based on cases of a Psychiatric Intensive Care Unit specific indications and applications of catheterism of central-veins in these special instances are presented, the psychiatric indications and contraindications for such measures are submitted in addition to those known from other medical fields. The mode of insertion, duration, infusionregimen and rates of complications are reviewed in 102 cases. Two of the common veinous-catheter systems are compared as for practicability. PMID:417008

  14. Culture and psychiatric diagnosis.

    PubMed

    Lewis-Fernández, Roberto; Aggarwal, Neil Krishan

    2013-01-01

    Since the publication of DSM-IV in 1994, neurobiologists and anthropologists have criticized the rigidity of its diagnostic criteria that appear to exclude whole classes of alternate illness presentations, as well as the lack of attention in contemporary psychiatric nosology to the role of contextual factors in the emergence and characteristics of psychopathology. Experts in culture and mental health have responded to these criticisms by revising the very process of diagnosis for DSM-5. Specifically, the DSM-5 Cultural Issues Subgroup has recommended that concepts of culture be included more prominently in several areas: an introductory chapter on Cultural Aspects of Psychiatric Diagnosis - composed of a conceptual introduction, a revised Outline for Cultural Formulation, a Cultural Formulation Interview that operationalizes this Outline, and a glossary on cultural concepts of distress - as well as material directly related to culture that is incorporated into the description of each disorder. This chapter surveys these recommendations to demonstrate how culture and context interact with psychiatric diagnosis at multiple levels. A greater appreciation of the interplay between culture, context, and biology can help clinicians improve diagnostic and treatment planning. PMID:23816860

  15. Mechanism of Mitochondrial Connexin43′s Protection of the Neurovascular Unit under Acute Cerebral Ischemia-Reperfusion Injury

    PubMed Central

    Hou, Shuai; Shen, Ping-Ping; Zhao, Ming-Ming; Liu, Xiu-Ping; Xie, Hong-Yan; Deng, Fang; Feng, Jia-Chun

    2016-01-01

    We observed mitochondrial connexin43 (mtCx43) expression under cerebral ischemia-reperfusion (I/R) injury, analyzed its regulation, and explored its protective mechanisms. Wistar rats were divided into groups based on injections received before middle cerebral artery occlusion (MCAO). Cerebral infarction volume was detected by 2,3,5-triphenyltetrazolim chloride staining, and cell apoptosis was observed by transferase dUTP nick end labeling. We used transmission electron microscopy to observe mitochondrial morphology and determined superoxide dismutase (SOD) activity and malondialdehyde (MDA) content. MtCx43, p-mtCx43, protein kinase C (PKC), and p-PKC expression were detected by Western blot. Compared with those in the IR group, cerebral infarction volumes in the carbenoxolone (CBX) and diazoxide (DZX) groups were obviously smaller, and the apoptosis indices were down-regulated. Mitochondrial morphology was damaged after I/R, especially in the IR and 5-hydroxydecanoic acid (5-HD) groups. Similarly, decreased SOD activity and increased MDA were observed after MCAO; CBX, DZX, and phorbol-12-myristate-13-acetate (PMA) reduced mitochondrial functional injury. Expression of mtCx43 and p-mtCx43 and the p-Cx43/Cx43 ratio were significantly lower in the IR group than in the sham group. These abnormalities were ameliorated by CBX, DZX, and PMA. MtCx43 may protect the neurovascular unit from acute cerebral IR injury via PKC activation induced by mitoKATP channel agonists. PMID:27164087

  16. Racial and Ethnic Differences in Acute Coronary Syndrome and Myocardial Infarction Within the United States: From Demographics to Outcomes.

    PubMed

    Graham, Garth

    2016-05-01

    In the United States, different races, ethnicities, and their subgroups experience disparities regarding acute coronary syndrome (ACS) and myocardial infarction (MI). This review highlights these differences across 4 stages that comprise the ACS/MI narrative: (1) patient demographics, (2) patient comorbidities and health risks, (3) treatments and their delays, and (4) outcomes. Overall, black and Hispanic ACS/MI patients are more likely to present with comorbidities, experience longer delays before treatment, and suffer worse outcomes when compared with non-Hispanic white patients. More specifically, across the studies analyzed, black and Hispanic ACS/MI patients were consistently more likely to be younger or female, or to have hypertension or diabetes, than non-Hispanic white patients. ACS/MI disparities also exist among Asian populations, and these are briefly outlined. However, black, Hispanic, and non-Hispanic white ACS/MI patients were the 3 most-studied racial and ethnic groups, indicating that additional studies of other minority groups, such as Native Americans, Asian populations, and black and Hispanic subgroups, are needed for their utility in reducing disparities. Despite notable improvement in ACS/MI treatment quality measures over recent decades, disparities persist. Causes are complex and extend beyond the healthcare system to culture and patients' personal characteristics; sophisticated solutions will be required. Continued research has the potential to further reduce or eliminate disparities in the comorbidities, delays, and treatments surrounding ACS and MI, extending healthy lifespans of many underserved and minority populations, while reducing healthcare costs. PMID:27028198

  17. Clinical Characteristics and 30-Day Outcomes of Intermittent Hemodialysis for Acute Kidney Injury in an African Intensive Care Unit

    PubMed Central

    Tumukunde, Janat; Ssemogerere, Lameck; Ayebale, Emmanuel; Agaba, Peter; Yakubu, Jamali; Lubikire, Aggrey; Nabukenya, Mary

    2016-01-01

    Introduction. Acute kidney injury (AKI) is a common occurrence in the intensive care unit (ICU). Studies have looked at outcomes of renal replacement therapy using intermittent haemodialysis (IHD) in ICUs with varying results. Little is known about the outcomes of using IHD in resource-limited settings where continuous renal replacement therapy (CRRT) is limited. We sought to determine outcomes of IHD among critically ill patients admitted to a low-income country ICU. Methods. A retrospective review of patient records was conducted. Patients admitted to the ICU who underwent IHD for AKI were included in the study. Patients' demographic and clinical characteristics, cause of AKI, laboratory parameters, haemodialysis characteristics, and survival were interpreted and analyzed. Primary outcome was mortality. Results. Of 62 patients, 40 had complete records. Median age of patients was 38.5 years. Etiologic diagnoses associated with AKI included sepsis, malaria, and ARDS. Mortality was 52.5%. APACHE II (OR 4.550; 95% CI 1.2–17.5, p = 0.028), mechanical ventilation (OR 13.063; 95% CI 2.3–72, p = 0.003), and need for vasopressors (OR 16.8; 95% CI 3.4–82.6, p = 0.001) had statistically significant association with mortality. Conclusion. IHD may be a feasible alternative for RRT in critically ill haemodynamically stable patients in low resource settings where CRRT may not be available. PMID:27042657

  18. Lower mean corpuscular hemoglobin concentration is associated with poorer outcomes in intensive care unit admitted patients with acute myocardial infarction

    PubMed Central

    Huang, Yuan-Lan

    2016-01-01

    Background Accumulated studies have shown that hematological parameters [e.g., red blood cell distribution width (RDW), hemoglobin, platelet count] and serum potassium level can impact the prognosis of patients with acute myocardial infarction (AMI). However, no previous study has evaluated the prognostic values of these laboratory tests simultaneously. Methods This study is based on an intensive care unit (ICU) database named Multiparameter Intelligent Monitoring in Intensive Care II (MIMIC II). Adult patients with AMI were included, and their hematological parameters and serum ion levels on admission were extracted. The relationships between these laboratory tests and hospital mortality were evaluated using a logistic regression model and receiver operating characteristic (ROC) curve analysis. The effects of these laboratory tests on 1-year mortality were evaluated using a Cox hazard regression model and Kaplan-Meier curve analysis. Results In univariable analysis, increased white blood cell (WBC), neutrophil percentage, mean corpuscular volume (MCV), RDW, potassium and decreased red blood cell (RBC), hemoglobin, mean corpuscular hemoglobin concentration (MCHC), hematocrit and percentage of lymphocyte, monocyte, basophil and eosinophil were significantly associated with hospital mortality. In multivariable analyses, basophil percentage, potassium, WBC and MCHC were independently associated with hospital morality, while WBC, RDW, MCHC, potassium and percentages of neutrophil and lymphocyte were associated with 1-year mortality. Conclusions Hematological parameters and serum potassium can provide prognostic information in AMI patients. MCHC is an independent prognostic factor for both short and long term outcomes of AMI. PMID:27294086

  19. Feigning Acute Intermittent Porphyria

    PubMed Central

    Elkhatib, Rania; Idowu, Modupe; Brown, Gregory S.; Jaber, Yasmeen M.; Reid, Matthew B.; Person, Cheryl

    2014-01-01

    Acute intermittent porphyria (AIP) is an autosomal dominant genetic defect in heme synthesis. Patients with this illness can have episodic life-threatening attacks characterized by abdominal pain, neurological deficits, and psychiatric symptoms. Feigning this illness has not been reported in the English language literature to date. Here, we report on a patient who presented to the hospital with an acute attack of porphyria requesting opiates. Diligent assessment of extensive prior treatment records revealed thirteen negative tests for AIP. PMID:25525547

  20. Current and emerging models of residential psychiatric treatment, with special reference to the California situation.

    PubMed

    Atkinson, R M

    1975-04-01

    The author reviews the steps that have led to the progressive deemphasis of psychiatric hospitalization in California and surveys the empirical basis for rejecting the usefulness of hospitalization. He discusses the four alternative residential models that have emerged in California as substitutes for state mental hospitals--general hospital psychiatric units, board and care homes, private psychiatric facilities available through vendor contracts, and convalescent hospitals. The author also touches briefly upon some important problems, including the possible fate of public general hospital psychiatric units, community mental health services, and the commitment law in California. PMID:1091160

  1. A predictive instrument for acute ischemic heart disease to improve coronary care unit admission practices: a potential on-line tool in a computerized electrocardiograph.

    PubMed

    Selker, H P; D'Agostino, R B; Laks, M M

    1988-01-01

    Each year, 1.5 million patients are admitted to coronary care units (CCUs) for suspected acute ischemic heart disease, but for half of these, the diagnosis is ultimately ruled out. In this study, conducted in the emergency rooms (ERs) of six New England hospitals, the authors sought to develop a diagnostic aid to help ER physicians reduce the numbers of CCU admissions for patients without true acute cardiac ischemia. In phase 1, from data on 2,801 patients, they developed a predictive instrument for use in a handheld programmable calculator, which, based on a mathematical logistic regression formula, computes a patient's probability of having acute cardiac ischemia. In phase 2, a 1-year prospective trial including 2,320 ER patients at the six hospitals, physicians' diagnostic specificity for acute ischemia increased when the probability value determined by the instrument was made available to them (p = 0.002), without a drop in sensitivity. Among patients without acute ischemia, the number of CCU admissions decreased 30% (p = 0.003), without an increase in missed diagnoses of ischemia. The proportion of patients in the CCU without acute ischemia dropped from 44% to 33%. If similar findings were widespread, the use of this predictive instrument could reduce the number of CCU admissions in the United States by more than 250,000 per year. As originally envisioned, the physician could use a pocket-sized programmable calculator to allow quick access to the instrument's probability value, or an ER triage nurse might compute the probability value and write it on the clinical record for the physician's use.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:3063767

  2. Munchausen syndrome mimicking psychiatric disease with concomitant genuine physical illness

    PubMed Central

    Almeida, Jaime; da Silva, Joaquim Alves; Xavier, Miguel; Gusmão, Ricardo

    2010-01-01

    Munchausen syndrome is a disorder in which patients intentionally produce symptoms mimicking physical or psychiatric illnesses with the aim to assume the sick role and to gain medical attention. Once a patient receives a Munchausen syndrome diagnosis every complaint made thence tends to be regarded with scepticism by clinical staff. However, it is possible that a bona fide illness, which might be disregarded, may coexist in these patients. We report a case of MS mimicking psychiatric disease with concomitant genuine acute physical illness. Despite the initial doubts about the veracity of the latter, due to its prompt recognition, treatment was successful. PMID:22798096

  3. Alcoholism and co-morbid psychiatric disorders among American Indians.

    PubMed

    Westermeyer, J

    2001-01-01

    Much of the data reported here regarding American Indian (AI) people has originated from specific areas with particular peoples. Thus, one must be cautious in applying information from one tribe to the hundreds of tribes living across the United States. As with any people, psychiatric disorder may be a pre-existing rationale for using alcohol. Or alternatively, alcohol may lead to various psychiatric disorders, such as organic mental conditions, posttraumatic stress disorder, or other conditions. A third alternative is that both alcoholism and other psychiatric disorder merely happen to affect the same person by chance. Recognizing alcoholism and treating it in a timely manner before disabling or even permanent psychiatric disorders ensue are key strategies. In addition, clinicians must be able to recognize and then either treat or refer co-morbid patients for appropriate care. Some psychiatric disorders, such as panic disorder, posttraumatic stress disorder, and various organic mental disorders may occur more often in some AI groups. Other co-morbid conditions, such as eating disorders, may occur less often among AI patients with alcoholism. It could be argued that resources should go solely to preventive efforts, thereby negating the need for psychiatric services. However, successful prevention of alcoholism may hinge upon, and increase the need for greater psychiatric services in AI communities. PMID:11698982

  4. Decreasing Psychiatric Admission Wait Time in the Emergency Department by Facilitating Psychiatric Discharges.

    PubMed

    Stover, Pamela R; Harpin, Scott

    2015-12-01

    Limited capacity in a psychiatric unit contributes to long emergency department (ED) admission wait times. Regulatory and accrediting agencies urge hospitals nationally to improve patient flow for better access to care for all types of patients. The purpose of the current study was to decrease psychiatric admission wait time from 10.5 to 8 hours and increase the proportion of patients discharged by 11 a.m. from 20% to 50%. The current study compared pre- and post-intervention data. Plan-Do-Study-Act cycles aimed to improve discharge processes and timeliness through initiation of new practices. Admission wait time improved to an average of 5.1 hours (t = 3.87, p = 0.006). The proportion of discharges occurring by 11 a.m. increased to 46% (odds ratio = 3.42, p < 0.0001). Improving discharge planning processes and timeliness in a psychiatric unit significantly decreased admission wait time from the ED, improving access to psychiatric care. PMID:26505524

  5. Trends in the age adjusted mortality from acute ST segment elevation myocardial infarction in the United States (1988-2004) based on race, gender, infarct location and comorbidities.

    PubMed

    Movahed, Mohammed-Reza; John, Jooby; Hashemzadeh, Mehrnoosh; Jamal, M Mazen; Hashemzadeh, Mehrtash

    2009-10-15

    Treatment of acute ST-segment elevation myocardial infarction (STEMI) has dramatically changed over the past 2 decades. The goal of this study was to determine trends in the mortality of patients with acute STEMIs in the United States over a 16-year period (1988 to 2004) on the basis of gender, race, infarct location, and co-morbidities. The Nationwide Inpatient Sample database was used to analyze the age-adjusted mortality rates for STEMI from 1988 to 2004 for inpatients age >40. International Classification of Diseases, Ninth Revision, Clinical Modification codes consistent with acute STEMI were used. The Nationwide Inpatient Sample database contained a total of 1,316,216 patients who had diagnoses of acute STEMIs from 1988 to 2004. The mean age of these patients was 66.92 +/- 12.82 years. A total of 163,915 hospital deaths occurred during the study period. From 1988, the age-adjusted mortality rate decreased gradually for all acute STEMIs for the entire study period (in 1988, 406.86 per 100,000, 95% confidence interval 110.25 to 703.49; in 2004, 286.02 per 100,000, 95% confidence interval 45.21 to 526.84). Furthermore, unadjusted mortality decreased from 15% in 1988 to 10% in 2004 (p <0.01). This decrease was similar between the genders, among most ethnicities, and in patients with diabetes and those with congestive heart failure. However, women and African Americans had higher rates of acute STEMI-related mortality compared to men and Caucasians over the years studied. In conclusion, age-adjusted mortality from acute STEMIs has significantly decreased over the past 16 years, with persistent higher mortality rates in women and African Americans the study period. PMID:19801019

  6. Protected engagement time in mental health inpatient units.

    PubMed

    McCrae, Niall

    2014-04-01

    Protected engagement time in mental health inpatient units is a fixed period each day during which administrative activities and visiting are suspended so that nurses can focus on individual patient contact. However, there are a number of barriers to implementing this strategy effectively, which include high workloads, staff shortages and lack of supervision to support therapeutic interventions. This article discusses some of these barriers and suggests that managers of acute psychiatric units should ensure that patients have appropriate emotional support, and that skilled mental health nurses should be supported to devote time to therapeutic interventions. PMID:24673233

  7. Psychiatric Comorbidity and Complications.

    PubMed

    Mason, Michael J; Aplasca, Alexis; Morales-Theodore, Rosa; Zaharakis, Nikola; Linker, Julie

    2016-07-01

    This article highlights the prevalence of co-occurring disorders among adolescents and underscores the complexity and opportunities of treating these patients in a systematic, comprehensive approach. As evidenced by this review, the need exists to develop and test models of care that integrate co-occurring disorders into both psychiatric and substance abuse treatment settings. The challenge for pediatric practitioners is to provide detailed assessments linked to evidence-based treatment plans to account for the variations in adolescent development and the unique risk factor profile of each patient. The issues related to co-morbidity are vast and continue to grow with rapidly increasing research literature. PMID:27338972

  8. Symposium--psychiatric education.

    PubMed

    Berger, D M

    1976-04-01

    The process of learning in groups, as exemplified by the author's experience in a multidiscipline conference on a surgical ward of a general hospital has been examined. A sequence of six developmental states has been identified: initial ambivalence; passive receptivity; resistance; task orientation; the work group and consolidation. These findings have been compared with those of other studies dealing with sequential stages in group development. The psychiatric consultant's role in expediting these phases and some of the difficulties encountered have been mentioned. PMID:953947

  9. Depersonalization in psychiatric patients: a transcultural study.

    PubMed

    Sierra, Mauricio; Gomez, Juliana; Molina, Juan J; Luque, Rogelio; Muñoz, Juan F; David, Anthony S

    2006-05-01

    There is evidence suggesting that the prevalence of depersonalization in psychiatric patients can vary across cultures. To explore the possible influence of culture on the prevalence of depersonalization, we compared psychiatric inpatient samples from the United Kingdom (N = 31), Spain (N = 68), and Colombia (N = 41) on standardized and validated self-rating measures of dissociation and depersonalization: the Cambridge Depersonalization Scale and the Dissociative Experiences Scale (DES). Colombian patients were found to have lower global scores on the Cambridge Depersonalization Scale and the DES and all its subscales, with the exception of DES-Absorption. No differences were found for measures of depression or anxiety. These findings seem to support the view that depersonalization is susceptible to cultural influences. Attention is drawn to the potential relevance of the sociological dimension "individualism-collectivism" on the experience of the self, and it is proposed that cultures characterized by high individualism may confer vulnerability to depersonalization experiences. PMID:16699385

  10. Early Acute Kidney Injury based on Serum Creatinine or Cystatin C in Intensive Care Unit after Major Trauma

    PubMed Central

    Zand, Farid; Sabetian, Golnar; Abbasi, Ghasem; Rezaianzadeh, Abbas; Salehi, Alireza; Khosravi, Abbas; Geramizadeh, Bita; Taregh, Shuja Ulhaq; Javadpour, Shohreh

    2015-01-01

    Background: Acute kidney injury (AKI) is a common problem in critically ill patients and is independently associated with increased morbidity and mortality. Recently, serum cystatin C has been shown to be superior to creatinine in early detection of renal function impairment. We compared estimated GFR based on serum cystatin C with estimated GFR based on serum creatinine for early detection of renal dysfunction according to the RIFLE criteria. Methods: During 9 months, three hundred post trauma patients that were referred to the intensive care unit of a referral trauma hospital were recruited. Serum creatinine and serum cystatin C were measured and the estimated GFR within 24 hours of ICU admission was calculated. The primary outcome was the incidence of AKI according to the RIFLE criteria within 2nd to 7th day of admission. Results: During the first week of ICU admission, 21% of patients experienced AKI. After adjusting for major confounders, only the patients with first day’s serum cystatin level higher than 0.78 mg/l were at higher risk of first week AKI (OR=6.14, 95% CI: 2.5-14.7, P<0.001). First day’s serum cystatin C and injury severity score were the major risk factors for ICU mortality (OR=3.54, 95% CI: 1.7-7.4, P=0.001) and (OR=4.6, 95% CI: 1.5-14, P=0.007), respectively. Conclusion: Within 24 hours after admission in ICU due to multiple trauma, high serum cystatin C level may have prognostic value in predicting early AKI and mortality during ICU admission. However, such correlation was not seen neither with creatinine nor cystatin C based GFR. PMID:26538776

  11. Frequency, Etiology and Several Sociodemographic Characteristics of Acute Poisoning in Children Treated in the Intensive Care Unit

    PubMed Central

    Azemi, Mehmedali; Berisha, Majlinda; Kolgeci, Selim; Bejiqi, Ramush

    2012-01-01

    Aim: The aim of this work has been to present the frequency, etiology and several other socio-demographic characteristics of acute poisoning in children. The treated patients and methods of work: The treated patients were children of all age groups hospitalized in the Pediatric Clinic of Prishtina during year 2009. The study was done retrospectively. The diagnosis was done on the basis of heteroanamnesis and in several cases on the basis of the anamnesis data of a child, routine laboratory tests and toxicologic analysis. Results: 66 (9.4%) poisoned children were treated in the Intensive Care Unit. The biggest number of patients, 37 (56.06%) of them, were male, and out of that number 36 (54.55%) cases were coming from rural areas. The biggest number of them 49 (74.98%) were over 2-6 years old. The poisoning was mostly caused through the digestive tract (ingestion), it happened with 55 cases (83.33%), 56 cases (84,80%) suffered from severe poisoning, whereas 59 cases (89,50%) suffered from accidental poisoning. Regarding the type of the substances that caused poisoning, the most frequent were drugs in 34 (51.50%) cases and pesticides in 20 (30.30%) cases. Among drugs, the most dominant were those belonging to a group of benzodiazepines (10 cases) and metoclopramide (4 cases). Among pesticides the most dominant one that caused poisoning was malation (5 cases), then paration and cipermetrina appeared in 3 cases each. The biggest number of cases, 64 (96.96%) of them, were treated, whereas 2 cases (3.40%) passed away. Conclusion: The practice proved that that our people are not well informed about the poisoning in general, therefore it is necessary that they be educated by the use of all media, written and electronic, as well as other methods of medical education. PMID:23678312

  12. The Main Etiologies of Acute Kidney Injury in the Newborns Hospitalized in the Neonatal Intensive Care Unit

    PubMed Central

    Momtaz, Hossein Emad; Sabzehei, Mohammad Kazem; Rasuli, Bahman; Torabian, Saadat

    2014-01-01

    Introduction: Acute kidney injury (AKI) is one of the most common diseases among the newborns hospitalized in the neonatal intensive care units (NICUs), which is usually resulted from predisposing factors including sepsis, hypovolemia, asphyxia, respiratory distress syndrome (RDS), and heart failure. The goal of this study was to assess main etiologies, relevant risk factors, and early outcome of neonatal AKI. Materials and Methods: In a cross- sectional study, 49 consecutive neonates hospitalized in NICU of Besat hospital with diagnosis of AKI from October 2009 to October 2011 were investigated through census sampling method. AKI was diagnosed based on urine output and serum creatinine levels. Results: The prevalence of AKI was 1.54% (49 out of 3166 newborns hospitalized in NICU) with the female: male was 7:1. Thirty-nine patients (79.5%) were full-term neonates. Oliguria was observed in 38 (77.5%) patients. Sepsis was the most common predisposing factor for AKI in 77.5% of patients (n = 38) accompanied with the highest mortality rate among other factors (30.5%). Other leading causes of AKI included hypovolemia secondary to dehydration, followed by hypoxia secondary to RDS, patent ductus arteriosus, posterior urethral valve, asphyxia, and renal venous thrombosis. A positive relationship was observed between neonates' age, sex, urine output, and also between serum creatinine levels with initiation of dialysis. The mortality rate among the newborns hospitalized with AKI was 36.7%. Eighteen (36.7%) newborns were treated with peritoneal dialysis (PD) of whom 10 patients (55.6%) died, 31 patients were managed conservatively of whom five neonate died (25.9%). Discussion: Prognosis of AKI in the oliguric neonates requiring PD is very poor. It is thus recommended to prevent AKI by predicting and rapid diagnosis of AKI in patients with potential risk factors and also by early and effective treatment of such factors in individuals with AKI. PMID:25024976

  13. Staff gender ratio and aggression in a forensic psychiatric hospital.

    PubMed

    Daffern, Michael; Mayer, Maggie; Martin, Trish

    2006-06-01

    Gender balance in acute psychiatric inpatient units remains a contentious issue. In terms of maintaining staff and patient safety, 'balance' is often considered by ensuring there are 'sufficient' male nurses present on each shift. In an ongoing programme of research into aggression, the authors investigated reported incidents of patient aggression and examined the gender ratio on each shift over a 6-month period. Contrary to the popular notion that a particular gender ratio might have some relationship with the likelihood of aggressive incidents, there was no statistically significant difference in the proportion of male staff working on the shifts when there was an aggressive incident compared with the shifts when there was no aggressive incident. Further, when an incident did occur, the severity of the incident bore no relationship with the proportion of male staff working on the shift. Nor did the gender of the shift leader have an impact on the decision to seclude the patient or the likelihood of completing an incident form following an aggressive incident. Staff confidence in managing aggression may be influenced by the presence of male staff. Further, aspects of prevention and management may be influenced by staff gender. However, results suggest there is no evidence that the frequency or severity of aggression is influenced by staff gender ratio. PMID:16643344

  14. Recurrent psychiatric hospitalization.

    PubMed Central

    Voineskos, G.; Denault, S.

    1978-01-01

    Undue emphasis has been placed on rising rates of readmission to psychiatric facilities. After a decade of preoccupation with discharge rates, readmission statistics have been singled out in the last 15 years as the key factor for assessing hospital effectiveness. A study of a group of patients at high risk for recurrent hospitalization revealed that these patients were characterized more by features relating to environmental supports than by diagnosis. The operational definition for recurrent hospitalization (five or more admissions during the 2-year period preceding the latest admission) was effective in identifying this group; this is the first reported instance in which the definition has specified a certain number of admissions within a time-limited period. The findings of this study, as well as of an analysis of case histories and consumer opinion, led to the design of a pilot program for persons undergoing recurrent hospitalization. Readmission statistics are useless or misleading as measures of hospital effectiveness and efficiency; what matters is the way the former patients function in the community after discharge. Rather than simply trying to reduce the readmission rate psychiatric facilities should be examining the types of persons who are hospitalized recurrently to develop programs aimed at improving the functioning of these people in the community. PMID:630483

  15. Twelve-month prevalence of psychiatric disorders and treatment-seeking among Asian Americans/Pacific Islanders in the United States: Results from the National Epidemiological Survey on Alcohol and Related Conditions

    PubMed Central

    Xu, Yang; Okuda, Mayumi; Hser, Yih-Ing; Hasin, Deborah; Liu, Shang-Min; Grant, Bridget F.; Blanco, Carlos

    2011-01-01

    To compare the 12-month prevalence of psychiatric disorders in Asian Americans/Pacific Islanders in contrast to non–Hispanic whites; and further compare persistence and treatment-seeking rates for psychiatric disorders among Asian American/Pacific Islanders and non-Hispanic whites, analyses from the 2001–2002 National Epidemiologic Survey on Alcohol and Related Conditions, Wave 1 (n =43,093) were conducted for the subsample of 1,332 Asian Americans/Pacific Islanders (596 men and 736 women) and 24,507 non-Hispanic whites (10,845 men and 13,662 women). The past 12-month prevalence for any psychiatric disorder was significantly lower in Asian American/Pacific Islander males and females than non-Hispanic white males and females. Asian American/Pacific Islander males were less likely than non-Hispanic white males to have any mood, anxiety, substance use, and personality disorders, whereas the prevalence of mood disorders among Asian American/Pacific Islander females did not differ from those of non-Hispanic white females. In some cases, such as drug use disorders, both male and female Asian Americans/Pacific Islanders were more likely to have more persistent disorders than non-Hispanic whites. Compared to non-Hispanic white females, Asian American/Pacific Islander females had lower rates of treatment-seeking for any mood/anxiety disorders. Although less prevalent than among non-Hispanic whites, psychiatric disorders are not uncommon among Asian Americans/Pacific Islanders. The lower treatment seeking rates for mood/anxiety disorders in Asian American/Pacific Islander females underscore the unmet needs for psychiatric service among this population. PMID:21238989

  16. [Dual diagnosis in psychiatric inpatients: prevalence and general characteristics].

    PubMed

    Rodríguez-Jiménez, Roberto; Aragüés, María; Jiménez-Arriero, Miguel Angel; Ponce, Guillermo; Muñoz, Antonio; Bagney, Alexandra; Hoenicka, Janet; Palomo, Tomás

    2008-06-01

    Comorbidity between a substance use disorder (SUD) and another psychiatric disorder is known as dual diagnosis. It is of great relevance due to its important clinical consequences and costs of care. There are practically no published studies on dual diagnosis prevalence in patients admitted to psychiatric hospitalization units in general hospitals (PHUGH) in our country. The objectives were to estimate the prevalence of dual diagnosis in psychiatric inpatients admitted consecutively to a Psychiatric Hospitalization Unit (Hospital Universitario 12 de Octubre, Madrid, Spain) in one year, to compare clinical and sociodemographic variables between the dual diagnosis group (DD group) and the group with a psychiatric disorder but no SUD (PD group), and to study the types of substances used. This is a retrospective study, based on the review of the clinical charts of the 257 patients admitted to this PHUGH in one year. The results showed that, excluding nicotine dependence, 24.9% of our inpatients had a SUD as well as another psychiatric disorder. A statistically significant predominance of men was found in the DD group, as well as a younger age at the time of the study, at the beginning of their psychiatric attention and on their first psychiatric admission, and they had received diagnoses of schizophrenia or related psychoses more often than the PD group, who had mostly affective disorders. The substances most frequently used in the DD group were alcohol (78.1%), cannabis (62.5%), and cocaine (51.6%). Due to the high prevalence and repercussions of dual diagnosis, it would be advisable to have specialized therapeutic programs for its treatment. PMID:18717266

  17. Psychiatric Comorbidities in Restless Legs Syndrome.

    PubMed

    Kallweit, Ulf; Werth, Esther; Seiz, Angela; Sefidan, Sandra; Dahmen, Norbert; Manconi, Mauro; Ehlert, Ulrike; Bassetti, Claudio L A

    2016-01-01

    Restless legs syndrome (RLS) is a neurological sleep disorder with frequent (39%) coexisting psychiatric comorbidities. Patients with any psychiatric comorbidity had fewer periodic leg movements in sleep. Psychiatric disorders should be taken into account in patients with RLS. PMID:27019065

  18. The Psychiatric Disorders of Childhood.

    ERIC Educational Resources Information Center

    Shaw, Charles R.; Lucas, Alexander R.

    A general textbook on the psychiatric disorders of childhood, the book is intended to be an introductory text for students and practitioners working with children (such as psychiatric and pediatric residents and psychologists, teachers, medical students). The genesis of mental illness is discussed in terms of the contributions of heredity and the…

  19. Occupational Psychiatric Disorders in Korea

    PubMed Central

    Kang, Seong-Kyu

    2010-01-01

    We searched databases and used various online resources to identify and systematically review all articles on occupational psychiatric disorders among Korean workers published in English and Korean before 2009. Three kinds of occupational psychiatric disorders were studied: disorders related to job stress and mental illness, psychiatric symptoms emerging in victims of industrial injuries, and occupational psychiatric disorders compensated by Industrial Accident Compensation Insurance (IACI). Korea does not maintain official statistical records for occupational psychiatric disorders, but several studies have estimated the number of occupational psychiatric disorders using the Korea Workers' Compensation and Welfare Service (COMWEL, formerly KLWC) database. The major compensated occupational psychiatric disorders in Korea were "personality and behavioral disorders due to brain disease, damage, and dysfunction", "other mental disorders due to brain damage and dysfunction and to physical diseases", "reactions to severe stress and adjustment disorders", and "depressive episodes". The most common work-related psychiatric disorders, excluding accidents, were "neurotic, stress-related, and somatoform disorders" followed by "mood disorders". PMID:21258596

  20. New Frontiers in Psychiatric Technology.

    ERIC Educational Resources Information Center

    Fuzessery, Zoltan, Ed.

    The second annual educational workshop concerned utilization of psychiatric technicians for technical service to allied professions. Manuscripts are included for the following presentations: (1) "Brief History of Colorado Psychiatric Technicians Association" by Francis L. Hedges, (2) "Hominology--The Approach to the Whole Man" by Theodore C. Kahn,…

  1. College Students with Psychiatric Disabilities

    ERIC Educational Resources Information Center

    Singh, Delar K.

    2011-01-01

    This paper focuses on college students with psychiatric disabilities. It defines and discusses various psychiatric conditions such as mood disorders, anxiety disorders, eating disorders, and personality disorders. It concludes with accommodations that a college professor can make to help these students succeed in higher education. (Contains 1…

  2. Broader Indications for Psychiatric Consultation

    PubMed Central

    Steinberg, Paul

    1987-01-01

    A liaison approach to psychiatric consultation increases the patient population who can benefit from psychiatric assessment during hospitalization for medical or surgical conditions. It also broadens the scope of the psychiatric investigation of the individual patient. The meaning of the illness to the patient, and the patient's present methods of adapting to his or her illness are important considerations. Unconscious concerns, which interfere with the patient's compliance to medical treatment, may be sufficiently clarified and resolved so that medical progress is expedited. Psychiatric consultation can be used to prevent an untoward psychological reaction to illness, if this is foreseen. This preventive consultation, which is often possible only because of the family physician's awareness of the psychological vulnerability of some of her or his patients, can result in reduced medical and psychiatric morbidity. PMID:21263836

  3. Surgery for psychiatric disorders.

    PubMed

    Luigjes, Judy; de Kwaasteniet, Bart P; de Koning, Pelle P; Oudijn, Marloes S; van den Munckhof, Pepijn; Schuurman, P Richard; Denys, Damiaan

    2013-01-01

    Surgery in psychiatric disorders has a long history and has regained momentum in the past few decades with deep brain stimulation (DBS). DBS is an adjustable and reversible neurosurgical intervention using implanted electrodes to deliver controlled electrical pulses to targeted areas of the brain. It holds great promise for therapy-refractory obsessive-compulsive disorder. Several double-blind controlled and open trials have been conducted and the response rate is estimated around 54%. Open trials have shown encouraging results with DBS for therapy-refractory depression and case reports have shown potential effects of DBS on addiction. Another promising indication is Tourette syndrome, where potential efficacy of DBS is shown by several case series and a few controlled trials. Further research should focus on optimizing DBS with respect to target location and increasing the number of controlled double-blinded trials. In addition, new indications for DBS and new target options should be explored in preclinical research. PMID:22465369

  4. Exorcism: a psychiatric viewpoint.

    PubMed Central

    Trethowan, W. H.

    1976-01-01

    Doctors, for several reasons, should be concerned with exorcism is the view of Professor Trethowan, who in this paper, looks at the main features of exorcism as practised in the middle ages and now appearing in the modern world, as was seen in the recent Ossett case in Britain. He examines in some detail the nature of supposed demoniacal possession and describes its symptoms and signs. He also touches on the social, as opposed to the religious, background in which demoniacal possession flourished (not lacking in the world today), so leading to an examination of the psychodynamic aspects of demoniacal possession and the question of absolute evil. Finally he compares the techniques of exorcism and of modern psychiatric practice. PMID:966260

  5. The impact of psychiatric comorbidity on Medicare reimbursement for inpatient medical care.

    PubMed

    Goldberg, R J; Daly, J; Golinger, R C

    1994-01-01

    Funding for psychiatric consultation-liaison (C-L) services has been a difficult problem. It has been suggested that the identification of psychiatric co-morbidities in Medicare patients on medical services could generate incremental hospital revenue by moving patients from a lower to a higher paying Diagnostic Related Group (DRG). This increased revenue could be used as a means of supporting the psychiatric C-L service. This study documents the financial impact of screening for and documenting psychiatric co-morbidities on a general acute medical service. We clinically assessed 100 consecutive Medicare admissions and found 25 psychiatric co-morbidities in 20 patients. In only one case did the psychiatric diagnosis result in moving the case to a higher DRG. However, the need for psychiatric consultation remains evident as there was significant lack of recognition and documentation of the psychiatric diagnoses by the medical team. The authors discuss both the financial and clinical implications of screening medical inpatients for psychiatric co-morbidities and propose directions for further studies in this area. PMID:8039679

  6. Patients treated in a coronary care unit without acute myocardial infarction: identification of high risk subgroup for subsequent myocardial infarction and/or cardiovascular death.

    PubMed Central

    Nordlander, R; Nyquist, O

    1979-01-01

    Consecutive patients admitted to a coronary care unit (CCU) during one year were studied. The diagnosis of acute myocardial infarction was not substantiated by our criteria in 206 of the patients discharged from the CCU. Of these, 193 were retrospectively followed up during one year. Seventeen of the patients (9%) died from cardiovascular causes during the 1-year period. Another 14 patients (7%) had a subsequent non-fatal acute myocardial infarction during the same period. The majority of the patients had coronary artery disease. Only 32 (17%) could be classified as non-coronary cases, and these had an excellent prognosis without any subsequent acute myocardial infarctions or deaths. The occurrence of transient ST-T shifts in serial electrocardiograms obtained during the first 3 days in hospital selected a subgroup of patients who had a high risk for subsequent non-fatal acute myocardial infarction and/or cardiovascular death. This high risk subgroup provides a basis for more aggressive diagnostic and therapeutic intervention. Images PMID:465239

  7. Psychiatric manifestations of treatable hereditary metabolic disorders in adults

    PubMed Central

    2014-01-01

    Detecting psychiatric disorders of secondary origin is a crucial concern for the psychiatrist. But how can this reliably be done among a large number of conditions, most of which have a very low prevalence? Metabolic screening undertaken in a population of subjects with psychosis demonstrated the presence of treatable metabolic disorders in a significant number of cases. The nature of the symptoms that should alert the clinician is also a fundamental issue and is not limited to psychosis. Hereditary metabolic disorders (HMD) are a rare but important cause of psychiatric disorders in adolescents and adults, the signs of which may remain isolated for years before other more specific organic signs appear. HMDs that present purely with psychiatric symptoms are very difficult to diagnose due to low awareness of these rare diseases among psychiatrists. However, it is important to identify HMDs in order to refer patients to specialist centres for appropriate management, disease-specific treatment and possible prevention of irreversible physical and neurological complications. Genetic counselling can also be provided. This review focuses on three HMD categories: acute, treatable HMDs (urea cycle abnormalities, remethylation disorders, acute intermittent porphyria); chronic, treatable HMDs (Wilson’s disease, Niemann-Pick disease type C, homocystinuria due to cystathionine beta-synthase deficiency, cerebrotendinous xanthomatosis); and chronic HMDs that are difficult to treat (lysosomal storage diseases, X-linked adrenoleukodystrophy, creatine deficiency syndrome). We also propose an algorithm for the diagnosis of HMDs in patients with psychiatric symptoms. PMID:25478001

  8. Improving Mental Status Questionnaire (MSQ) completion on admission to the Acute Surgical Receiving Unit (ASRU), Ninewells Hospital, Dundee

    PubMed Central

    Okwemba, Sylvia; Copeland, Lauren

    2014-01-01

    Delirium is common yet poorly identified in the UK. Early recognition is a key prognostic factor; delay here being associated with: increased mortality, increased morbidity, prolonged hospital stay, long term disability, and increased risk of developing dementia. Improvement in the diagnosis and management of delirium has scope to improve patient care, clinical outcomes, and ultimately an improved patient experience. As patients aged ≥75 years are at an increased risk of developing delirium, we focused the improvement project to this age group. The baseline data demonstrated that the average ≥75 year-old patient admitted to the Acute Surgical Receiving Unit (ASRU) at Ninewells Hospital had 5.4 out of 12 predisposing and precipitating risk factors for delirium; thus there was great potential for delirium to develop in these patients. During the analysis of the baseline data it became clear that we could not go ahead and implement the initial proposed improvement as the completion of the mental status questionnaire (MSQ) was inconsistent and low at 14.99%. Completion of the MSQ is vital in establishing any cognitive deficit at admission, and for providing a baseline for the continuing admission. As a consequence of this, we had to shift the main aim of the improvement project from improving the identification, diagnosis, and management of delirium, to improving the completion rate of the MSQ in our target age group. Consultations with members of the admission team were held to determine ways of improving the MSQ completion rate. It became clear that the completion of the MSQ relied on clinical staff remembering all 10 questions that constitute the test. The main intervention to facilitate improvement involved affixing a sticker with all 10 questions of the MSQ within the admissions document. The main aim was to increase the percentage of cognitive screening by the Mental State Questionnaire (MSQ) to 95% in patients aged ≥75 on admission to ASRU at Ninewells

  9. Torture: psychiatric sequelae and phenomenology.

    PubMed

    Doerr-Zegers, O; Hartmann, L; Lira, E; Weinstein, E

    1992-05-01

    Torture has been defined by the United Nations (declaration of December 9, 1975) as "every act by which a public functionary (or another person at his instigation) intentionally inflicts on another person serious pain or suffering, ...physical or mental, with the object of obtaining information or of punishing him...or of intimidating that person or others." In Chile, from the 1973 military coup d'Etat up to the 1988 plebiscite, torture was practiced in a systematic way, as a method of interrogation and as a means of intimidation of detainees and, indirectly, of the population at large. In the beginning, torture was applied in military station units and in police stations, in the facilities of sport fields and prisoners' camps; but above all, in clandestine detention centers and prisons belonging to the secret police (Amnesty International 1977, 1983; CODEPU 1984, 1985, 1986; Lira and Weinstein 1987; Muñoz 1986; Rodríguez de Ruiz-Tagle 1978). In spite of the bloodshed of the 1973 coup d'Etat, the phenomenon of torture came as a total surprise for the detainees, who had very often voluntarily surrendered themselves to the new authorities, and who, given the civil traditions of the country, expected treatment in accordance with a society subject to the law. The military government regularly denied having undertaken the practice of torture. According to Lira and Weinstein (20), this denial of such an extreme experience or horror made it even more difficult to overcome the trauma and fostered the development of chronic psychiatric pathology. PMID:1603873

  10. Demographics, Psychiatric Diagnoses, and Other Characteristics of North American Deaf and Hard-of-Hearing Inpatients

    ERIC Educational Resources Information Center

    Black, Patricia A.; Glickman, Neil S.

    2006-01-01

    This study examined demographic and clinical data from a specialty deaf inpatient unit so as to better understand characteristics of severely and chronically mentally ill deaf people. The study compares deaf and hearing psychiatric inpatients on demographic variables, psychiatric discharge diagnoses, a language assessment measure, a cognitive…

  11. What are the potential outcomes of integrating emotionally competent behaviours into the care of psychiatric patients?

    PubMed

    Doas, M D

    2013-04-01

    This descriptive study explored the concept of emotional competence in inpatient psychiatric nurse's daily interactions. Psychiatric registered nurses were asked to identify interactions of emotional competence they experienced on the nursing unit. Content analysis revealed deficits in self-awareness, mood management and managing relationships. PMID:22676309

  12. [Family and psychiatric hospitalization in a general hospital].

    PubMed

    de Mello, Rita Mello; Schneider, Jacó Fernando

    2011-06-01

    This study aims to identify the reasons that lead relatives to hospitalize patients in a psychiatric unit of a general hospital. It is a qualitative study based on Alfred Schutz' phenomenological sociology. Fourteen relatives, each with one family member hospitalized, were interviewed from August to October 2009. The guiding question of the phenomenological interview was "What do you expect from psychiatric hospitalization in a general hospital?". Phenomenological sociology was used to understand and interpret the interviews. Statements showed three concrete categories, that lead to the reasons for: treatment guidelines and continuity; prospects for improvement; ideas about normality. This research shows the experiences of relatives, contributing with mental health professionals' reflection about their actions and about the involvement of families in a general hospital's psychiatric unit. PMID:21987981

  13. Management challenges in psychiatric patients with severe mandibular pain: a case report.

    PubMed

    Cheng, A; Kunchur, R; Goss, A N

    2011-03-01

    A 68-year-old man was admitted to the psychiatric unit of a major hospital as he was threatening self-harm due to uncontrolled left mandibular pain. Although he had significant psychiatric issues, psychiatric treatment did not help him. Further review at three weeks post-admission showed that he had had many months of unsuccessful dental treatment and this had triggered his psychiatric crisis. Multidisciplinary investigation and communication showed that he had trigeminal neuralgia secondary to vascular changes in his temporal lobe. He responded well to explanation and anti-neuralgic medication. Simple guidelines on how dental practitioners can cope with such patients are presented. PMID:21332745

  14. Circadian Disruption in Psychiatric Disorders.

    PubMed

    Jones, Stephanie G; Benca, Ruth M

    2015-12-01

    Evidence suggests that abnormalities in circadian rhythms might prove causally or pathophysiologically significant in psychiatric illness. The circadian regulation of hormonal and behavioral timekeeping processes is often altered in patients with major depression, bipolar disorder, and schizophrenia, and a susceptibility to rhythm instability may contribute to the functional impairment. For some patients, interventions that stabilize or resynchronize circadian rhythms prove therapeutically effective. Circadian disruption in the clinical profiles of most psychiatric illnesses and the treatment efficacy of chronobiological interventions suggest that attention to circadian phenotypes in a range of psychiatric disorders may help to uncover shared pathophysiologic mechanisms. PMID:26568124

  15. [Psychiatric complications of cannabis use].

    PubMed

    Coscas, Sarah; Benyamina, Amine; Reynaud, Michel; Karila, Laurent

    2013-12-01

    Cannabis is the most widely used illicit substance, especially among young people. Cannabis use is extremely commonplace and frequently comorbid with psychiatric disorders that raise questions about the etiology. The use of cannabis is an aggravating factor of all psychiatric disorders. Psychiatric complications are related to the age of onset, duration of exposure and individual risk factors of the individual (mental and social health). The panic attack is the most common complication. The link with psychosis is narrow that leads to increased prevention for vulnerable populations. Cannabis is also an indicator of increased depressive vulnerability and an aggravating factor for bipolar disorder. PMID:24579344

  16. The effect of songwriting on knowledge of coping skills and working alliance in psychiatric patients: a randomized clinical effectiveness study.

    PubMed

    Silverman, Michael J

    2011-01-01

    The purpose of this study was to determine the effects of a songwriting intervention on psychiatric patients' knowledge of coping skills and working alliance. Participants were randomly assigned to scripted and manualized experimental (n=48) or control (n=41) conditions. The experimental condition was a group psychoeducational music therapy songwriting session concerning coping skills while the control condition was a group psychoeducational session concerning coping skills. Both conditions were single-session therapy with patients on an acute adult psychiatric unit. Results indicated no significant between group differences in measures of knowledge of coping skills, consumer working alliance, or perception of enjoyment (p>.05), although the experimental condition tended to have slightly higher mean scores than the control group for these measures. There was a significant between group difference in measures of therapist working alliance (p<.001), with the therapist scoring the experimental group higher than the control group. Although the music therapy group had a higher mean rate of previous psychiatric hospitalizations, their perception of enjoyment scores were still higher than those of the control condition, a finding incongruent in the literature. Furthermore, despite the increased number of previous hospitalizations, the music therapy condition had higher attendance rates than the control condition, thus possibly providing incentives for funding. It seems that group songwriting about coping skills can be as effective a psychosocial intervention as traditional talk-based psychoeducation to teach psychiatric inpatients how to proactively manage their illness. Additionally, music therapy can be as effective as talk-based psychoeducation in establishing working alliance. Implications for clinical practice, limitations, and suggestions for future research are provided. PMID:21866716

  17. Psychiatric Emergencies in Pregnant Women.

    PubMed

    Wilson, Michael P; Nordstrom, Kimberly; Shah, Asim A; Vilke, Gary M

    2015-11-01

    Psychiatric emergencies in pregnancy can be difficult to manage. The authors (both practicing psychiatrists and emergency clinicians) review the evaluation and treatment of common mental health diagnoses in pregnancy. PMID:26493527

  18. The psychiatric Münchausen

    PubMed Central

    Ben-Tovim, David I.

    1978-01-01

    Two cases of patients with the Münchausen syndrome who sought admission for fictitious psychiatric illnesses are presented - one case involves an accomplice. The patients' authentic life histories are used in the discussion of the syndrome's aetiological factors.

  19. Psychiatric Comorbidities among Female Adolescents with Anorexia Nervosa

    ERIC Educational Resources Information Center

    Salbach-Andrae, Harriet; Lenz, Klaus; Simmendinger, Nicole; Klinkowski, Nora; Lehmkuhl, Ulrike; Pfeiffer, Ernst

    2008-01-01

    This study investigated current comorbid Axis I diagnoses associated with Anorexia Nervosa (AN) in adolescents. The sample included 101 female adolescents treated at a psychiatric unit for primary DSM-IV diagnoses of AN. 73.3% of the AN patients were diagnosed as having a current comorbidity of at least one comorbid Axis I diagnosis, with no…

  20. Profiles of Personal Resiliency in Child and Adolescent Psychiatric Inpatients

    ERIC Educational Resources Information Center

    Kumar, Geetha; Steer, Robert A.; Gulab, Nazli A.

    2010-01-01

    To ascertain whether children and adolescents whose ages ranged from 9 to 17 years described distinct profiles of personal resiliency, the Resiliency Scales for Children and Adolescents (RSCA) were administered to 100 youth who were admitted to an inpatient psychiatric unit and were diagnosed with various "DSM-IV-TR" disorders along with the Beck…

  1. Alcoholism and Co-Morbid Psychiatric Disorders among American Indians

    ERIC Educational Resources Information Center

    Westermeyer, Joseph

    2001-01-01

    Much of the data reported here regarding American Indian (AI) people has originated from specific areas with particular peoples. Thus, one must be cautious in applying information from one tribe to the hundreds of tribes living across the United States. As with any people, psychiatric disorder may be a pre-existing rationale for using alcohol. Or…

  2. Some Determinants of Employee Turnover in a Psychiatric Facility.

    ERIC Educational Resources Information Center

    Zautra, Alex J.; And Others

    1987-01-01

    Used research from illness-prevention and job-enrichment approaches to enhancing quality of work environments to create instruments assessing number of job stressors and level of task interest on psychiatric hospital units. Instruments successfully predicted employee turnover during one year. Job stress and interaction between job stress and task…

  3. Psychiatric aspects of Parkinson's disease

    PubMed Central

    Grover, Sandeep; Somaiya, Mansi; Kumar, Santhosh; Avasthi, Ajit

    2015-01-01

    Parkinson's disease (PD) is essentially characterized by the motor symptoms in the form of resting tremor, rigidity and bradykinesia. However, over the years it has been recognized that motor symptoms are just the “tip of the iceberg” of clinical manifestations of PD. Besides motor symptoms, PD characterized by many non-motor symptoms, which include cognitive decline, psychiatric disturbances (depression, psychosis and impulse control), sleep difficulties, autonomic failures (gastrointestinal, cardiovascular, urinary, thermoregulation) and pain syndrome. This review evaluates the various aspects of psychiatric disorders including cognitive decline and sleep disturbances in patients with PD. The prevalence rate of various psychiatric disorders is high in patients with PD. In terms of risk factors, various demographic, clinical and treatment-related variables have been shown to be associated with higher risk of development of psychiatric morbidity. Evidence also suggests that the presence of psychiatric morbidity is associated with poorer outcome. Randomized controlled trials, evaluating the various pharmacological and non-pharmacological treatments for management of psychiatric morbidity in patients with PD are meager. Available evidence suggests that tricyclic antidepressants like desipramine and nortriptyline are efficacious for management of depression. Among the antipsychotics, clozapine is considered to be the best choice for management of psychosis in patients with PD. Among the various cognitive enhancers, evidence suggest efficacy of rivastigmine in management of dementia in patients with PD. To conclude, this review suggests that psychiatric morbidity is highly prevalent in patients with PD. Hence, a multidisciplinary approach must be followed to improve the overall outcome of PD. Further studies are required to evaluate the efficacy of various other measures for management of psychiatric morbidity in patients with PD. PMID:25552854

  4. Psychiatric aspects of Parkinson's disease.

    PubMed

    Grover, Sandeep; Somaiya, Mansi; Kumar, Santhosh; Avasthi, Ajit

    2015-01-01

    Parkinson's disease (PD) is essentially characterized by the motor symptoms in the form of resting tremor, rigidity and bradykinesia. However, over the years it has been recognized that motor symptoms are just the "tip of the iceberg" of clinical manifestations of PD. Besides motor symptoms, PD characterized by many non-motor symptoms, which include cognitive decline, psychiatric disturbances (depression, psychosis and impulse control), sleep difficulties, autonomic failures (gastrointestinal, cardiovascular, urinary, thermoregulation) and pain syndrome. This review evaluates the various aspects of psychiatric disorders including cognitive decline and sleep disturbances in patients with PD. The prevalence rate of various psychiatric disorders is high in patients with PD. In terms of risk factors, various demographic, clinical and treatment-related variables have been shown to be associated with higher risk of development of psychiatric morbidity. Evidence also suggests that the presence of psychiatric morbidity is associated with poorer outcome. Randomized controlled trials, evaluating the various pharmacological and non-pharmacological treatments for management of psychiatric morbidity in patients with PD are meager. Available evidence suggests that tricyclic antidepressants like desipramine and nortriptyline are efficacious for management of depression. Among the antipsychotics, clozapine is considered to be the best choice for management of psychosis in patients with PD. Among the various cognitive enhancers, evidence suggest efficacy of rivastigmine in management of dementia in patients with PD. To conclude, this review suggests that psychiatric morbidity is highly prevalent in patients with PD. Hence, a multidisciplinary approach must be followed to improve the overall outcome of PD. Further studies are required to evaluate the efficacy of various other measures for management of psychiatric morbidity in patients with PD. PMID:25552854

  5. Psychiatric manifestations in cerebrotendinous xanthomatosis

    PubMed Central

    Fraidakis, M J

    2013-01-01

    Cerebrotendinous xanthomatosis (CTX) is a rare and severe, but treatable, inborn disorder of bile acid biosynthesis and sterol storage with autosomal recessive inheritance and variable clinical presentation. CTX treatment consists of chenodeoxycholic acid and must be started as early as possible to prevent permanent disability. Psychiatric manifestations are rare and non-specific, and often lead to significant diagnostic and treatment delay. Therefore, better recognition of the gamut of psychiatric manifestations in CTX can diminish the risk of misdiagnosis and irreversible neurological deterioration. We hereby describe the psychiatric features in CTX. A complete review of all published cases of CTX in the medical literature was undertaken and the case reports with psychiatric presentation were collected and analyzed. We also describe the psychiatric features in relation to the neurological semeiology in six patients with CTX diagnosed at the La Salpêtrière Hospital. We conclude that psychiatric manifestations in CTX follow a bimodal/bitemporal pattern, appearing early in the disease course in the form of a behavioral/personality disorder associated with learning difficulties or mental retardation, or manifesting in advanced disease in the setting of dementia as rich neuropsychiatric syndromes, such as frontal, orbitofrontal or frontotemporal syndromes of cortico-subcortical dementia encompassing behavioral/personality disturbance, affective/mood disorders or psychotic disorders. Behavioral/personality disturbance in childhood or adolescence, especially when accompanied by learning difficulties, should therefore lead to further investigation to exclude CTX, as early diagnosis and treatment is critical for prognosis. PMID:24002088

  6. Cutaneous factitia in elderly patients: alarm signal for psychiatric disorders

    PubMed Central

    Chiriac, Anca; Foia, Liliana; Birsan, Cristina; Goriuc, Ancuta; Solovan, Caius

    2014-01-01

    Background The factitious disorders, more commonly known in daily practice as pathomimia, are expressed in dermatology units by skin lesions induced voluntarily by the patient, in order to draw attention of the medical staff and/or the family members. The disorder is often challenging to diagnose and even more difficult to document in front of the patient or relatives. It represents a challenge for the physician, and any attempt at treatment may be followed by recurrence of the self-mutilation. This paper describes two cases of pathomimia diagnosed by dermatologists and treated in a psychiatry unit, highlighting the importance of collaboration in these situations. Patients and methods Two case reports, describing old female patients with pathomimia, hospitalized in a department of dermatology for bizarre skin lesions. Results The first case was a 77-year-old female with unknown psychiatric problems and atrophic skin lesions on the face, self-induced for many months, with multiple hospitalizations in dermatology units, with no response to different therapeutic patterns, and full recovery after psychiatric treatment for a major depressive syndrome. The second case was a 61-year-old female patient with disseminated atrophic scars on the face, trunk, and limbs. She raised our interest because of possible psychiatric issues, as she had attempted to commit suicide. The prescription of antidepressants led to a significant clinical improvement. Conclusion These cases indicate that a real psychiatric disease may be recorded in patients suffering from pathomimia. Therefore, complete psychiatric evaluation in order to choose the proper therapy is mandatory for all these cases. Dermatologists and all physicians who take care of old patients must recognize the disorder in order to provide optimum care for this chronic condition. We emphasize therefore the importance of psychiatric evaluation and treatment to avoid the major risk of suicide. Skin lesions must be regarded as an

  7. The devil is in the detail: Acute Guillain-Barré syndrome camouflaged as neurosarcoidosis in a critically ill patient admitted to an Intensive Care Unit.

    PubMed

    Sarada, Pooja Prathapan; Sundararajan, Krishnaswamy

    2016-04-01

    Guillain-Barré syndrome (GBS) is an acute demyelinating polyneuropathy, usually evoked by antecedent infection. Sarcoidosis is a multisystem chronic granulomatous disorder with neurological involvement occurring in a minority. We present a case of a 43-year-old Caucasian man who presented with acute ascending polyradiculoneuropathy with a recent diagnosis of pulmonary sarcoidosis. The absence of acute flaccid paralysis excluded a clinical diagnosis of GBS in the first instance. Subsequently, a rapid onset of proximal weakness with multi-organ failure led to the diagnosis of GBS, which necessitated intravenous immunoglobulin and plasmapheresis to which the patient responded adequately, and he was subsequently discharged home. Neurosarcoidosis often masquerades as other disorders, leading to a diagnostic dilemma; also, the occurrence of a GBS-like clinical phenotype secondary to neurosarcoidosis may make diagnosing coexisting GBS a therapeutic challenge. This article not only serves to exemplify the rare association of neurosarcoidosis with GBS but also highlights the need for a high index of clinical suspicion for GBS and accurate history taking in any patient who may present with rapidly progressing weakness to an Intensive Care Unit. PMID:27303139

  8. The devil is in the detail: Acute Guillain–Barré syndrome camouflaged as neurosarcoidosis in a critically ill patient admitted to an Intensive Care Unit

    PubMed Central

    Sarada, Pooja Prathapan; Sundararajan, Krishnaswamy

    2016-01-01

    Guillain–Barré syndrome (GBS) is an acute demyelinating polyneuropathy, usually evoked by antecedent infection. Sarcoidosis is a multisystem chronic granulomatous disorder with neurological involvement occurring in a minority. We present a case of a 43-year-old Caucasian man who presented with acute ascending polyradiculoneuropathy with a recent diagnosis of pulmonary sarcoidosis. The absence of acute flaccid paralysis excluded a clinical diagnosis of GBS in the first instance. Subsequently, a rapid onset of proximal weakness with multi-organ failure led to the diagnosis of GBS, which necessitated intravenous immunoglobulin and plasmapheresis to which the patient responded adequately, and he was subsequently discharged home. Neurosarcoidosis often masquerades as other disorders, leading to a diagnostic dilemma; also, the occurrence of a GBS-like clinical phenotype secondary to neurosarcoidosis may make diagnosing coexisting GBS a therapeutic challenge. This article not only serves to exemplify the rare association of neurosarcoidosis with GBS but also highlights the need for a high index of clinical suspicion for GBS and accurate history taking in any patient who may present with rapidly progressing weakness to an Intensive Care Unit. PMID:27303139

  9. Engram formation in psychiatric disorders

    PubMed Central

    Gebicke-Haerter, Peter J.

    2014-01-01

    Environmental factors substantially influence beginning and progression of mental illness, reinforcing or reducing the consequences of genetic vulnerability. Often initiated by early traumatic events, “engrams” or memories are formed that may give rise to a slow and subtle progression of psychiatric disorders. The large delay between beginning and time of onset (diagnosis) may be explained by efficient compensatory mechanisms observed in brain metabolism that use optional pathways in highly redundant molecular interactions. To this end, research has to deal with mechanisms of learning and long-term memory formation, which involves (a) epigenetic changes, (b) altered neuronal activities, and (c) changes in neuron-glia communication. On the epigenetic level, apparently DNA-methylations are more stable than histone modifications, although both closely interact. Neuronal activities basically deliver digital information, which clearly can serve as basis for memory formation (LTP). However, research in this respect has long time neglected the importance of glia. They are more actively involved in the control of neuronal activities than thought before. They can both reinforce and inhibit neuronal activities by transducing neuronal information from frequency-encoded to amplitude and frequency-modulated calcium wave patterns spreading in the glial syncytium by use of gap junctions. In this way, they serve integrative functions. In conclusion, we are dealing with two concepts of encoding information that mutually control each other and synergize: a digital (neuronal) and a wave-like (glial) computing, forming neuron-glia functional units with inbuilt feedback loops to maintain balance of excitation and inhibition. To better understand mental illness, we have to gain more insight into the dynamics of adverse environmental impact on those cellular and molecular systems. This report summarizes existing knowledge and draws some outline about further research in molecular

  10. Infant psychiatric disorders.

    PubMed

    Bolten, Margarete I

    2013-02-01

    Infant mental health problems include difficulties to regulate emotions or attention, crying, sleeping or feeding problems as well as aggressive behavior. Early identifications of these problems help to change developmental trajectories and improve developmental outcomes. Psychiatric assessment and classification have to take into account the rapid processes of development as well as the inseparable linkage between symptoms of the infant, psychosocial risks in the family environment, and parent-child relations. The proposed DSM-5 classification system presents a systematic description of mental health disorders which are relevant for infant psychiatry. However, the proposal has provided rather limited attention to developmental differences and parent-infant relations. Therefore, additional classification systems, like the Zero-to-Three (DC: 0-3R), are strongly recommended. In terms of assessment and in accordance with the guidelines of the American Academy of Child and Adolescent Psychiatry, infant psychiatrists have to consider the close relation between somatic and mental health and the interplay between behaviors of the caregiver and the infant. Therefore, the assessment has to be multidisciplinary and relationship based. A standard assessment in infancy includes a clinical interview, behavior observations, caregiver questionnaires, and a pediatric screening. All assessments should pay attention to motor, cognitive, language, and social-emotional development. Because infant development is embedded in the family context, socio-economic factors, parents' mental problems, including drug abuse, domestic violence, and trauma history should be assessed. The treatment has to be oriented toward symptoms and development and has to address underlying medical conditions. The focus should be on parent-child interactions. Evidence-based interventions are based on attachment theory, use social-learning perspectives, and behavioral approaches. PMID:23229140

  11. The Future of Psychiatric Collaboration in Federally Qualified Health Centers.

    PubMed

    Kaliebe, Kristopher E

    2016-08-01

    Federally qualified health centers (FQHCs) provide comprehensive care to underserved and disadvantaged populations. FQHCs now comprise the largest primary care network in the United States. Currently, many FQHCs provide limited access to psychiatric services; and when such services are available, most use traditional on-site psychiatric clinics. The author reviews the rationale for increasing access to behavioral health care in FQHCs by adopting collaborative models of care, describes challenges to adopting these models in FQHCs, and discusses ways to increase the primary care team's ability to support patient self-care and family functioning. PMID:27032666

  12. Accountability and psychiatric disorders: how do forensic psychiatric professionals think?

    PubMed

    Höglund, Pontus; Levander, Sten; Anckarsäter, Henrik; Radovic, Susanna

    2009-01-01

    Swedish penal law does not exculpate on the grounds of diminished accountability; persons judged to suffer from severe mental disorder are sentenced to forensic psychiatric care instead of prison. Re-introduction of accountability as a condition for legal responsibility has been advocated, not least by forensic psychiatric professionals. To investigate how professionals in forensic psychiatry would assess degree of accountability based on psychiatric diagnoses and case vignettes, 30 psychiatrists, 30 psychologists, 45 nurses, and 45 ward attendants from five forensic psychiatric clinics were interviewed. They were asked (i) to judge to which degree (on a dimensional scale from 1 to 5) each of 12 psychiatric diagnoses might affect accountability, (ii) to assess accountability from five case vignettes, and (iii) to list further factors they regarded as relevant for their assessment of accountability. All informants accepted to provide a dimensional assessment of accountability on this basis and consistently found most types of mental disorders to reduce accountability, especially psychotic disorders and dementia. Other factors thought to be relevant were substance abuse, social network, personality traits, social stress, and level of education. PMID:19811835

  13. Acute and Chronic Pain on the Battlefield: Lessons Learned from Point of Injury to the United States.

    PubMed

    Croll, Scott M; Griffith, Scott R

    2016-01-01

    Historically, war tends to accelerate innovation within military medicine. In this article, the authors argue this truism has recurred in the case of acute and chronic pain management for combatants in the global war on terrorism (GWOT). Advances in regional anesthesia techniques and multimodal acute pain care are highlighted in light of the typical weapons, injuries, and comorbid conditions of the modern combat era. Reported success of providing chronic pain care in the war theater during GWOT is discussed in the context of operational requirements for current and future wars. A description is provided of the Pain Management Task Force (PMTF) and Pain Campaign Plan which was initiated during GWOT. The PMTF effort enhanced pain education and clinical pain care through leadership and organizational changes, which created broader access to pain treatments for patients and more standardized treatment capabilities across the enterprise. PMID:27215875

  14. Psychiatric Comorbidity in Alcohol Dependence.

    PubMed

    Fein, George

    2015-12-01

    We review our clinical studies of psychiatric comorbidity in short-term and long-term abstinent and in treatment naïve alcoholics (STAA, LTAA and TNA). TNA ypically have less severe alcoholism than treated abstinent samples and evidence less severe psychiatric disturbance. Lifetime psychiatric diagnoses are the norm for STAA and LTAA but not for TNA. Individuals with alcohol and drug use disorders show greater antisocial personality disturbance, but do not show differences in the mood or anxiety domains or in borderline personality disorder (BPD) symptoms. The studies show that alcoholics can achieve and maintain abstinence in the face of ongoing mood, anxiety, or BPD problems. By contrast, for ASPD, LTAA essentially stop current antisocial behaviors in all seven domains of antisocial behaviors. We believe that ongoing antisocial behavior is not consistent with maintaining abstinence, and that LTAA modify their antisocial behavior despite continued elevated social deviance proneness and antisocial dispositionality. Abstinent individuals without lifetime psychiatric disorders and TNA show more (subdiagnostic threshold) psychiatric symptoms and abnormal psychological measures than non-alcoholic controls in the mood, anxiety, BPD, and antisocial domains. In summary, our studies show that although LTAA have achieved multi-year abstinence, they still report significant psychological distress compared to NAC. We believe this distress may negatively affect their quality of life. This suggests the importance of developing effective care models to address comorbid mental health problems in LTAA. We also show that antisocial personality disorder symptoms decline to the levels seen in normal controls, and that excluding individuals from research with a psychiatric diagnosis does not control for subdiagnostic psychiatric differences between alcoholics and controls. PMID:26590836

  15. Educating Mental Health Clinicians About Sensory Modulation to Enhance Clinical Practice in a Youth Acute Inpatient Mental Health Unit: A Feasibility Study.

    PubMed

    Blackburn, Julie; McKenna, Brian; Jackson, Brian; Hitch, Danielle; Benitez, Jessica; McLennan, Cathy; Furness, Trentham

    2016-07-01

    There is an emergence of literature describing effective sensory modulation (SM) interventions to de-escalate violence and aggression among mental health inpatients. However, the evidence is limited to adult settings, with the effect of SM in youth acute settings unknown. Yet, before SM may be used as a de-escalation intervention in youth acute settings, multidisciplinary staff need to be educated about and supported in the clinical application of SM. In the current study, an online SM education package was developed to assist mental health staff understand SM. This was blended with action learning sets (ALS), small group experiential opportunities consisting staff and consumers to learn about SM resources, and the support of SM trained nurses. The aims of the study were to evaluate the effectiveness of this SM education intervention in (a) transferring knowledge of SM to staff, and (b) translating this knowledge into practice in a youth acute inpatient mental health unit. A mixed methods research design with an 11-item pre- and post-education questionnaire was used along with three-month follow-up focus groups. The SM education improved understanding about SM (all 11-items p ≤ 0.004, r ≥ 0.47). Three-months after SM education, four themes evident in the focus group data emerged about the practice and process of SM; (1) translating of learning into practice, (2) SM in practice, (3) perceptions of SM benefits, and (4) limitations of SM. A blended SM education process enhanced clinical practice in the unit, yet participants were mindful of limitations of SM in situations of distress or escalating agitation. PMID:27253182

  16. Characteristics of High Staff Intensive Medicare Psychiatric Inpatients

    PubMed Central

    Cromwell, Jerry; Maier, Jan; Gage, Barbara; Drozd, Edward; Osber, Deborah; Richter, Erin; Greenwald, Leslie; Goldman, Howard

    2004-01-01

    Previous analyses of the costs of Medicare psychiatric inpatients have been limited by the use of claims and provider cost reports that fail to quantify differences in patient characteristics and routine costs. This article uses new primary data from 66 psychiatric inpatient units in 40 facilities nationwide to measure the times staff spend in therapeutic and other activities caring for Medicare patients. Patient days are divided into two groups of very high and low staff intensity and patient characteristics compared in each group. Results identify key patient characteristics associated with high staffing days, including old age, dementia and cognitive impairment, severe psychiatric diagnosis, deficits in activities of daily living (ADLs), and assaultive or agitated behaviors. Policy implications and suggested enhancements are made with regard to the proposed CMS case-mix classification system based on claims data alone. PMID:15776703

  17. The Reliability of Psychiatric Diagnosis Revisited

    PubMed Central

    Rankin, Eric; France, Cheryl; El-Missiry, Ahmed; John, Collin

    2006-01-01

    Background: The authors reviewed the topic of reliability of psychiatric diagnosis from the turn of the 20th century to present. The objectives of this paper are to explore the reasons of unreliability of psychiatric diagnosis and propose ways to improve the reliability of psychiatric diagnosis. Method: The authors reviewed the literature on the concept of reliability of psychiatric diagnosis with emphasis on the impact of interviewing skills, use of diagnostic criteria, and structured interviews on the reliability of psychiatric diagnosis. Results: Causes of diagnostic unreliability are attributed to the patient, the clinician and psychiatric nomenclature. The reliability of psychiatric diagnosis can be enhanced by using diagnostic criteria, defining psychiatric symptoms and structuring the interviews. Conclusions: The authors propose the acronym ‘DR.SED,' which stands for diagnostic criteria, reference definitions, structuring the interview, clinical experience, and data. The authors recommend that clinicians use the DR.SED paradigm to improve the reliability of psychiatric diagnoses. PMID:21103149

  18. Psychiatric nursing as 'different' care: experience of Iranian mental health nurses in inpatient psychiatric wards.

    PubMed

    Zarea, K; Nikbakht-Nasrabadi, A; Abbaszadeh, A; Mohammadpour, A

    2013-03-01

    Patients with mental illness require unique and specific care. The purpose of this study was to explore the experiences of nurses, who provide such care for mentally ill people, within the context of Iranian culture. This hermeneutic phenomenological study was carried out in a university-affiliated hospital in an urban area of Iran. We interviewed 10 mental health nurses to capture in detail their experiences in psychiatric units, and the approach developed by Diekelmann et al. was employed to analyse the data. Four themes and five sub-themes were identified: 'being engaged with patients' (sub-themes: 'struggle for monitor/control', 'safety/security concerns', 'supporting physiological and emotional needs'), 'being competent', 'altruistic care' and 'facing difficulties and challenges' (sub-themes: 'socio-cultural' and 'organizational challenges'). The results provide valuable insights and greater understanding of the professional experiences of psychiatric nurses in Iran, and indicate the need for a stable and responsible organizational structure for those nurses who are expected to manage patient care in psychiatric wards. PMID:22384949

  19. Undergraduate college students' perceptions of psychiatric nurses.

    PubMed

    Wantz, Richard A; Firmin, Michael W; Stolzfus, Melissa J; Ray, Brigitte N; Holmes, Hannah J; Geib, Ellen F

    2012-11-01

    We surveyed undergraduate students' perceptions of psychiatric nurses' effectiveness and analyzed other sources of data. Students reported that psychiatric nurses' strengths include helping in situations that involve psychiatric symptoms, mental health evaluation, and drug abuse. Psychiatric nurses also were said to be effective when helping an individual with psychiatric symptoms, such as delusions and hallucinations. Friends or associates, common knowledge, school and education, and movies are some sources by which students learn about psychiatric nurses. Sources that provided less influential information include insurance carriers, newspapers, and personal experience. PMID:23146011

  20. Psychiatric comorbidity of childhood obesity.

    PubMed

    Kalarchian, Melissa A; Marcus, Marsha D

    2012-06-01

    The onset of psychiatric symptoms and disorders is relatively common in childhood, occurring among youths across the weight spectrum. However, available research suggests that certain psychiatric comorbidities are more prevalent in obese children and adolescents than in healthy weight youths. First, we review research on disordered eating, including evidence to suggest that loss of control eating is associated with weight gain and obesity in youths, as well as poor outcome in family-based treatment of paediatric obesity. Second, we highlight evidence on the relationship between depression and obesity, especially in girls. Third, we present data on attention deficit hyperactivity disorder (ADHD), particularly the symptoms of impulsivity and inattention, and childhood obesity. We also consider that some medical conditions and psychotropic medications contribute to weight gain and obesity in children and adolescents. Throughout the review, we emphasize that psychiatric comorbidity may be a cause or consequence of childhood obesity, or they may share common aetiological factors. PMID:22724645

  1. [Movement disorders is psychiatric diseases].

    PubMed

    Hidasi, Zoltan; Salacz, Pal; Csibri, Eva

    2014-12-01

    Movement disorders are common in psychiatry. The movement disorder can either be the symptom of a psychiatric disorder, can share a common aetiological factor with it, or can be the consequence of psychopharmacological therapy. Most common features include tic, stereotypy, compulsion, akathisia, dyskinesias, tremor, hypokinesia and disturbances of posture and gait. We discuss characteristics and clinical importance of these features. Movement disorders are frequently present in mood disorders, anxiety disorders, schizophrenia, catatonia, Tourette-disorder and psychogenic movement disorder, leading to differential-diagnostic and therapeutical difficulties in everyday practice. Movement disorders due to psychopharmacotherapy can be classified as early-onset, late-onset and tardive. Frequent psychiatric comorbidity is found in primary movement disorders, such as Parkinson's disease, Wilson's disease, Huntington's disease, diffuse Lewy-body disorder. Complex neuropsychiatric approach is effective concerning overlapping clinical features and spectrums of disorders in terms of movement disorders and psychiatric diseases. PMID:25577484

  2. Assessments of urine cofilin-1 in patients hospitalized in the intensive care units with acute kidney injury

    NASA Astrophysics Data System (ADS)

    Lee, Yi-Jang; Chao, Cheng-Han; Chang, Ying-Feng; Chou, Chien

    2013-02-01

    The actin depolymerizing factor (ADF)/cofilin protein family has been reported to be associated with ischemia induced renal disorders. Here we examine if cofilin-1 is associated with acute kidney injury (AKI). We exploited a 96-well based fiber-optic biosensor that uses conjugated gold nanoparticles and a sandwich immunoassay to detect the urine cofilin-1 level of AKI patients. The mean urine cofilin-1 level of the AKI patients was two-fold higher than that of healthy adults. The receiver operating characteristic (ROC) curve showed that cofilin-1 is a potential biomarker for discriminating AKI patients from healthy adults for intensive care patients.

  3. Work and common psychiatric disorders.

    PubMed

    Henderson, M; Harvey, S B; Overland, S; Mykletun, A; Hotopf, M

    2011-05-01

    Psychiatric disorders are now the most common reason for long-term sickness absence. The associated loss in productivity and the payment of disability benefits places a substantial burden on the economies of many developed countries. The occupational dysfunction associated with psychiatric disorders can also lead to poverty and social isolation. As a result the area of work and psychiatric disorders is a high priority for policymakers. There are two main agendas: for many researchers and clinicians the focus is on the need to overcome stigma and ensure people with severe psychiatric disorders have meaningful work; however the public health agenda predominantly relates to the more common disorders such as depression and anxiety, which contribute a greater burden of disability benefits and pensions. In this review we attempt to address this second agenda. The relatively sparse evidence available reveals a complex field with significant interplay between medical, psychological social and cultural factors. Sick leave can be a 'process' as well as an 'event'. In this review we propose a staged model where different risk and protective factors contribute to the onset of psychiatric disorders in the working population, the onset of short-term sickness absence, and the transition from short- to long-term absence. We also examine strategies to manage psychiatric disorder in the workforce with a view towards returning the employee to work. Our aim in this review is to highlight the complexity of the area, to stimulate debate and to identify important gaps in knowledge where further research might benefit both patients and wider society. PMID:21558098

  4. Religious ideas and psychiatric disorders.

    PubMed

    Beit-Hallahmi, B; Argyle, M

    1977-01-01

    The evidence presented above points to the need for considering factors other than purely religious ones in determining the role of religious ideas in psychiatric disorders. The occurrence of religious ideas as part of the content of individual delusional systems in psychiatric patients can be explained on the basis of exposure to religious ideas through the social environment. It may be also related to the prominence of religion, vis-a-vis other belief systems, in the social envirnment. When considering psychopathological explanations for intense religious experiences, one has to be conscious again of the social factors involved. When an unusual experience having religious content becomes normative in a certain group (for whatever reasons), trying to explain its appearance on the basis of individual psychodynamics or psychopathology becomes very difficult. There seems to be an inverse relationship between the social nature of a religious experience and its psychopathological nature, i.e., there is more psychopathology in individuals reporting solitary religious experiences, or individual religious ideas. Thus the solitary experience seems to be more influenced by disturbed individual dynamics, but in other cases social factors seem to be crucial. Our overall conclusion is that a psychiatric analysis of the role of religious factors in psychopathology has to be first a social-psychiatric analysis. An individual presenting psychiatric symptoms and religious ideas has to be evaluated in light of his social background, since the specific content of psychiatric symptoms seems to be determined by social background factors. Individual psychodynamics determine the appearance of symptoms, but their particular form will be the result of these background factors, one of which is religion. PMID:863602

  5. Psychiatric Disorders: Diagnosis to Therapy

    PubMed Central

    Krystal, John H.; State, Matthew W.

    2014-01-01

    Recent findings in a range of scientific disciplines are challenging the conventional wisdom regarding the etiology, classification and treatment of psychiatric disorders. This review focuses on the current state of the psychiatric diagnostic nosology and recent progress in three areas: genomics, neuroimaging, and therapeutics development. The accelerating pace of novel and unexpected findings is transforming the understanding of mental illness and represents a hopeful sign that the approaches and models that have sustained the field for the past 40 years are yielding to a flood of new data and presaging the emergence of a new and more powerful scientific paradigm. PMID:24679536

  6. The nature of psychiatric disorders.

    PubMed

    Kendler, Kenneth S

    2016-02-01

    A foundational question for the discipline of psychiatry is the nature of psychiatric disorders. What kinds of things are they? In this paper, I review and critique three major relevant theories: realism, pragmatism and constructivism. Realism assumes that the content of science is real and independent of human activities. I distinguish two "flavors" of realism: chemistry-based, for which the paradigmatic example is elements of the periodic table, and biology-based, for which the paradigm is species. The latter is a much better fit for psychiatry. Pragmatism articulates a sensible approach to psychiatric disorders just seeking categories that perform well in the world. But it makes no claim about the reality of those disorders. This is problematic, because we have a duty to advocate for our profession and our patients against other physicians who never doubt the reality of the disorders they treat. Constructivism has been associated with anti-psychiatry activists, but we should admit that social forces play a role in the creation of our diagnoses, as they do in many sciences. However, truly socially constructed psychiatric disorders are rare. I then describe powerful arguments against a realist theory of psychiatric disorders. Because so many prior psychiatric diagnoses have been proposed and then abandoned, can we really claim that our current nosologies have it right? Much of our current nosology arose from a series of historical figures and events which could have gone differently. If we re-run the tape of history over and over again, the DSM and ICD would not likely have the same categories on every iteration. Therefore, we should argue more confidently for the reality of broader constructs of psychiatric illness rather than our current diagnostic categories, which remain tentative. Finally, instead of thinking that our disorders are true because they correspond to clear entities in the world, we should consider a coherence theory of truth by which disorders

  7. Acute Pneumonia.

    PubMed

    Arshad, Hammad; Fasanya, Adebayo; Cheema, Tariq; Singh, Anil C

    2016-01-01

    Acute pneumonia is an active infection of the lungs that results when an individual at risk gets exposed to a particular microbiological pathogen. Acute pneumonia is the leading cause of death in the United States that is attributable to an infection. The risk factors, pathogenesis, and microbiological organisms involved differ if the pneumonia develops in the community versus health care-associated environment. The development of concise and comprehensive guidelines has led to an improvement in the management of the problem. However, the emergence of multidrug-resistant organisms and the increase in the percentage of elderly population keep mortality risk very substantial. PMID:26919676

  8. Teaching Psychodynamics to Psychiatric Residents through Psychiatric Outpatient Interviews

    ERIC Educational Resources Information Center

    Cardoso Zoppe, Eva Helena C.; Schoueri, Patricia; Castro, Monica; Neto, Francisco Lotufo

    2009-01-01

    Objective: This study evaluates whether a course that was designed for first-year psychiatric residents and that specifically addressed psychodynamic principles fostered residents' progress in knowledge, skills, and attitudes regarding these concepts. Methods: The course was given in the 2005 academic year to all residents (N=18) in their first…

  9. Thalamic transcriptome screening in three psychiatric states.

    PubMed

    Chu, Tearina T; Liu, Yuexun; Kemether, Eileen

    2009-11-01

    The prefrontal cortex has been implicated in schizophrenia (SZ) and affective disorders by gene expression studies. Owing to reciprocal connectivity, the thalamic nuclei and their cortical fields act as functional units. Altered thalamic gene expression would be expected to occur in association with cortical dysfunction. We screened the expression of the entire human genome of neurons harvested by laser-capture microdissection (LCM) from the thalamic primary relay to dorsolateral prefrontal cortex in three psychiatric disease states as compared with controls. Microarray analysis of gene expression showed the largest number of dysregulated genes was in SZ, followed by major depression (MD) and bipolar mood bipolar (BP) (1152, 385 and 288, respectively). Significantly, IGF1-mTOR-, AKT-, RAS-, VEGF-, Wnt- and immune-related signaling, eIF2- and proteasome-related genes were unique to SZ. Vitamin D receptor and calcium signaling pathway were unique to BP. AKAP95 pathway and pantothenate and CoA biosynthesis were unique to MD. There are significant differences among the three psychiatric disorders in MDNp cells. These findings offer new insights into the transcriptional dysregulation in the thalamus of SZ/BP/MD subjects. PMID:19834500

  10. Hyperbaric programs in the United States: Locations and capabilities of treating decompression sickness, arterial gas embolisms, and acute carbon monoxide poisoning: survey results.

    PubMed

    Chin, Walter; Jacoby, Laura; Simon, Olivia; Talati, Nisha; Wegrzyn, Gracelene; Jacoby, Rachelle; Proano, Jacob; Sprau, Susan E; Markovitz, Gerald; Hsu, Rita; Joo, Ellie

    2016-01-01

    Hyperbaric oxygen therapy is the primary treatment for arterial gas embolism, decompression sickness and acute carbon monoxide poisoning. Though there has been a proliferation of hyperbaric centers throughout the United States, a scarcity of centers equipped to treat emergency indications makes transport of patients necessary. To locate and characterize hyperbaric chambers capable of treating emergency cases, a survey of centers throughout the entire United States was conducted. Using Google, Yahoo, HyperbaricLink and the UHMS directory, a database for United States chambers was created. Four researchers called clinicians from the database to administer the survey. All centers were contacted for response until four calls went unreturned or a center declined to be included. The survey assessed chamber readiness to respond to high-acuity patients, including staff availability, use of medical equipment such as ventilators and intravenous infusion devices, and responding yes to treating hyperbaric emergencies within a 12-month period. Only 43 (11.9%, N = 361) centers had equipment, intravenous infusion pumps and ventilators, and staff necessary to treat high-acuity patients. Considering that a primary purpose of hyperbaric oxygen therapy is the treatment of arterial gas embolism and decompression sickness, more hyperbaric centers nationwide should be able to accommodate these emergency cases quickly and safely. PMID:27000011

  11. Utilization of medical services by psychiatric patients.

    PubMed

    Norfleet, M A; Burnell, G M

    1981-03-01

    The relationship between medical and psychiatric utilization of services was examined in a two-year study of two groups of psychiatric patients: high users of psychiatric services (more than ten visits in one year) and low users of psychiatric services (ten or fewer visits in one year). The high-utilization group made more than 60 per cent of the total psychiatric visits in the two-year period, but only 21 per cent of the total medical visits. However, patients in this group increased their utilization of medical services when psychiatric utilization was reduced, raising the question of whether high-utilization patients tend to substitute medical visits for psychiatric visits. In contrast, patients in the low-utilization group were able to hold their medical utilization constant when they reduced psychiatric utilization. Analysis of factors influencing utilization patterns might allow illness behavior in patients to be predetermined and lead to better and more cost-effective health care. PMID:7203418

  12. Alcohol Abuse and Other Psychiatric Disorders

    MedlinePlus

    Skip to main content National Institute on Alcohol Abuse and Alcoholism (NIAAA) Main Menu Search Search form ... Health & Health Disparities Other Psychiatric Disorders Other Substance Abuse HIV/AIDS Other Psychiatric Disorders In the current ...

  13. Psychiatric morbidity associated with motor vehicle accidents.

    PubMed

    Blanchard, E B; Hickling, E J; Taylor, A E; Loos, W

    1995-08-01

    The primary purpose of this report was to determine the extent of psychiatric morbidity and comorbidity among a sample of recent victims of motor vehicle accidents (MVAs) in comparison to a nonaccident control population. Victims of recent MVAs (N = 158), who sought medical attention as a result of the MVA, were assessed in a University-based research clinic, 1 to 4 months after the accident for acute psychiatric and psychosocial consequences as well as for pre-MVA psychopathology using structured clinical interviews (Clinician-Administered PTSD Scale, SCID, SCID-II, LIFE Base). Age- and gender-matched controls (N = 93) who had had no MVAs in the past year served as controls. Sixty-two MVA victims (39.2%) met DSM-III-R criteria for posttraumatic stress disorder (PTSD), and 55 met DSM-IV criteria. The MVA victims who met the criteria for PTSD were more subjectively distressed and had more impairment in role function (performance at work/school/homemaking, relationships with family or friends) than the MVA victims who did not meet the PTSD criteria or the controls. A high percentage (53%) of the MVA-PTSD group also met the criteria for current major depression, with most of that developing after the MVA. A prior history of major depression appears to be a risk factor for developing PTSD after an MVA (p = .0004): 50% of MVA victims who developed PTSD had a history of previous major depression, as compared with 23% of those with a less severe reaction to the MVA. A prior history of PTSD from earlier trauma also is associated with developing PTSD or a subsyndromal form of it (25.2%) (p = .0012). Personal injury MVAs exact substantial psychosocial costs on the victims. Early intervention, especially in vulnerable populations, might prevent some of this. PMID:7643060

  14. How to evacuate a psychiatric hospital: a Hurricane Katrina success story.

    PubMed

    Thomas, Joan; Lackey, Nancy

    2008-01-01

    This article describes the successful evacuation of an entire psychiatric hospital from New Orleans, Louisiana, to Memphis, Tennessee, on a weekend night. The destination site was 400 miles away and buses were used for transport. The evacuation occurred shortly before Hurricane Katrina struck New Orleans and included 73 adult, adolescent, and child acute psychiatric patients. Thirty-five staff members also participated in the evacuation with their families and pets. This report is significant because little is known about how to implement a disaster plan that involves the transport of an entire psychiatric hospital-patients, nurses, physicians, staff, and family members--to another city. The knowledge gained can also benefit psychiatric nurses and their organizations when establishing or modifying their disaster plans. PMID:18251350

  15. The Psychoactive Effects of Psychiatric Medication: The Elephant in the Room

    PubMed Central

    Cohen, David; Porter, Sally

    2013-01-01

    The psychoactive effects of psychiatric medications have been obscured by the presumption that these medications have disease-specific actions. Exploiting the parallels with the psychoactive effects and uses of recreational substances helps to highlight the psychoactive properties of psychiatric medications and their impact on people with psychiatric problems. We discuss how psychoactive effects produced by different drugs prescribed in psychiatric practice might modify various disturbing and distressing symptoms, and we also consider the costs of these psychoactive effects on the mental well-being of the user. We examine the issue of dependence, and the need for support for people wishing to withdraw from psychiatric medication. We consider how the reality of psychoactive effects undermines the idea that psychiatric drugs work by targeting underlying disease processes, since psychoactive effects can themselves directly modify mental and behavioral symptoms and thus affect the results of placebo-controlled trials. These effects and their impact also raise questions about the validity and importance of modern diagnosis systems. Extensive research is needed to clarify the range of acute and longer-term mental, behavioral, and physical effects induced by psychiatric drugs, both during and after consumption and withdrawal, to enable users and prescribers to exploit their psychoactive effects judiciously in a safe and more informed manner. PMID:24592667

  16. Intensive care unit nurses' perceptions of patient participation in the acute phase of chronic obstructive pulmonary disease exacerbation: an interview study

    PubMed Central

    Kvangarsnes, Marit; Torheim, Henny; Hole, Torstein; Öhlund, Lennart S

    2013-01-01

    Aim To report a study conducted to explore intensive care unit nurses’ perceptions of patient participation in the acute phase of chronic obstructive pulmonary disease exacerbation. Background An acute exacerbation is a life-threatening situation, which patients often consider to be extremely frightening. Healthcare personnel exercise considerable power in this situation, which challenges general professional notions of patient participation. Design Critical discourse analysis. Methods In the autumn of 2009, three focus group interviews with experienced intensive care nurses were conducted at two hospitals in western Norway. Two groups had six participants each, and one group had five (N = 17). The transcribed interviews were analysed by means of critical discourse analysis. Findings The intensive care nurses said that an exacerbation is often an extreme situation in which healthcare personnel are exercising a high degree of control and power over patients. Patient participation during exacerbation often takes the form of non-involvement. The participating nurses attached great importance to taking a sensitive approach when meeting patients. The nurses experienced challenging ethical dilemmas. Conclusion This study shows that patient participation should not be understood in universal terms, but rather in relation to a specific setting and the interactions that occur in this setting. Healthcare personnel must develop skill, understanding, and competence to meet these challenging ethical dilemmas. A collaborative inter-professional approach between physicians and nurses is needed to meet the patients’ demand for involvement. PMID:22512673

  17. Legal Considerations of Psychiatric Nursing Practice.

    PubMed

    Barloon, Linda Funk; Hilliard, Wanda

    2016-06-01

    There are major legal issues that affect psychiatric nursing and guidelines for practicing in a legal and responsible manner. Advances in understanding of psychiatric conditions and developments in how nurses care for psychiatric patients result in changes in regulations, case law, and policies that govern nursing practice. Professional development, keeping abreast of current research and literature regarding clinical practice and trends, and involvement in professional organizations are some of the ways that psychiatric nurses can meet the challenges of their profession. PMID:27229273

  18. A cluster of salivirus A1 (Picornaviridae) infections in newborn babies with acute gastroenteritis in a neonatal hospital unit in Hungary.

    PubMed

    Boros, Ákos; Raáb, Margit; Károly, Éva; Karai, Adrienn; Kátai, Andrea; Bolba, Nóra; Pankovics, Péter; Reuter, Gábor

    2016-06-01

    Salivirus (family Picornaviridae) may be associated with acute gastroenteritis in humans, but there have been no reports of salivirus outbreaks. Salivirus A1 infection with faecal virus concentrations of 2.1-2.6 × 10(9)/g were identified retrospectively in newborn babies, between the ages of 1.5 and 5 days, with apparent clinical symptoms of diarrhea (100 %), fever (40 %), vomiting (40 %), and loss of appetite (40 %) in a neonatal hospital unit in Hungary in July 2013. The complete genome sequence of the salivirus (including the 5'-terminal end) was determined. Salivirus mono-infection may be associated with gastroenteritis in babies who are a few days old. Salivirus testing should be done in public health laboratories in gastroenteritis outbreaks with unknown etiology. PMID:27001303

  19. Severe Acute Asthma Exacerbation in Children: A Stepwise Approach for Escalating Therapy in a Pediatric Intensive Care Unit

    PubMed Central

    Nievas, I. Federico Fernandez; Anand, Kanwaljeet J. S.

    2013-01-01

    OBJECTIVES An increasing prevalence of pediatric asthma has led to increasing burdens of critical illness in children with severe acute asthma exacerbations, often leading to respiratory distress, progressive hypoxia, and respiratory failure. We review the definitions, epidemiology, pathophysiology, and clinical manifestations of severe acute asthma, with a view to developing an evidence-based, stepwise approach for escalating therapy in these patients. METHODS Subject headings related to asthma, status asthmaticus, critical asthma, and drug therapy were used in a MEDLINE search (1980–2012), supplemented by a manual search of personal files, references cited in the reviewed articles, and treatment algorithms developed within Le Bonheur Children's Hospital. RESULTS Patients with asthma require continuous monitoring of their cardiorespiratory status via noninvasive or invasive devices, with serial clinical examinations, objective scoring of asthma severity (using an objective pediatric asthma score), and appropriate diagnostic tests. All patients are treated with β-agonists, ipratropium, and steroids (intravenous preferable over oral preparations). Patients with worsening clinical status should be progressively treated with continuous β-agonists, intravenous magnesium, helium-oxygen mixtures, intravenous terbutaline and/or aminophylline, coupled with high-flow oxygen and non-invasive ventilation to limit the work of breathing, hypoxemia, and possibly hypercarbia. Sedation with low-dose ketamine (with or without benzodiazepines) infusions may allow better toleration of non-invasive ventilation and may also prepare the patient for tracheal intubation and mechanical ventilation, if indicated by a worsening clinical status. CONCLUSIONS Severe asthma can be a devastating illness in children, but most patients can be managed by using serial objective assessments and the stepwise clinical approach outlined herein. Following multidisciplinary education and training, this

  20. Blood tests: One too many? Evaluating blood requesting guidance developed for acute patients admitted to trauma and orthopaedic units.

    PubMed

    Faulkner, Alastair; Reidy, Mike; Scicluna, Gabrielle; Love, Gavin J; Joss, Judith

    2016-03-01

    In a recently published report from the Academy of Medical Royal Colleges, around 20% of clinical practice which encompasses blood science investigations is considered wasteful. Blood tests including liver function tests (LFTs), C-reactive protein (CRP), coagulation screens, and international normalising ratios (INR) are frequently requested for patients who undergo emergency hospital admission. The paucity of guidance available for blood requesting in acute trauma and orthopaedic admissions can lead to inappropriate requesting practices and over investigation. Acute admissions over a period of one month were audited retrospectively for the frequency and clinical indications of requests for LFTs, coagulation screens/INR, and CRP. The total number of blood tests requested for the duration of the patient's admission was recorded. Initial auditing of 216 admissions in January 2014 demonstrated a striking amount of over-investigation. Clinical guidelines were developed with multidisciplinary expert input and implemented within the department. Re-audit of 233 admissions was carried out in September 2014. Total no. of LFTs requested: January 895, September 336 (-62.5%); coagulation screens/INR requested: January 307, September 210 (-31.6%); CRPs requested: January 894, September 317 (-64.5%). No. of blood requests per patient: January (M=4.81, SD 4.75), September (M=3.60, SD=4.70). Approximate combined total cost of LFT, coagulation/INR, CRP in January £2674.14 and September £1236.19 (-£1437.95, -53.77%). A large decrease was observed in admission requesting and subsequent monitoring (p<0.01) following the implementation. This both significantly reduced cost and venepuncture rates. PMID:26696248

  1. PSYCHIATRIC DISORDERS ASSOCIATED WITH FXTAS

    PubMed Central

    Seritan, Andreea L.; Ortigas, Melina; Seritan, Stefan; Bourgeois, James A.; Hagerman, Randi J.

    2015-01-01

    Carriers of the FMR1 premutation (with 55-200 CGG repeats) may present with multiple medical and psychiatric disorders. Middle-aged carriers (males more often than females) may suffer from fragile X-associated tremor/ataxia syndrome (FXTAS). FXTAS is a newly discovered neurodegenerative disease characterized by intention tremor and ataxia, along with several other neurological features. Psychiatric manifestations are common in premutation carriers of both genders and include attention deficits, anxiety, depression, irritability, impulse dyscontrol, and substance abuse or dependence. Major depressive disorder, panic disorder with or without agoraphobia, generalized anxiety disorder, social phobia, and specific phobia are among the psychiatric diagnoses often encountered in premutation carriers, including those with FXTAS. Later in the course of the illness, cognitive deficits (including dementia) may occur. In this paper, we discuss common psychiatric phenotypes in FXTAS, based on a thorough review of the literature, as well as our own research experience. Symptomatic pharmacologic treatments are available, although disease modifying agents have not yet been developed. PMID:25620899

  2. Psychiatric Morbidity of Cannabis Abuse

    PubMed Central

    Sarkar, Jaydip; Murthy, Pratima; Singh, Swaran P

    2003-01-01

    The paper evaluates the hypothesis that cannabis abuse is associated with a broad range of psychiatric disorders in India, an area with relatively high prevalence of cannabis use. Retrospective case-note review of all cases with cannabis related diagnosis over a 11 -year period, for subjects presenting to a tertiary psychiatric hospital in southern India was carried out. Information pertaining to sociodemographic, personal, social, substance-use related, psychiatric and treatment histories, was gathered. Standardized diagnoses were made according to Diagnostic Criteria for Research of the World Health Organization, on the basis of information available. Cannabis abuse is associated with widespread psychiatric morbidity that spans the major categories of mental disorders under the ICD-10 system, although proportion of patients with psychotic disorders far outweighed those with non-psychotic disorders. Whilst paranoid psychoses were more prevalent, a significant number of patients with affective psychoses, particularly mania, was also noted. Besides being known as either the causative agent or a potent risk factor in cases of paranoid psychoses, cannabis appears to have similar capabilities with regard to affective psychoses, particularly in cases of mania. It is suggested that cannabis has the potential to act as a "life event stressor" amongst subjects vulnerable to develop affective psychoses and the possible aetiopathogenesis of such a finding is discussed. PMID:21206852

  3. Poetry Therapy in Psychiatric Nursing.

    ERIC Educational Resources Information Center

    Anderson, Catherine J.

    Poetry therapy has been in use with adult psychiatric patients at Saint Elizabeths Hospital, Washington, D.C, for 10 years. The treatment used involves reading poetry, listening to recordings, studying poets, and writing poetry. The patients' choice of poems is not restricted by the staff, but different types of poetry appeal to different types of…

  4. Associations among Major Psychiatric Diagnoses.

    ERIC Educational Resources Information Center

    Wolf, Abraham W.; And Others

    1988-01-01

    Examined the frequency and associations of multiple diagnoses in 205 psychiatric inpatients, assessing past and current episodes of illness. Over one-half of the sample received more than one diagnosis. Alcoholism, antisocial personality, and drug dependence formed one group; primary depression, primary mania, and secondary affective disorder,…

  5. Job satisfaction in psychiatric nursing.

    PubMed

    Ward, M; Cowman, S

    2007-08-01

    In recent years, mental health services across Europe have undergone major organizational change with a move from institutional to community care. In such a context, the impact of change on the job satisfaction of psychiatric nurses has received little attention in the literature. This paper reports on the job satisfaction of psychiatric nurses and data were collected in 2003. The population of qualified psychiatric nurses (n = 800) working in a defined geographical health board area was surveyed. Methodological triangulation with a between-methods approach was used in the study. Data were collected on job satisfaction using a questionnaire adopted from the Occupational Stress Indicator. A response rate of 346 (43%) was obtained. Focus groups were used to collect qualitative data. Factors influencing levels of job satisfaction predominantly related to the nurses work location. Other factors influencing job satisfaction included choice of work location, work routine, off duty/staff allocation arrangements, teamwork and working environment. The results of the study highlight to employers of psychiatric nurses the importance of work location, including the value of facilitating staff with choices in their working environment, which may influence the recruitment and retention of nurses in mental health services. PMID:17635253

  6. [Psychiatric evaluation in civil law].

    PubMed

    Foerster, K

    1992-03-01

    Aspects of civil law of importance for the psychiatrist as expert witness are those dealing with disability pensions accident insurance, compensation in civil law and rights of the seriously disabled. The legal basis of each is briefly outlined, and some guidelines given for psychiatric court reports. Some outstanding theoretical and practical problems are mentioned. PMID:1579170

  7. Antidepressant adherence after psychiatric hospitalization

    PubMed Central

    Zivin, Kara; Ganoczy, Dara; Pfeiffer, Paul N.; Miller, Erin M.; Valenstein, Marcia

    2010-01-01

    Objective Depressed patients discharged from psychiatric hospitalizations face increased risks for adverse outcomes including suicide, yet antidepressant adherence rates during this high-risk period are unknown. Using Veterans Affairs (VA) data, we assessed antidepressant adherence and predictors of poor adherence among depressed veterans following psychiatric hospitalization. Method We identified VA patients nationwide with depressive disorders who had a psychiatric hospitalization between April 1, 1999 and September 30, 2003, received antidepressant medication, and had an outpatient appointment following discharge. We calculated medication possession ratios (MPRs), a measure of medication adherence, within three and six months following discharge. We assessed patient factors associated with having lower levels of adherence (MPRs <0.8) after discharge. Results 20,931 and 23,182 patients met criteria for three and six month MPRs. The mean three month MPR was 0.79 (s.d.=0.37). The mean six month MPR was 0.66 (s.d.=0.40). Patients with poorer adherence were male, younger, non-white, and had a substance abuse disorder, but were less likely to have PTSD or other anxiety disorders. Conclusion Poor antidepressant adherence is common among depressed patients after psychiatric hospitalization. Efforts to improve adherence at this time may be critical in improving the outcomes of these high-risk patients. PMID:19609666

  8. Psychiatric illness and sexual function.

    PubMed

    Segraves, R T

    1998-05-01

    Impaired sexual function has been noted to occur in various psychiatric illnesses. In affective disorders, disturbances of libido, erection and orgasm have been reported. Disordered sexual behavior has also been noted in patients with schizophrenia and anorexia nervosa. Clinical speculation suggests that anxiety disorders may also be associated with a higher prevalence of sexual problems. PMID:9647976

  9. Comorbidity of Psychiatric Disorders and Parental Psychiatric Disorders in a Sample of Iranian Children with ADHD

    ERIC Educational Resources Information Center

    Ghanizadeh, Ahmad; Mohammadi, Mohammad Reza; Moini, Rozita

    2008-01-01

    Objective: To study the psychiatric comorbidity of a clinical sample of children with ADHD and the psychiatric disorders in their parents. Method: Structured psychiatric interviews assessing lifetime psychiatric disorders by "DSM-IV" criteria, using the Farsi version of the Schedule for Affective Disorders and Schizophrenia. Results: The mean age…

  10. Validation of the Excited Component of the Positive and Negative Syndrome Scale (PANSS-EC) in a naturalistic sample of 278 patients with acute psychosis and agitation in a psychiatric emergency room

    PubMed Central

    2011-01-01

    Background Despite the wide use of the Excited Component of the Positive and Negative Syndrome Scale (PANSS-EC) in a clinical setting to assess agitated patients, a validation study to evaluate its psychometric properties was missing. Methods Data from the observational NATURA study were used. This research describes trends in the use of treatments in patients with acute psychotic episodes and agitation seen in emergency departments. Exploratory principal component factor analysis was performed. Spearman's correlation and regression analyses (linear regression model) as well as equipercentile linking of Clinical Global Impression of Severity (CGI-S), Agitation and Calmness Evaluation Scale (ACES) and PANSS-EC items were conducted to examine the scale's diagnostic validity. Furthermore, reliability (Cronbach's alpha) and responsiveness were evaluated. Results Factor analysis resulted in one factor being retained according to eigenvalue ≥1. At admission, the PANSS-EC and CGI-S were found to be linearly related, with an average increase of 3.4 points (p < 0.001) on the PANSS-EC for each additional CGI-S point. The PANSS-EC and ACES were found to be linearly and inversely related, with an average decrease of 5.5 points (p < 0.001) on the PANSS-EC for each additional point. The equipercentile method shows the poor sensitivity of the ACES scale. Cronbach's alpha was 0.86 and effect size was 1.44. Conclusions The factorial analyses confirm the unifactorial structure of the PANSS-EC subscale. The PANSS-EC showed a strong linear correlation with rating scales such as CGI-S and ACES. PANSS-EC has also shown an excellent capacity to detect real changes in agitated patients. PMID:21447155

  11. Change in cognitive performance is associated with functional recovery during post-acute stroke rehabilitation: a multi-centric study from intermediate care geriatric rehabilitation units of Catalonia.

    PubMed

    Pérez, Laura Mónica; Inzitari, Marco; Roqué, Marta; Duarte, Esther; Vallés, Elisabeth; Rodó, Montserrat; Gallofré, Miquel

    2015-10-01

    Recovery after a stroke is determined by a broad range of neurological, functional and psychosocial factors. Evidence regarding these factors is not well established, in particular influence of cognition changes during rehabilitation. We aimed to investigate whether selective characteristics, including cognitive performance and its change over time, modulate functional recovery with home discharge in stroke survivors admitted to post-acute rehabilitation units. We undertook a multicenter cohort study, including all patients discharged from acute wards to any geriatric rehabilitation unit in Catalonia-Spain during 2008. Patients were assessed for demographics, clinical and functional variables using Conjunt Mínim Bàsic de Dades dels Recursos Sociosanitaris (CMBD-RSS), which adapts the Minimum Data Set tool used in America's nursing homes. Baseline-to-discharge change in cognition was calculated on repeated assessments using the Cognitive Performance Scale (CPS, range 0-6, best-worst cognition). The multivariable effect of these factors was analyzed in relation to the outcome. 879 post-stroke patients were included (mean age 77.48 ± 10.18 years, 52.6% women). A worse initial CPS [OR (95% CI) = 0.851 (0.774-0.935)] and prevalent fecal incontinence [OR (95% CI) = 0.560 (0.454-0.691)] reduced the likelihood of returning home with functional improvement; whereas improvement of CPS, baseline to discharge, [OR (95% CI) = 1.348 (1.144-1.588)], more rehabilitation days within the first 2 weeks [OR (95% CI) = 1.011 (1.006-1.015)] and a longer hospital stay [OR (95% CI) = 1.011 (1.006-1.015)] were associated with the outcome. In our sample, different clinical characteristics, including cognitive function and its improvement over time, are associated with functional improvement in stroke patients undergoing rehabilitation. Our results might provide information to further studies aimed at exploring the influence of cognition changes during rehabilitation. PMID:26050232

  12. Optimization of psychopharmacotherapy for schizophrenia in a male, locked, non-acute unit serving for persistently ill patients over one year.

    PubMed

    Suzuki, Takefumi; Uchida, Hiroyuki; Takeuchi, Hiroyoshi; Tsunoda, Kenichi; Ishizuki, Tomomi; Mimura, Masaru

    2015-07-30

    We describe real-world psychopharmacological treatment in a Japanese, male, closed psychiatric unit where clozapie was still unavailable. Fifty-five persistently-ill patients with schizophrenia (ICD-10), mean ± S.D. age: 57.5 ± 13.0 y.o., duration of illness and admissions: 30.9 ± 15.2 years and 20.7 ± 14.5 years, respectively) treated longitudinally were evaluated. The rule was to treat with a simplest possible psychotropic regimen without polypharmacy. Compared to the baseline, the number and dose of antipsychotics were reduced from 1.9 to 1.1 and 1012 mg/day to 607 mg/day, respectively. The number of total psychotropics was minimized from 4.7 to 2.1, with a simplified once or twice daily dosing. Overall, the CGI-Severity and FACT-Sz (global functioning) improved slightly from 5.8 to 5.5 and 28.7 to 32.6, respectively. Of note, no patients got worse in comparison with the baseline clinical presentation. Forty-four patients were successfully treated with a single antipsychotic; only seven needed two antipsychotics simultaneously while 36 had been treated with antipsychotic polypharmacy at baseline. Benzodiazepines (mostly lorazepam) and antiparkinsonian drugs were prescribed in 28 and only two, respectively. Nineteen needed adjunctive valproate (average blood levels: 99.3 ± 21.8 μg/mL) and nine used lithium (0.61 ± 0.26 mEq/L). Optimization of psychopharmacotherapy is still possible for difficult-to-treat patients and, while augmentation of an antipsychotic with mood stabilizers is frequently needed, antipsychotic polypharmacy should be exceptional. PMID:25935376

  13. Academic Accommodations for Students with Psychiatric Disabilities.

    ERIC Educational Resources Information Center

    Souma, Alfred; Rickerson, Nancy; Burgstahler, Sheryl

    This brief paper summarizes the literature on academic accommodations for students with psychiatric disabilities. A definition of psychiatric disability precedes a brief summary of the following specific psychiatric diagnoses: depression, bipolar affective disorder; borderline personality disorder; schizophrenia; and anxiety disorders. Also noted…

  14. Psychiatric disorders and traumatic brain injury

    PubMed Central

    Schwarzbold, Marcelo; Diaz, Alexandre; Martins, Evandro Tostes; Rufino, Armanda; Amante, Lúcia Nazareth; Thais, Maria Emília; Quevedo, João; Hohl, Alexandre; Linhares, Marcelo Neves; Walz, Roger

    2008-01-01

    Psychiatric disorders after traumatic brain injury (TBI) are frequent. Researches in this area are important for the patients’ care and they may provide hints for the comprehension of primary psychiatric disorders. Here we approach epidemiology, diagnosis, associated factors and treatment of the main psychiatric disorders after TBI. Finally, the present situation of the knowledge in this field is discussed. PMID:19043523

  15. Change Trajectories: Children's Patterns of Improvement in Acute-Stay Inpatient Care.

    PubMed

    Leon, Scott C; Miller, Steven A; Stoner, Alison M; Fuller, Anne; Rolnik, Ashley

    2016-04-01

    This study estimated classes of children's acute-stay psychiatric acuity trajectories in terms of shape (i.e., linear, quadratic, cubic) and rate of change (slope). A total of 788 children served on three child units (ages 4-12) were studied. The Children's Acuity of Psychiatric Illness (CAPI) was completed each weekday by trained frontline staff on the milieu. Latent class growth analysis was applied to the data, and seven acuity trajectory classes provided the most parsimonious fit. Four classes evidenced a significant quadratic term, one class a significant linear term, and two classes did not evidence a significant change in acuity. The classes varied in survival time to rehospitalization, in pre-treatment community service use and rates of seclusion, restraint, and emergency medications during the episode. Overall, the results suggest that acute-stay patients may have distinct and identifiable psychiatric acuity change patterns during their episodes and that some may experience non-linear (i.e., quadratic) acuity trajectories. PMID:25073517

  16. The Banner Psychiatric Center: A Model for Providing Psychiatric Crisis Care to the Community while Easing Behavioral Health Holds in Emergency Departments

    PubMed Central

    Little-Upah, Pat; Carson, Chris; Williamson, Robert; Williams, Tom; Cimino, Michael; Mehta, Neena; Buehrle, Jeff; Kisiel, Steve

    2013-01-01

    Banner Health in the Phoenix, AZ, metropolitan area provides individuals in a behavioral health crisis with an alternative to presenting to an Emergency Department (ED). By implementing a process to quickly move patients out of our ED, our health care system has been able to greatly reduce the hold time for behavioral health patients. Through access to psychiatric clinicians around the clock at the Banner Psychiatric Center, patients now receive the appropriate treatment and needed care in a timely manner. Finally, disposition of patients into appropriate levels of care has freed up acute care Level 1 beds to be available to patients who meet those criteria. PMID:23596368

  17. Cognitive functioning in schizophrenia: implications for psychiatric rehabilitation.

    PubMed

    Spaulding, W D; Fleming, S K; Reed, D; Sullivan, M; Storzbach, D; Lam, M

    1999-01-01

    Research in psychopathology and the cognitive neurosciences suggests new applications in psychiatric rehabilitation. Analysis of performance deficits on laboratory tasks can contribute to treatment planning, individual and family counseling, and staff consultation, much like it does in cases of brain injury and other types of central nervous system neuropathology. Recognition of the nature of cognitive impairments in schizophrenia can inform design of psychosocial techniques such as social and living skills training. Cognitive impairments are increasingly seen as potential targets for pharmacological and psychosocial treatment and rehabilitation. In this article, three key issues for application of cognitive technology in psychiatric rehabilitation of schizophrenia and related disorders are formulated as straightforward, clinically relevant questions: (1) What is the prognostic significance of cognitive impairment in acute psychosis? (2) Can cognitive functioning improve in the chronic, residual course? (3) How does cognitive improvement benefit other aspects of recovery and rehabilitation? These questions are addressed through review of previous findings and new multivariate analyses of cognitive functioning in the acute, post-acute, and chronic residual phases of schizophrenia. PMID:10416731

  18. Psychiatric treatments in dermatology: an update.

    PubMed

    Sambhi, R; Lepping, P

    2010-03-01

    There is a considerable degree of connection between psychiatry and dermatology. This connection is relevant both for diagnosis and management of dermatological pathology. This article summarises common psychiatric conditions seen in patients with skin disease, both primary psychiatric disorders and psychiatric disorders secondary to dermatological pathology. Diagnosis of relevant psychiatric conditions such as anxiety, depression, obsessive-compulsive disorder, delusional parasitosis and dermatitis artefacta, and psychiatric treatments are discussed. It gives an update of psychopharmacology relevant to the dermatologist including important interactions between psychotropic and dermatological agents. PMID:19874324

  19. Incidence and viral aetiologies of acute respiratory illnesses (ARIs) in the United States: a population-based study.

    PubMed

    Szilagyi, P G; Blumkin, A; Treanor, J J; Gallivan, S; Albertin, C; Lofthus, G K; Schnabel, K C; Donahue, J G; Thompson, M G; Shay, D K

    2016-07-01

    We conducted prospective, community-wide surveillance for acute respiratory illnesses (ARIs) in Rochester, NY and Marshfield, WI during a 3-month period in winter 2011. We estimated the incidence of ARIs in each community, tested for viruses, and determined the proportion of ARIs associated with healthcare visits. We used a rolling cross-sectional design to sample participants, conducted telephone interviews to assess ARI symptoms (defined as a current illness with feverishness or cough within the past 7 days), collected nasal/throat swabs to identify viruses, and extracted healthcare utilization from outpatient/inpatient records. Of 6492 individuals, 321 reported an ARI within 7 days (4·9% total, 5·7% in Rochester, 4·4% in Marshfield); swabs were collected from 208 subjects. The cumulative ARI incidence for the entire 3-month period was 52% in Rochester [95% confidence interval (CI) 42-63] and 35% in Marshfield (95% CI 28-42). A specific virus was identified in 39% of specimens: human coronavirus (13% of samples), rhinovirus (12%), RSV (7%), influenza virus (4%), human metapneumovirus (4%), and adenovirus (1%). Only 39/200 (20%) had a healthcare visit (2/9 individuals with influenza). ARI incidence was ~5% per week during winter. PMID:26931351

  20. Emergency department triage of acute heart failure triggered by pneumonia; when an intensive care unit is needed?

    PubMed

    Siniorakis, Eftychios E; Arapi, Sophia M; Panta, Stamatia G; Pyrgakis, Vlassios N; Ntanos, Ioannis Th; Limberi, Sotiria J

    2016-10-01

    Community acquired pneumonia (CAP) is a frequent triggering factor for decompensation of a chronic cardiac dysfunction, leading to acute heart failure (AHF). Patients with AHF exacerbated by CAP, are often admitted through the emergency department for ICU hospitalization, even though more than half the cases do not warrant any intensive care treatment. Emergency department physicians are forced to make disposition decisions based on subjective criteria, due to lack of evidence-based risk scores for AHF combined with CAP. Currently, the available risk models refer distinctly to either AHF or CAP patients. Extrapolation of data by arbitrarily combining these models, is not validated and can be treacherous. Examples of attempts to apply acuity scales provenient from different disciplines and the resulting discrepancies, are given in this review. There is a need for severity classification tools especially elaborated for use in the emergency department, applicable to patients with mixed AHF and CAP, in order to rationalize the ICU dispositions. This is bound to facilitate the efforts to save both lives and resources. PMID:27390973

  1. Psychiatric complications in the critically ill cardiac patient.

    PubMed Central

    Sanders, K M; Cassem, E H

    1993-01-01

    Psychiatric consultation to the critically ill cardiac patient focuses on several common problems: anxiety, delirium, depression, personality reactions, and behavioral disturbances. A review of the causes and treatment of anxiety in the coronary care unit is followed by a discussion of delirium in the critically ill cardiac patient. A description of delirium associated with the use of the intraaortic balloon pump and its treatment with high doses of intravenous haloperidol is also included. After the initial crisis has been stabilized in the critical care unit, the premorbid personality traits of the patient may emerge as behavioral disturbances--particularly as the duration of stay increases. The use of psychiatric consultation completes the discussion. PMID:8219821

  2. [Authority in the psychiatric clinic].

    PubMed

    Laemmel, K

    1983-01-01

    Although considerable progress was made as far as therapy and individual rights of the patients are concerned today the psychiatric hospital is more than ever the butt of open citicism. One of the reasons for that is the odium of involuntarity and authority surrounding it. It is based on the ill-fame and dubious reputation of the nineteenth century "asylum". The problem of authority concerns today's hospitals as much as ever. How the hospital is run depends naturally in the first place on the personality of it's director his views on authority, as much as on his understanding and ability to handle the intensive dynamic processes in the institution. Recognizing the boundaries of his actual knowledge and training, his "authoritative authority", makes him wisely limit his goals and activities. Power or "authoritarian authority" must be employed with restraint and moderation but without hesitancy when necessary. The clinic represents for the patient a total milieu. It's therapeutic effect relies a great deal on the regulatory influence of the daily routine based on the authority of the treatment team. Jones' ideas of the "Therapeutic Community" have only limited value for today's psychiatric hospital. Even less significant contributions have been made by the antipsychiatric movement or the Marxist-inspired reformers of the last decades. Only that is therapeutic which in the final analysis helps the patient to cope successfully with reality. Even today the use of involuntary measures-seclusion and medication etc. remain a necessary tool for the treatment of some patients. As every institution is always part of a public or private structure, it's authority is always bridled by these. Ethical clinical psychiatry requires an ethical political state, if it is not to become it's henchman. Even in democratic countries problems may arise around involuntary hospitalization, the care of psychiatrically ill criminals or the legalities around medicating the uncooperative psychotic

  3. Discussing the psychiatric manifestations of 22q11.2 deletion syndrome: an exploration of clinical practice among medical geneticists

    PubMed Central

    Morris, Emily; Inglis, Angela; Friedman, Jan; Austin, Jehannine

    2013-01-01

    Purpose The aim of this study was to determine the frequency with which medical geneticists discuss the psychiatric manifestations of 22q11.2 deletion syndrome (22q11DS) with families in relation to the frequency with which they discuss the other manifestations of the syndrome and to explore relationships between discussion of these features and stigma toward psychiatric disorders. Methods We surveyed medical geneticists in the United States and Canada regarding the frequency with which they discuss various features of 22q11DS with families in the context of four clinical scenarios in which only the age of the patient at diagnosis differed. Respondents also completed a 20-item validated psychometric measure of stigma towards psychiatric disorders. Results 308/546 medical geneticists completed the survey (56% response rate). Psychiatric disorders were discussed significantly less often than other features of 22q11DS (p<0.0001), but psychiatric disorders were discussed significantly more often when the patient was ≥ 13 years old (p<0.0001), than when the patient was younger. Geneticists who discussed psychiatric disorders the least had significantly higher levels of stigma towards psychiatric disorders (p=0.007). Conclusion Psychiatric risks are less often discussed with families during childhood. Education for physicians to help reduce stigma towards psychiatric disorders (which may impede discussion of psychiatric disorders) may warrant exploration in this population. PMID:23579435

  4. United States stock market performance and acute myocardial infarction rates in 2008-2009 (from the Duke Databank for Cardiovascular Disease).

    PubMed

    Fiuzat, Mona; Shaw, Linda K; Thomas, Laine; Felker, G Michael; O'Connor, Christopher M

    2010-12-01

    We sought to examine the relation between the United States economic decrease in 2008 and cardiovascular events as measured by local acute myocardial infarction (AMI) rates. Mental stress and traumatic events have been shown to be associated with increased risk of MI in patients with ischemic heart disease. This was an observational study of data from the Duke Databank for Cardiovascular Disease and includes patients undergoing angiography for evaluation of ischemic heart disease from January 2006 to July 2009. Patients with AMI occurring within 3 days before catheterization were used to calculate AMI rates. Stock market values were examined to determine the period of severe economic decrease, and time trends in AMI rates were examined over the same period. Time series models were used to assess the relation between United States stock market National Association of Securities Dealers Automated Quotation (NASDAQ) and rates of AMI. Of 11,590 patients included in the study cohort, 2,465 patients had an AMI during this period. Time series analysis showed a significant increase in AMI rates during a period of stock market decrease from October 2008 to April 2009 (p = 0.003), which remained statistically significant when adjusted for seasons (p = 0.02). In conclusion, unadjusted and adjusted analyses of patients in the Duke Databank for Cardiovascular Disease indicated a significant correlation between a period of stock market decrease and increased AMI rates in our local cohort. PMID:21094353

  5. Enhancement of recovery from psychiatric illness by methylfolate.

    PubMed

    Godfrey, P S; Toone, B K; Carney, M W; Flynn, T G; Bottiglieri, T; Laundy, M; Chanarin, I; Reynolds, E H

    1990-08-18

    41 (33%) of 123 patients with acute psychiatric disorders (DSM III diagnosis of major depression or schizophrenia) had borderline or definite folate deficiency (red-cell folate below 200 micrograms/l) and took part in a double-blind, placebo-controlled trial of methylfolate, 15 mg daily, for 6 months in addition to standard psychotropic treatment. Among both depressed and schizophrenic patients methylfolate significantly improved clinical and social recovery. The differences in outcome scores between methylfolate and placebo groups became greater with time. These findings add to the evidence implicating disturbances of methylation in the nervous system in the biology of some forms of mental illness. PMID:1974941

  6. Enhancement of recovery from psychiatric illness by methylfolate.

    PubMed

    Procter, A

    1991-08-01

    "41 (33%) of 123 patients with acute psychiatric disorders (DSM III diagnosis of major depression or schizophrenia) had borderline or definite folate deficiency (red-cell folate below 200 micrograms/l) and took part in a double-blind, placebo-controlled trial of methylfolate, 15 mg daily, for 6 months in addition to standard psychotropic treatment. Among both depressed and schizophrenic patients methylfolate significantly improved clinical and social recovery. The differences in outcome scores between methylfolate and placebo groups became greater with time. These findings add to the evidence implicating disturbances of methylation in the nervous system in the biology of some forms of mental illness." PMID:1773245

  7. "Boarding" Psychiatric Patients in Emergency Rooms: One Court Says "No More".

    PubMed

    Appelbaum, Paul S

    2015-07-01

    "Boarding" involuntary psychiatric patients in medical emergency rooms is common in many parts of the United States. The practice, driven by a shortage of alternative resources, including limited inpatient capacity, can result in patients' being held for days without treatment or a hospital room, often in busy corridors or treatment rooms. A recent challenge to this practice led the Washington Supreme Court to declare it illegal and resulted in the appropriation of substantial funding to create new psychiatric beds. Centralized psychiatric crisis services, with appropriate payment models, may offer another approach to reducing the need for holding patients awaiting inpatient admission. PMID:26130151

  8. The association between combat exposure and negative behavioral and psychiatric conditions.

    PubMed

    Gallaway, Michael Shayne; Fink, David S; Millikan, Amy M; Mitchell, Mary M; Bell, Michael R

    2013-07-01

    This study evaluated the association between cumulative combat exposures and negative behavioral and psychiatric conditions. A total of 6128 active-duty soldiers completed a survey approximately 6 months after their unit's most recent combat deployment. The soldiers self-reported combat exposures and behavioral and psychiatric conditions. Multivariable logistic regression was used to assess the association between cumulative combat exposures and behavioral and psychiatric outcomes. In comparison with the referent group of soldiers not previously deployed, the soldiers categorized as having the highest cumulative combat exposures were significantly associated with self-reporting a history of behavioral and psychiatric diagnoses, problematic alcohol misuse, aggression, criminal behavior, and physical altercations with a significant other. The magnitude and the consistency of the association among the soldiers with the highest number of combat exposures suggest that the number of cumulative combat deployment exposures is an important consideration for identifying and treating high-risk soldiers and units returning from combat. PMID:23817154

  9. Multicenter Approach to Recurrent Acute and Chronic Pancreatitis in the United States: The North American Pancreatitis Study 2 (NAPS2)

    PubMed Central

    Whitcomb, David C.; Yadav, Dhiraj; Adam, Slivka; Hawes, Robert H.; Brand, Randall E.; Anderson, Michelle A.; Money, Mary E.; Banks, Peter A.; Bishop, Michele D.; Baillie, John; Sherman, Stuart; DiSario, James; Burton, Frank R.; Gardner, Timothy B.; Amann, Stephen T.; Gelrud, Andres; Lo, Simon K.; DeMeo, Mark T.; Steinberg, William M.; Kochman, Michael L.; Etemad, Babak; Forsmark, Christopher E.; Elinoff, Beth; Greer, Julia B.; O’Connell, Michael; Lamb, Janette; Barmada, M. Michael

    2008-01-01

    Background Recurrent acute pancreatitis (RAP) and chronic pancreatitis (CP) are complex syndromes associated with numerous etiologies, clinical variables and complications. We developed the North American Pancreatitis Study 2 (NAPS2) to be sufficiently powered to understand the complex environmental, metabolic and genetic mechanisms underlying RAP and CP. Methods Between August 2000 and September 2006, a consortium of 20 expert academic and private sites prospectively ascertained 1,000 human subjects with RAP or CP, plus 695 controls (spouse, family, friend or unrelated). Standardized questionnaires were completed by both the physicians and study subjects and blood was drawn for genomic DNA and biomarker studies. All data were double-entered into a database and systematically reviewed to minimize errors and include missing data. Results A total of 1,000 subjects (460 RAP, 540 CP) and 695 controls who completed consent forms and questionnaires and donated blood samples comprised the final dataset. Data were organized according to diagnosis, supporting documentation, etiological classification, clinical signs and symptoms (including pain patterns and duration, and quality of life), past medical history, family history, environmental exposures (including alcohol and tobacco use), medication use and therapeutic interventions. Upon achieving the target enrollment, data were organized and classified to facilitate future analysis. The approaches, rationale and datasets are described, along with final demographic results. Conclusion The NAPS2 consortium has successfully completed a prospective ascertainment of 1,000 subjects with RAP and CP from the USA. These data will be useful in elucidating the environmental, metabolic and genetic conditions, and to investigate the complex interactions that underlie RAP and CP. PMID:18765957

  10. Psychiatric Aspects of Organ Transplantation

    PubMed Central

    Kalra, G.; Desousa, A.

    2011-01-01

    Surgical transplantation of human organs from deceased as well as living donors to sick and dying patients began after the Second World War. Over the past 50 years the transplantation of human organs, tissues and cells has become a worldwide practice which has extended, and greatly enhanced the quality of hundreds of thousands of lives. The field of transplantation medicine provides an important chance for liaison between psychiatric professionals and other transplant physicians and surgeons. The discrepancy between the ever-increasing demand for organs but the decreasing supply makes it important to evaluate and prioritize individuals who are in dire need of the organ. However, this also gives rise to certain ethical questions. The following paper discusses various psychiatric aspects of organ transplantation in general. PMID:25013589

  11. SUICIDAL COMMUNICATION IN PSYCHIATRIC PATIENTS

    PubMed Central

    Anand, R.; Trivedi, J.K.; Gupta, S.C.

    1983-01-01

    In this enquiry a cross-sectional study of hospitalized psychiatric patients was undertaken to assess prevalence and nature of suicidal behaviour. We have been able to delineate these subjects into three categories i.e. non-communicators, partial communicators and definite communicators on the basis of their scores upon 31ucid.il intent questionnaire. A follow up study of these patients which is in progress may further provide knowledge about relationship between predictive criterion and their final outcome. PMID:21847269

  12. Imaging genetics and psychiatric disorders.

    PubMed

    Hashimoto, R; Ohi, K; Yamamori, H; Yasuda, Y; Fujimoto, M; Umeda-Yano, S; Watanabe, Y; Fukunaga, M; Takeda, M

    2015-01-01

    Imaging genetics is an integrated research method that uses neuroimaging and genetics to assess the impact of genetic variation on brain function and structure. Imaging genetics is both a tool for the discovery of risk genes for psychiatric disorders and a strategy for characterizing the neural systems affected by risk gene variants to elucidate quantitative and mechanistic aspects of brain function implicated in psychiatric disease. Early studies of imaging genetics included association analyses between brain morphology and single nucleotide polymorphisms whose function is well known, such as catechol-Omethyltransferase (COMT) and brain-derived neurotrophic factor (BDNF). GWAS of psychiatric disorders have identified genes with unknown functions, such as ZNF804A, and imaging genetics has been used to investigate clues of the biological function of these genes. The difficulty in replicating the findings of studies with small sample sizes has motivated the creation of largescale collaborative consortiums, such as ENIGMA, CHARGE and IMAGEN, to collect thousands of images. In a genome-wide association study, the ENIGMA consortium successfully identified common variants in the genome associated with hippocampal volume at 12q24, and the CHARGE consortium replicated this finding. The new era of imaging genetics has just begun, and the next challenge we face is the discovery of small effect size signals from large data sets obtained from genetics and neuroimaging. New methods and technologies for data reduction with appropriate statistical thresholds, such as polygenic analysis and parallel independent component analysis (ICA), are warranted. Future advances in imaging genetics will aid in the discovery of genes and provide mechanistic insight into psychiatric disorders. PMID:25732148

  13. Imaging Genetics and Psychiatric Disorders

    PubMed Central

    Hashimoto, R; Ohi, K; Yamamori, H; Yasuda, Y; Fujimoto, M; Umeda-Yano, S; Watanabe, Y; Fukunaga, M; Takeda, M

    2015-01-01

    Imaging genetics is an integrated research method that uses neuroimaging and genetics to assess the impact of genetic variation on brain function and structure. Imaging genetics is both a tool for the discovery of risk genes for psychiatric disorders and a strategy for characterizing the neural systems affected by risk gene variants to elucidate quantitative and mechanistic aspects of brain function implicated in psychiatric disease. Early studies of imaging genetics included association analyses between brain morphology and single nucleotide polymorphisms whose function is well known, such as catechol-O-methyltransferase (COMT) and brain-derived neurotrophic factor (BDNF). GWAS of psychiatric disorders have identified genes with unknown functions, such as ZNF804A, and imaging genetics has been used to investigate clues of the biological function of these genes. The difficulty in replicating the findings of studies with small sample sizes has motivated the creation of large-scale collaborative consortiums, such as ENIGMA, CHARGE and IMAGEN, to collect thousands of images. In a genome-wide association study, the ENIGMA consortium successfully identified common variants in the genome associated with hippocampal volume at 12q24, and the CHARGE consortium replicated this finding. The new era of imaging genetics has just begun, and the next challenge we face is the discovery of small effect size signals from large data sets obtained from genetics and neuroimaging. New methods and technologies for data reduction with appropriate statistical thresholds, such as polygenic analysis and parallel independent component analysis (ICA), are warranted. Future advances in imaging genetics will aid in the discovery of genes and provide mechanistic insight into psychiatric disorders. PMID:25732148

  14. Psychiatric Thoughts in Ancient India*

    PubMed Central

    Abhyankar, Ravi

    2015-01-01

    A review of the literature regarding psychiatric thoughts in ancient India is attempted. Besides interesting reading, many of the concepts are still relevant and can be used in day-to-day practice especially towards healthy and happy living. Certain concepts are surprisingly contemporary and valid today. They can be used in psychotherapy and counselling and for promoting mental health. However, the description and classification of mental illness is not in tune with modern psychiatry. PMID:25838724

  15. Adolescent cocaine abuse. Addictive potential, behavioral and psychiatric effects.

    PubMed

    Estroff, T W; Schwartz, R H; Hoffmann, N G

    1989-12-01

    Four hundred seventy-nine drug abusing adolescent patients enrolled in seven Straight, Inc. Adolescent Drug-Abuse Treatment Programs in five geographic regions across the United States were studied to determine the severity and patterns of cocaine abuse. Of these, 341 admitted to cocaine use and became part of this survey. Cocaine use was categorized as heavy, intermediate, or light. Areas examined were the addictive spectrum, psychosocial dysfunction, and psychiatric symptoms. Intermediate and heavy users of cocaine abused significantly less marijuana and inhalants than light cocaine abusers. Heavy and intermediate users were more likely to use cocaine intravenously and to use crack. They developed tachyphylaxis more frequently, progressed to weekly use in less than 3 months more frequently, and became preoccupied with obtaining and using cocaine significantly more frequently. They used more sedative hypnotics to calm themselves and engaged in more criminal behavior, such as stealing from parents and stores and passing bad checks. They had more arrests for possession of drugs, stole more cars, sold more drugs, and were more likely to trade sexual favors to obtain the drug. Heavy and intermediate users were significantly more psychiatrically disturbed than light users, becoming more suspicious, nervous, aggressive, and demonstrating increased symptoms of fatigue, sleeplessness, decreased appetite, and increasing cocaine dysphoria. All of these symptoms could be mistaken for psychiatric disorders. This study suggests that cocaine is as addictive in adolescents as in adults; possibly more so. It also causes psychosocial dysfunction and psychiatric symptoms. Further research into cocaine addiction among adolescents is indicated. PMID:2582695

  16. Intensified Mycophenolate Mofetil Dosing and Higher Mycophenolic Acid Trough Levels Reduce Severe Acute Graft-versus-Host Disease After Double-Unit Cord Blood Transplantation

    PubMed Central

    Harnicar, S.; Ponce, D.M.; Hilden, P.; Zheng, J.; Devlin, S.M.; Lubin, M.; Pozotrigo, M.; Mathew, S.; Adel, N.; Kernan, N.A.; O'Reilly, R.; Prockop, S.; Scaradavou, A.; Hanash, A.; Jenq, R.; van den Brink, M.; Giralt, S.; Perales, M.A.; Young, J.W.; Barker, J.N.

    2015-01-01

    While mycophenolate mofetil (MMF) has replaced corticosteroids as immunosuppression in cord blood transplantation (CBT), optimal MMF dosing has yet to be established. We intensified MMF dosing from every 12 to 8 hours to augment graft-versus-host disease (GVHD) prophylaxis in double-unit CBT (dCBT) and evaluated outcomes according to the total daily MMF dose/kg in 174 double-unit CBT recipients (median age 39 years, range 1–71) transplanted for hematologic malignancies. Recipients of a MMF dose ≤ the median (36 mg/kg/day) had an increased day 100 grade III-IV acute GVHD (aGVHD) incidence compared with patients who received > 36 mg/kg/day (24% versus 8%, p = 0.008). Recipients of ≤ the median dose who had highly HLA-allele (1-3/6) mismatched dominant units had the highest day 100 grade III-IV aGVHD incidence of 37% (p = 0.009). This finding was confirmed in multivariate analysis (p = 0.053). In 83 patients evaluated for mycophenolic acid (MPA) troughs, those with a mean week 1-2 trough < 0.5 mcg/mL had an increased day 100 grade III-IV aGVHD of 26% versus 9% (p = 0.063), and those who received a low total daily MMF dose and had a low week 1-2 MPA trough had a 40% incidence (p = 0.008). Higher MMF dosing or MPA troughs had no impact on engraftment after myeloablation. This analysis supports intensified MMF dosing in mg/kg/day and MPA trough level monitoring early post-transplant in dCBT recipients. PMID:25687796

  17. Genetic influences on the neural and physiological bases of acute threat: A research domain criteria (RDoC) perspective.

    PubMed

    Sumner, Jennifer A; Powers, Abigail; Jovanovic, Tanja; Koenen, Karestan C

    2016-01-01

    The NIMH Research Domain Criteria (RDoC) initiative aims to describe key dimensional constructs underlying mental function across multiple units of analysis-from genes to observable behaviors-in order to better understand psychopathology. The acute threat ("fear") construct of the RDoC Negative Valence System has been studied extensively from a translational perspective, and is highly pertinent to numerous psychiatric conditions, including anxiety and trauma-related disorders. We examined genetic contributions to the construct of acute threat at two units of analysis within the RDoC framework: (1) neural circuits and (2) physiology. Specifically, we focused on genetic influences on activation patterns of frontolimbic neural circuitry and on startle, skin conductance, and heart rate responses. Research on the heritability of activation in threat-related frontolimbic neural circuitry is lacking, but physiological indicators of acute threat have been found to be moderately heritable (35-50%). Genetic studies of the neural circuitry and physiology of acute threat have almost exclusively relied on the candidate gene method and, as in the broader psychiatric genetics literature, most findings have failed to replicate. The most robust support has been demonstrated for associations between variation in the serotonin transporter (SLC6A4) and catechol-O-methyltransferase (COMT) genes with threat-related neural activation and physiological responses. However, unbiased genome-wide approaches using very large samples are needed for gene discovery, and these can be accomplished with collaborative consortium-based research efforts, such as those of the Psychiatric Genomics Consortium (PGC) and Enhancing Neuro Imaging Genetics through Meta-Analysis (ENIGMA) Consortium. PMID:26377804

  18. Adult Neurogenesis and Psychiatric Disorders.

    PubMed

    Kang, Eunchai; Wen, Zhexing; Song, Hongjun; Christian, Kimberly M; Ming, Guo-Li

    2016-01-01

    Psychiatric disorders continue to be among the most challenging disorders to diagnose and treat because there is no single genetic or anatomical locus that is causative for the disease. Current treatments are often blunt tools used to ameliorate the most severe symptoms, at the risk of disrupting functional neural systems. There is a critical need to develop new therapeutic strategies that can target circumscribed functional or anatomical domains of pathology. Adult hippocampal neurogenesis may be one such domain. Here, we review the evidence suggesting that adult hippocampal neurogenesis plays a role in emotional regulation and forms of learning and memory that include temporal and spatial memory encoding and context discrimination, and that its dysregulation is associated with psychiatric disorders, such as affective disorders, schizophrenia, and drug addiction. Further, adult neurogenesis has proven to be an effective model to investigate basic processes of neuronal development and converging evidence suggests that aberrant neural development may be an etiological factor, even in late-onset diseases. Constitutive neurogenesis in the hippocampus of the mature brain reflects large-scale plasticity unique to this region and could be a potential hub for modulation of a subset of cognitive and affective behaviors that are affected by multiple psychiatric disorders. PMID:26801682

  19. Explanatory models for psychiatric illness.

    PubMed

    Kendler, Kenneth S

    2008-06-01

    How can we best develop explanatory models for psychiatric disorders? Because causal factors have an impact on psychiatric illness both at micro levels and macro levels, both within and outside of the individual, and involving processes best understood from biological, psychological, and sociocultural perspectives, traditional models of science that strive for single broadly applicable explanatory laws are ill suited for our field. Such models are based on the incorrect assumption that psychiatric illnesses can be understood from a single perspective. A more appropriate scientific model for psychiatry emphasizes the understanding of mechanisms, an approach that fits naturally with a multicausal framework and provides a realistic paradigm for scientific progress, that is, understanding mechanisms through decomposition and reassembly. Simple subunits of complicated mechanisms can be usefully studied in isolation. Reassembling these constituent parts into a functioning whole, which is straightforward for simple additive mechanisms, will be far more challenging in psychiatry where causal networks contain multiple nonlinear interactions and causal loops. Our field has long struggled with the interrelationship between biological and psychological explanatory perspectives. Building from the seminal work of the neuronal modeler and philosopher David Marr, the author suggests that biology will implement but not replace psychology within our explanatory systems. The iterative process of interactions between biology and psychology needed to achieve this implementation will deepen our understanding of both classes of processes. PMID:18483135

  20. Psychiatric aspects of bariatric surgery

    PubMed Central

    Yen, Yung-Chieh; Huang, Chih-Kuan; Tai, Chi-Ming

    2014-01-01

    Purpose of review Bariatric surgery has been consistently shown to be effective in long-term marked weight loss and in bringing significant improvement to medical comorbidities such as metabolic syndrome. Empirical data suggest a high prevalence of psychiatric disorders among bariatric surgery candidates. In this review, we focus on the studies published recently with a high impact on our understanding of the role of psychiatry in bariatric surgery. Recent findings This article reviews the specific psychopathologies before surgery, changes in psychopathologies after surgery, suicide risk related to bariatric surgery, factors associated with weight loss, and recommendations for presurgical and postsurgical assessment and management. Research indicates a decrease in certain psychiatric symptoms after weight loss with bariatric surgery. However, the risk of suicide and unsuccessful weight loss in some bariatric surgery patients make monitoring following surgery as important as careful assessment and management before surgery. Specific considerations for youth and older populations and future potential research foci are discussed. Summary Recent publications suggest new directions for psychiatric evaluation and interventions for bariatric surgery patients. Future research on outcomes of specific populations, effectiveness of psychopharmacotherapy, and underlying pathophysiology are warranted for the advancement of treating bariatric surgery patients. PMID:25036421

  1. Predicting 1-Year Mortality Rate for Patients Admitted With an Acute Exacerbation of Chronic Obstructive Pulmonary Disease to an Intensive Care Unit: An Opportunity for Palliative Care

    PubMed Central

    Batzlaff, Cassandra M.; Karpman, Craig; Afessa, Bekele; Benzo, Roberto P.

    2015-01-01

    The objective of this study was to develop a model to aid clinicians in better predicting 1-year mortality rate for patients with an acute exacerbation of chronic obstructive pulmonary disease admitted to the medical intensive care unit (ICU) with the goal of earlier initiation of palliative care and end-of-life communications in this patient population. This retrospective cohort study included patients from a medical ICU from April 1, 1995, to November 30, 2009. Data collected from the Acute Physiology and Chronic Health Evaluation III database included demographic characteristics; severity of illness scores; noninvasive and invasive mechanical ventilation time; ICU and hospital length of stay; and ICU, hospital, and 1-year mortality. Statistically significant univariate variables for 1-year mortality were entered into a multivariate model, and the independent variables were used to generate a scoring system to predict 1-year mortality rate. At 1-year follow-up, 295 of 591 patients died (50%). Age and hospital length of stay were identified as independent determinants of mortality at 1 year by using multivariate analysis, and the predictive model developed had an area under the operating curve of 0.68. Bootstrap analysis with 1000 iterations validated the model, age, and hospital length of stay, entered the model 100% of the time (area under the operating curve=0.687; 95% CI, 0.686–0.688). A simple model using age and hospital length of stay may be informative for providers willing to identify patients with chronic obstructive pulmonary disease with high 1-year mortality rate who may benefit from end-of-life communications and from palliative care. PMID:24656805

  2. Time Interval from Symptom Onset to Hospital Care in Patients with Acute Heart Failure: A Report from the Tokyo Cardiac Care Unit Network Emergency Medical Service Database

    PubMed Central

    Shiraishi, Yasuyuki; Kohsaka, Shun; Harada, Kazumasa; Sakai, Tetsuro; Takagi, Atsutoshi; Miyamoto, Takamichi; Iida, Kiyoshi; Tanimoto, Shuzou; Fukuda, Keiichi; Nagao, Ken; Sato, Naoki; Takayama, Morimasa

    2015-01-01

    Aims There seems to be two distinct patterns in the presentation of acute heart failure (AHF) patients; early- vs. gradual-onset. However, whether time-dependent relationship exists in outcomes of patients with AHF remains unclear. Methods The Tokyo Cardiac Care Unit Network Database prospectively collects information of emergency admissions via EMS service to acute cardiac care facilities from 67 participating hospitals in the Tokyo metropolitan area. Between 2009 and 2011, a total of 3811 AHF patients were registered. The documentation of symptom onset time was mandated by the on-site ambulance team. We divided the patients into two groups according to the median onset-to-hospitalization (OH) time for those patients (2h); early- (presenting ≤2h after symptom onset) vs. gradual-onset (late) group (>2h). The primary outcome was in-hospital mortality. Results The early OH group had more urgent presentation, as demonstrated by a higher systolic blood pressure (SBP), respiratory rate, and higher incidence of pulmonary congestion (48.6% vs. 41.6%; P<0.001); whereas medical comorbidities such as stroke (10.8% vs. 7.9%; P<0.001) and atrial fibrillation (30.0% vs. 26.0%; P<0.001) were more frequently seen in the late OH group. Overall, 242 (6.5%) patients died during hospitalization. Notably, a shorter OH time was associated with a better in-hospital mortality rate (odds ratio, 0.71; 95% confidence interval, 0.51−0.99; P = 0.043). Conclusions Early-onset patients had rather typical AHF presentations (e.g., higher SBP or pulmonary congestion) but had a better in-hospital outcome compared to gradual-onset patients. PMID:26562780

  3. Acute kidney injury-incidence, prognostic factors, and outcome of patients in an Intensive Care Unit in a tertiary center: A prospective observational study

    PubMed Central

    Korula, Sara; Balakrishnan, Sindhu; Sundar, Shyam; Paul, Vergis; Balagopal, Anuroop

    2016-01-01

    Background and Aims: The information regarding the incidence of acute kidney injury (AKI) in medical Intensive Care Units (ICUs) in South India is limited. The aim of the study was to find the incidence, prognostic factors, and outcome of patients with AKI. We also assessed whether only urine output criteria of risk, injury, failure, loss, end (RIFLE) classification can be used to look at the outcome of AKI. Patients and Methods: This was a prospective, cross-sectional study of 6 months duration in a 28 bedded medical ICU of a tertiary center. AKI was defined as an absolute creatinine value of>1.6 mg/dl or a 25% increase from baseline creatinine values. Results: The incidence of AKI was 16.1%, and mortality was 7.8% in our study population. Among patients with AKI 87 (75.7%) patients had sepsis. 71.3% patients had metabolic acidosis on admission, and 47.8% patients were in shock. 57.4% of patient's required mechanical ventilation (MV). 39.1% of AKI patients required renal replacement therapy (RRT). Requirement of RRT was significantly affected by increasing age, Acute Physiology and Chronic Health Evaluation II and sequential organ failure assessment scores on admission, serum creatinine, and use of vasopressors. 49.5% of patients with AKI died within 28 days. Increasing age, MV, hemodialysis (HD), hypertension, chronic kidney disease, and requirement of noradrenaline support were associated with increasing 28 days mortality. The maximum RIFLE score with urine output criteria showed association to the requirement of HD in univariate analysis but did not show relation to mortality. Conclusion: The incidence of AKI was 16.1% in critically ill patients. In patients with AKI, 39.1% patients required HD and 28 days mortality was 49.5%. The study also showed good univariate association of urine output criteria of RIFLE classification to the requirement of HD in AKI patients. PMID:27390456

  4. Rising United States Hospital Admissions for Acute Bacterial Skin and Skin Structure Infections: Recent Trends and Economic Impact

    PubMed Central

    Kaye, Keith S.; Patel, Dipen A.; Stephens, Jennifer M.; Khachatryan, Alexandra; Patel, Ayush; Johnson, Kenneth

    2015-01-01

    Background The number of ambulatory patients seeking treatment for skin and skin structure infections (SSSI) are increasing. The objective of this study is to determine recent trends in hospital admissions and healthcare resource utilization and identify covariates associated with hospital costs and mortality for hospitalized adult patients with a primary SSSI diagnosis in the United States. Methods We performed a retrospective cross-sectional analysis (years 2005–2011) of data from the US Healthcare Cost and Utilization Project National Inpatient Sample. Recent trends, patient characteristics, and healthcare resource utilization for patients hospitalized with a primary SSSI diagnosis were evaluated. Descriptive and bivariate analyses were conducted to assess patient and hospital characteristics. Results A total of 1.8% of hospital admissions for the years 2005 through 2011 were for adult patients with a SSSI primary diagnosis. SSSI-related hospital admissions significantly changed during the study period (P < .001 for trend) ranging from 1.6% (in 2005) to 2.0% (in 2011). Mean hospital length of stay (LOS) decreased from 5.4 days in the year 2005 to 5.0 days in the year 2011 (overall change, P < .001) with no change in hospital costs. Patients with postoperative wound infections had the longest hospital stays (adjusted mean, 5.81 days; 95% confidence interval (CI), 5.80–5.83) and highest total costs (adjusted mean, $9388; 95% CI, $9366-$9410). Year of hospital admission was strongly associated with mortality; infection type, all patient refined diagnosis related group severity of illness level, and LOS were strongly associated with hospital costs. Conclusions Hospital admissions for adult patients in the United States with a SSSI primary diagnosis continue to increase. Decreasing hospital inpatient LOS and mortality rate may be due to improved early treatment. Future research should focus on identifying alternative treatment processes for patients with SSSI

  5. A clinical training unit for diarrhoea and acute respiratory infections: an intervention for primary health care physicians in Mexico.

    PubMed Central

    Bojalil, R.; Guiscafré, H.; Espinosa, P.; Viniegra, L.; Martínez, H.; Palafox, M.; Gutiérrez, G.

    1999-01-01

    In Tlaxcala State, Mexico, we determined that 80% of children who died from diarrhoea or acute respiratory infections (ARI) received medical care before death; in more than 70% of the cases this care was provided by a private physician. Several strategies have been developed to improve physicians' primary health care practices but private practitioners have only rarely been included. The objective of the present study was to evaluate the impact of in-service training on the case management of diarrhoea and ARI among under-5-year-olds provided by private and public primary physicians. The training consisted of a five-day course of in-service practice during which physicians diagnosed and treated sick children attending a centre and conducted clinical discussions of cases under guidance. Each training course was limited to six physicians. Clinical performance was evaluated by observation before and after the courses. The evaluation of diarrhoea case management covered assessment of dehydration, hydration therapy, prescription of antimicrobial and other drugs, advice on diet, and counselling for mothers; that of ARI case management covered diagnosis, decisions on antimicrobial therapy, use of symptomatic drugs, and counselling for mothers. In general the performance of public physicians both before and after the intervention was better than that of private doctors. Most aspects of the case management of children with diarrhoea improved among both groups of physicians after the course; the proportion of private physicians who had five or six correct elements out of six increased from 14% to 37%: for public physicians the corresponding increase was from 53% to 73%. In ARI case management, decisions taken on antimicrobial therapy and symptomatic drug use improved in both groups; the proportion of private physicians with at least three correct elements out of four increased from 13% to 42%, while among public doctors the corresponding increase was from 43% to 78%. Hands

  6. Psychiatric and medical management of marijuana intoxication in the emergency department.

    PubMed

    Bui, Quan M; Simpson, Scott; Nordstrom, Kimberly

    2015-05-01

    We use a case report to describe the acute psychiatric and medical management of marijuana intoxication in the emergency setting. A 34-year-old woman presented with erratic, disruptive behavior and psychotic symptoms after recreational ingestion of edible cannabis. She was also found to have mild hypokalemia and QT interval prolongation. Psychiatric management of cannabis psychosis involves symptomatic treatment and maintenance of safety during detoxification. Acute medical complications of marijuana use are primarily cardiovascular and respiratory in nature; electrolyte and electrocardiogram monitoring is indicated. This patient's psychosis, hypokalemia and prolonged QTc interval resolved over two days with supportive treatment and minimal intervention in the emergency department. Patients with cannabis psychosis are at risk for further psychotic sequelae. Emergency providers may reduce this risk through appropriate diagnosis, acute treatment, and referral for outpatient care. PMID:25987916

  7. Psychiatric and Medical Management of Marijuana Intoxication in the Emergency Department

    PubMed Central

    Bui, Quan M.; Simpson, Scott; Nordstrom, Kimberly

    2015-01-01

    We use a case report to describe the acute psychiatric and medical management of marijuana intoxication in the emergency setting. A 34-year-old woman presented with erratic, disruptive behavior and psychotic symptoms after recreational ingestion of edible cannabis. She was also found to have mild hypokalemia and QT interval prolongation. Psychiatric management of cannabis psychosis involves symptomatic treatment and maintenance of safety during detoxification. Acute medical complications of marijuana use are primarily cardiovascular and respiratory in nature; electrolyte and electrocardiogram monitoring is indicated. This patient’s psychosis, hypokalemia and prolonged QTc interval resolved over two days with supportive treatment and minimal intervention in the emergency department. Patients with cannabis psychosis are at risk for further psychotic sequelae. Emergency providers may reduce this risk through appropriate diagnosis, acute treatment, and referral for outpatient care. PMID:25987916

  8. In Emergency Department Patients with Acute Chest Pain, Stress Cardiac MRI Observation Unit Care Reduces 1- year Cardiac-Related Health Care Expenditures: A Randomized Trial

    PubMed Central

    Miller, Chadwick D.; Hwang, Wenke; Case, Doug; Hoekstra, James W.; Lefebvre, Cedric; Blumstein, Howard; Hamilton, Craig A.; Harper, Erin N.; Hundley, W. Gregory

    2013-01-01

    Objective To compare the direct cost of medical care and clinical events during the first year after patients with intermediate risk acute chest pain were randomized to stress cardiovascular magnetic resonance (CMR) observation unit (OU) testing, versus inpatient care. Background In a recent study, randomization to OU-CMR reduced median index hospitalization cost compared to inpatient care in patients presenting to the emergency department with intermediate risk acute chest pain. Methods Emergency department patients with intermediate risk chest pain were randomized to OU-CMR (OU care, cardiac markers, stress CMR) or inpatient care (admission, care per admitting provider). This analysis reports the direct cost of cardiac-related care and clinical outcomes (MI, revascularization, cardiovascular death) during the first year of follow-up subsequent to discharge. Consistent with health economics literature, provider cost was calculated from work-related relative value units using the Medicare conversion factor; facility charges were converted to cost using departmental specific cost-to-charge ratios. Linear models were used to compare cost accumulation among study groups. Results One-hundred nine (109) randomized subjects were included in this analysis (52 OU-CMR, 57 inpatient care). The median age was 56 years; baseline characteristics were similar in both groups. At 1 year, 6% of OU-CMR and 9% of inpatient care participants experienced a major cardiac event (p=0.72) with 1 patient in each group experiencing a cardiac event after discharge. First-year cardiac-related costs were significantly lower for participants randomized to OU-CMR compared to participants receiving inpatient care (geometric mean = $3101 vs $4742 including the index visit (p = .004) and $29 vs $152 following discharge (p = .012)). During the year following randomization, 6% of OU-CMR and 9% of inpatient care participants experienced a major cardiac event (p=0.72). Conclusions An OU-CMR strategy

  9. Survival in patients with acute myeloblastic leukemia in Germany and the United States: Major differences in survival in young adults.

    PubMed

    Pulte, Dianne; Jansen, Lina; Castro, Felipe A; Krilaviciute, Agne; Katalinic, Alexander; Barnes, Benjamin; Ressing, Meike; Holleczek, Bernd; Luttmann, Sabine; Brenner, Hermann

    2016-09-15

    Previous epidemiologic studies on AML have been limited by the rarity of the disease. Here, we present population level data on survival of patients with AML in Germany and the United States (US). Data were extracted from 11 population-based cancer registries in Germany and the Surveillance, Epidemiology, and End Results (SEER13) database in the US. Patients diagnosed with AML in 1997-2011 were included. Period analysis was used to estimate 5-year relative survival (RS) and trends in survival in the early 21st century. Overall 5-year age-adjusted RS for patients with AML in 2007-2011 was greater in Germany than in the US at 22.8% and 18.8%, respectively. Five-year RS was higher in Germany than in the US at all ages, with particularly large differences at ages 15-24 for whom 5-year RS was 64.3% in Germany and 55.0% in the US and 35-44, with 5-year RS estimates of 61.8% in Germany and 46.6% in the US. Most of the difference in 5-year RS was due to higher 1-year RS, with overall 1-year RS estimates of 47.0% in Germany and 38.5% in the US. A small increase in RS was observed between 2003-2005 and 2009-2011 in both countries, but no increase in survival was observed in either country for ages 75+. To our knowledge, this is the first detailed description of AML survival in Germany. Comparison to the US suggests that further analysis into risk factors for poor outcomes in AML in the US may be useful in improving survival. PMID:27176899

  10. Relation between parasuicide, suicide, psychiatric admissions, and socioeconomic deprivation.

    PubMed Central

    Gunnell, D. J.; Peters, T. J.; Kammerling, R. M.; Brooks, J.

    1995-01-01

    OBJECTIVE--To examine the relations between parasuicide, suicide, psychiatric inpatient admissions, and socioeconomic deprivation. DESIGN--Ecological analysis with data from routine information systems and the 1991 census. SETTING--24 localities in the area covered by the Bristol and District Health Authority (population 817,000), consisting of aggregations of neighbouring wards, with an average population of 34,000. SUBJECTS--6089 subjects aged over 10 years admitted to hospital after parasuicide between April 1990 and March 1994; 997 suicides occurring 1982-91; 4763 subjects aged 10-64 years admitted with acute psychiatric illness between April 1990 and March 1994. RESULTS--Localities varied significantly in standardised admission ratios for parasuicide and standardised mortality ratios for suicide (P < 0.001). Spearman's rank correlation coefficient between the standardised mortality ratio for suicide and standardised admission ratio for parasuicide was 0.73 (95% confidence interval 0.46 to 0.88). Correlation between parasuicide and Townsend score was 0.86 (0.70 to 0.94) and between suicide and Townsend score 0.73 (0.46 to 0.88). The partial correlation coefficient between suicide and parasuicide after the Townsend score was adjusted for was 0.29 (-0.13 to 0.62). The correlation between standardised admission ratio for parasuicide and standardised admission ratio for psychiatric illness was 0.76 (0.51 to 0.89) and between standardised mortality ratio for suicide and standardised admission ratio for psychiatric illness was 0.72 (0.45 to 0.87). CONCLUSION--A strong ecological association exists between suicide and parasuicide, with socioeconomic deprivation accounting for much of this relation. This strong association provides supporting evidence for the importance of social policy measures in attaining Health of the Nation targets on mental health. PMID:7627035

  11. Neuroimaging distinction between neurological and psychiatric disorders†

    PubMed Central

    Crossley, Nicolas A.; Scott, Jessica; Ellison-Wright, Ian; Mechelli, Andrea

    2015-01-01

    Background It is unclear to what extent the traditional distinction between neurological and psychiatric disorders reflects biological differences. Aims To examine neuroimaging evidence for the distinction between neurological and psychiatric disorders. Method We performed an activation likelihood estimation meta-analysis on voxel-based morphometry studies reporting decreased grey matter in 14 neurological and 10 psychiatric disorders, and compared the regional and network-level alterations for these two classes of disease. In addition, we estimated neuroanatomical heterogeneity within and between the two classes. Results Basal ganglia, insula, sensorimotor and temporal cortex showed greater impairment in neurological disorders; whereas cingulate, medial frontal, superior frontal and occipital cortex showed greater impairment in psychiatric disorders. The two classes of disorders affected distinct functional networks. Similarity within classes was higher than between classes; furthermore, similarity within class was higher for neurological than psychiatric disorders. Conclusions From a neuroimaging perspective, neurological and psychiatric disorders represent two distinct classes of disorders. PMID:26045351

  12. Prevalence of Psychiatric Illnesses among Ethnic Minority Elderly

    PubMed Central

    Alegría, Margarita; Chen, Chih-nan; Chan, Domin; Laderman, Mara

    2010-01-01

    OBJECTIVES To compare lifetime and 12-month prevalence of DSM-IV psychiatric disorders among a national representative sample of older Latinos, Asians, African-Americans, and Afro-Caribbean to non-Latino Whites. DESIGN Cross-sectional study conducted in 2001 through 2004. SETTING Urban and rural households in the contiguous United States. PARTICIPANTS A total of 4,245 community-dwelling residents aged 50 and older living in non-institutional settings. Data are from the NIMH Collaborative Psychiatric Epidemiology Surveys. METHODS The World Health Organization Composite International Diagnostic Interview assessed lifetime and 12-month psychiatric disorders. Interviewers matched the cultural background and language preference of participants. Bayesian estimates compared psychiatric disorder prevalence rates among ethnic/racial groups. RESULTS After gender adjustments, older non-Latino Whites had higher lifetime rates of any depressive disorder than African-Americans but were no different than older Latinos. Older Asians and Afro-Caribbean had significantly lower lifetime rates of any depressive, anxiety, and substance use disorders than non-Latino Whites. Immigrant Asians had higher lifetime rates of GAD than the U.S.-born Asians and immigrant Latinos had higher lifetime rates of dysthymia and GAD than U. S.-born Latinos. U.S. born Latinos had higher lifetime rates of substance abuse, especially alcohol abuse, than immigrant Latinos. There were no significant differences in the rates of 12-month psychiatric disorders between non-Latino whites and ethnic/racial minorities, except that older African-Americans had higher 12-month rates of any substance use disorder compared to non-Latino Whites. CONCLUSION Prevalence rates vary considerably by ethnicity and race as well as by nativity for older minorities, suggesting different patterns of illness and risk. PMID:20374401

  13. Paraneoplastic Encephalitis, Psychiatric Symptoms, and Hypoventilation in Ovarian Teratoma

    PubMed Central

    Vitaliani, Roberta; Mason, Warren; Ances, Beau; Zwerdling, Theodore; Jiang, Zhilong; Dalmau, Josep

    2007-01-01

    We report four young women who developed acute psychiatric symptoms, seizures, memory deficits, decreased level of consciousness, and central hypoventilation associated with ovarian teratoma (OT) and cerebrospinal fluid (CSF) inflammatory abnormalities. Three patients recovered with treatment of the tumor or immunosuppression and one died of the disorder. Five other OT patients with a similar syndrome and response to treatment have been reported. Our patients' serum or CSF showed immunolabeling of antigens that were expressed at the cytoplasmic membrane of hippocampal neurons and processes and readily accessed by antibodies in live neurons. Immunoprobing of a hippocampal-expression library resulted in the isolation of EFA6A, a protein that interacts with a member of the two-pore-domain potassium channel family and is involved in the regulation of the dendritic development of hippocampal neurons. EFA6A-purified antibodies reproduced the hippocampal immunolabeling of all patients' antibodies and colocalized with them at the plasma membrane. These findings indicate that in a young woman with acute psychiatric symptoms, seizures, and central hypoventilation, a paraneoplastic immune-mediated syndrome should be considered. Recognition of this disorder is important because despite the severity of the symptoms, patients usually recover. The location and function of the isolated antigen suggest that the disorder is directly mediated by antibodies. PMID:16178029

  14. Curriculum development: Preparing trainees to care for children and adolescents with psychiatric disorders.

    PubMed

    Foley, Kimberly P; Haggerty, Treah S; Harrison, Natasha

    2015-01-01

    Family physicians provide care for about one-third of the children and adolescents in the United States, many of whom present with psychological concerns. Family physicians often do not recognize these psychological disorders and therefore do not diagnose or treat them. This report describes the implementation of a curriculum designed to increase family medicine trainees' level of awareness that children/adolescents experience psychiatric conditions. This goal is achieved through the addition of a clinical child/adolescent psychologist faculty member, resident self-assessment of training needs and subsequent development of didactic presentations to address these needs. The curriculum relies on the acquisition of child/adolescent psychiatric screeners, development of child/adolescent-focused bibliotherapy materials, and the development of a longitudinal behavioral sciences curriculum. To facilitate the screening of child/adolescent psychiatric disorders, a comprehensive collection of age-appropriate psychiatric screeners were compiled and made readily available in all precepting areas. To assist with the identification of specific child/adolescent psychiatric deficit areas, family medicine resident physicians were presented with an inventory of child/adolescent psychiatric, psychosocial, and behavioral topics, based upon American Academy of Family Practice guidelines and Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition psychiatric disorders, and self-selected training deficiencies. PMID:26113643

  15. Differential Time Trends of Outcomes and Costs of Care for Acute Myocardial Infarction Hospitalizations by ST Elevation and Type of Intervention in the United States, 2001–2011

    PubMed Central

    Sugiyama, Takehiro; Hasegawa, Kohei; Kobayashi, Yasuki; Takahashi, Osamu; Fukui, Tsuguya; Tsugawa, Yusuke

    2015-01-01

    Background Little is known whether time trends of in‐hospital mortality and costs of care for acute myocardial infarction (AMI) differ by type of AMI (ST‐elevation myocardial infarction [STEMI] vs. non‐ST‐elevation [NSTEMI]) and by the intervention received (percutaneous coronary intervention [PCI], coronary artery bypass grafting [CABG], or no intervention) in the United States. Methods and Results We conducted a serial cross‐sectional study of all hospitalizations for AMI aged 30 years or older using the Nationwide Inpatient Sample, 2001–2011 (1 456 154 discharges; a weighted estimate of 7 135 592 discharges). Hospitalizations were stratified by type of AMI and intervention, and the time trends of in‐hospital mortality and hospital costs were examined for each combination of the AMI type and intervention, after adjusting for both patient‐ and hospital‐level characteristics. Compared with 2001, adjusted in‐hospital mortality improved significantly for NSTEMI patients in 2011, regardless of the intervention received (PCI odds ratio [OR] 0.68, 95% CI 0.56 to 0.83; CABG OR 0.57, 0.45 to 0.72; without intervention OR 0.61, 0.57 to 0.65). As for STEMI, a decline in adjusted in‐hospital mortality was significant for those who underwent PCI (OR 0.83; 0.73 to 0.94); however, no significant improvement was observed for those who received CABG or without intervention. Hospital costs per hospitalization increased significantly for patients who underwent intervention, but not for those without intervention. Conclusions In the United States, the decrease in in‐hospital mortality and the increase in costs differed by the AMI type and the intervention received. These non‐uniform trends may be informative for designing effective health policies to reduce the health and economic burdens of AMI. PMID:25801759

  16. Poznan acute Astronomical Observatory

    NASA Astrophysics Data System (ADS)

    Murdin, P.

    2000-11-01

    This Poznan acute Astronomical Observatory is a unit of the Adam Mickiewicz University, located in Poznan acute, Poland. From its foundation in 1919, it has specialized in astrometry and celestial mechanics (reference frames, dynamics of satellites and small solar system bodies). Recently, research activities have also included planetary and stellar astrophysics (asteroid photometry, catalysmic b...

  17. Treatment - mother-infant inpatient units.

    PubMed

    Glangeaud-Freudenthal, Nine M C; Howard, Louise M; Sutter-Dallay, Anne-Laure

    2014-01-01

    Infants of parents with psychiatric disorders may be particularly vulnerable and have a higher risk of developing psychiatric disorders in adulthood. Until the second half of the 20th century, women and infants were cared for separately. Today, hospitalisation of women with their babies in psychiatric mother-baby units enables psychiatric care of women and promotion of parent-infant interactions and child development. The distribution of psychiatric mother-baby units around the world, as well as within countries, varies strongly. Reasons for this may be related to the absence of national perinatal mental health policies related to psychiatric mother-baby unit location, differences in sources of referral for admission, and criteria for psychiatric mother-baby unit admission. Two principal national epidemiologic studies, in England and in France and Belgium, have described issues related to discharge from such care, as have smaller local studies, but no epidemiologic studies have yet demonstrated that joint inpatient psychiatric mother-baby unit care is cost-effective compared with separate care. PMID:24054169

  18. Use of ECMO in the Management of Severe Acute Respiratory Distress Syndrome: A Survey of Academic Medical Centers in the United States.

    PubMed

    Sharma, Nirmal S; Wille, Keith M; Zhi, Degui; Thannickal, Victor J; Brodie, Daniel M; Hoopes, Charles W; Diaz-Guzman, Enrique

    2015-01-01

    Mortality of severe acute respiratory distress syndrome (ARDS) remains high. Once conventional mechanical ventilation fails, alternative modes of therapy are used; most of which have limited evidence to support their use. No definitive guidelines exist for the management of these patients with alternate modalities of treatment. We conducted a cross-sectional national survey of 302 adult critical care training programs in the United States to understand the current preferences of intensivists regarding the use of different therapies for severe ARDS, including the use of extracorporeal membrane oxygenation (ECMO). A total of 381 responses were received: 203 critical care faculty and 174 critical care trainees. Airway pressure release ventilation was the initial choice of treatment reported by most when conventional mechanical ventilation strategy failed followed by inhaled nitric oxide and prone positioning. Extracorporeal membrane oxygenation availability was reported by 80% of the respondents at their institutions. Most respondents (83%) would consider ECMO in patients who fail optimal mechanical ventilation strategies, and the majority (60%) believed that ECMO use can facilitate lung protective ventilation, but few favored its use as a first-line modality. The majority of respondents reported limited knowledge of ECMO and desired specific ECMO education during training. PMID:25914957

  19. [Treatments for otorhinolaryngological patients with psychiatric disorders].

    PubMed

    Nishio, Ayako; Sumi, Takuro; Yamada, Masato; Kuwahata, Yuko

    2013-02-01

    There are few systems in place for patients with psychiatric disorders who need treatments for physical complications. In Tokyo, "The Tokyo metropolitan psychiatric emergency system" was established in 1981, and Ome Municipal General Hospital participated in it. Under this system, fifteen patients with psychiatric disorders were treated for otorhinolaryngological diseases in our department from April 2005 to March 2011. We reviewed the fifteen patients. The coexisting psychiatric disorders were schizophrenia in twelve patients, and mental retardation, Korsakoff's syndrome, and Alzheimer's dementia in one patient each, respectively. All the patients had been receiving psychiatric treatment. The otorhinolaryngological diseases were head and neck cancer in nine patients, chronic sinusitis in three patients, and benign salivary gland tumor, cholesteatoma, and epistaxis in one patient each, respectively. Among the fifteen patients, thirteen could complete their treatment, but two dropped out due to exacerbation of their psychiatric symptoms. The therapeutic course is uncertain in otorhinolaryngological diseases occurring concomitantly with psychiatric disorders, especially in head and neck cancer, because it may be difficult to prioritize the problem when determining the treatment options and delivering the treatment. Thus, we should treat patients with psychiatric disorders carefully on a case-by-case basis depending on their psychiatric symptoms. It is also important to cooperate with psychiatrists and patients' families. PMID:23539958

  20. Psychiatric comorbidities among female adolescents with anorexia nervosa.

    PubMed

    Salbach-Andrae, Harriet; Lenz, Klaus; Simmendinger, Nicole; Klinkowski, Nora; Lehmkuhl, Ulrike; Pfeiffer, Ernst

    2008-09-01

    This study investigated current comorbid Axis I diagnoses associated with Anorexia Nervosa (AN) in adolescents. The sample included 101 female adolescents treated at a psychiatric unit for primary DSM-IV diagnoses of AN. 73.3% of the AN patients were diagnosed as having a current comorbidity of at least one comorbid Axis I diagnosis, with no differences across AN subtypes. Mood disorders (60.4%) were most commonly identified, followed by the category anxiety disorders without obsessive-compulsive disorders (OCD) (25.7%), OCD (16.8%) and substance use disorders (7.9%). Two specific diagnoses differed across the two subtypes of AN. Substance use disorder was 18 times, and the category anxiety disorder without OCD was three times as likely to co-occur with AN binge-eating disorder and purging type than with AN restricting type. Clinicians should be alerted to the particularly high rate of psychiatric comorbidities in adolescents suffering from AN. PMID:17987378

  1. [Psychiatric and psychological aspects of premenstrual syndrome].

    PubMed

    Limosin, F; Ades, J

    2001-01-01

    Numerous, but heterogeneous studies have been performed about premenstrual syndrome, with finally a lack of credibility and interest among practitioners. More recently with the diagnosis criteria generalization, psychiatrists were more concerned about this syndrome, because of anxiety and mood symptoms involved in social impairment and need of medical care. In 1983 in the United States, the National Institute of Mental Health conference devoted to this topic proposed the first diagnosis criteria, requiring a prospective and daily assessment of the symptoms. In 1987, the American Psychiatric Association, in the DSM III-R, introduced the Late Luteal Phase Dysphoric Disorder diagnosis that became in 1994 in the DSM IV the Premenstrual Dysphoric Disorder, with the same diagnosis criteria. In the literature, prevalence rates are very heterogeneous according to the diagnosis criteria used and to the populations studied. One of the most relevant criteria is the induced impairment, such as avoidance of social activities, or search for medical care. Lifetime prevalence is thus estimated between 75 and 85% if considering the report of one or several symptoms, between 10 and 15% in case of medical care request, and between 2 and 5% in case of social activities interruption. To distinguish isolated complaints from a disabling disorder, self-questionnaires are the best way of assessment in a so complex and changing disease. Most of the epidemiological studies found a positive correlation between the premenstrual dysphoric symptoms and the lifetime major depressive disorder diagnosis. However, recent prospective studies failed to find an association between premenstrual syndrome and an increased risk of major depression. On the other hand, some studies showed that the premenstrual period is a risk period for associated psychiatric disorders exacerbations, as the obsessive-compulsive disorder, more severe alcohol intakes in case of alcoholism, symptoms increase in schizophrenics

  2. ASD, a Psychiatric Disorder, or Both? Psychiatric Diagnoses in Adolescents with High-Functioning ASD

    ERIC Educational Resources Information Center

    Mazefsky, Carla A.; Oswald, Donald P.; Day, Taylor N.; Eack, Shaun M.; Minshew, Nancy J.; Lainhart, Janet E.

    2012-01-01

    Varied presentations of emotion dysregulation in autism complicate diagnostic decision making and may lead to inaccurate psychiatric diagnoses or delayed autism diagnosis for high-functioning children. This pilot study aimed to determine the concordance between prior psychiatric diagnoses and the results of an autism-specific psychiatric interview…

  3. Rate of British psychiatric combat casualties compared to recent American wars.

    PubMed

    Price, H H

    2007-01-01

    This paper examines factors leading to the low rate of combat psychiatric casualties in the British recapture of the Falklands compared to the American experience in North Africa, Italy, Europe and South Pacific theatres during World War II, the Korean Conflict and Vietnam. The factors compared are those thought to affect rates seen in these past wars. The factors highlighted are psychiatric screening of evacuees, presence of psychiatric personnel in line units, intensity of combat and use of elite units. Factors also mentioned are presence of possible occult psychiatric casualties such as frostbite and malaria, amount of indirect fire and the offensive or defensive nature of the combat. A unique aspect of the Falklands War examined is the exclusive use of hospital ships to treat psychiatric casualties and the impact of the Geneva Convention rules regarding hospital ships on the classic treatment principles of proximity and expectancy. The types and numbers of various diagnoses are also presented. The British Campaign in the Falklands produced a remarkably low rate of psychiatric casualties. When viewed in light of American experience in recent wars, this low rate represents a concentration of optimal factors leading to healthy function in combat. The results of this war should not be used to predict a similar outcome in future combat as this particular constellation of factors may not recur. PMID:18214088

  4. Profile of psychiatric patients presenting to a tertiary care emergency department of Karachi.

    PubMed

    Shahid, Muhammad; Khan, Muhammad Zaman; Ejaz, Kiran; Nakeer, Rooham; Iftikhar, Sundus

    2015-05-01

    This study reviewed the presentations of psychiatric patients admitted through the Emergency Department (ED), The Aga Khan University Hospital, Karachi. Psychiatric patients admitted through the ED to the psychiatry ward were compared to those admitted through the same units other than the psychiatry ward, from 2006 to 2010 using medical records. Psychiatric patients were defined as those in whom psychiatry consult was generated and 1127 cases were included in study. There were 550 (48.8%) female patients. Most common presentations in the ED were sleep-related problems (n=205, 15.9%) followed by aggressive behavior (n=191, 14.8%). Depression was the most common diagnosis made in the ED (n=331, 29.3%) and at the time of discharge from the hospital (n=354, 29.5%). Psychiatric patients presenting to the ED had signs and symptoms which one generally disregards. However, these minor indicators can lead to major events in a patient's life. PMID:26008672

  5. Psychiatric disorders and sexual dysfunction.

    PubMed

    Waldinger, Marcel D

    2015-01-01

    Sexual problems are highly prevalent among patients with psychiatric disorders. They may be caused by the psychopathology of the psychiatric disorder but also by its pharmacotherapy. Both positive symptoms (e.g., psychosis, hallucinations) as well as negative symptoms (e.g., anhedonia) of schizophrenia may negatively interfere with interpersonal and sexual relationships. Atypical antipsychotics have fewer sexual side-effects than the classic antipsychotics. Mood disorders may affect libido, sexual arousal, orgasm, and erectile function. With the exception of bupropion, agomelatine, mirtazapine, vortioxetine, amineptine, and moclobemide, all antidepressants cause sexual side-effects. Selective serotonin reuptake inhibitors (SSRIs) may particularly delay ejaculation and female orgasm, but also can cause decreased libido and erectile difficulties. SSRI-induced sexual side-effects are dose-dependent and reversible. Very rarely, their sexual side-effects persist after SSRI discontinuation. This is often preceded by genital anesthesia. Some personality characteristics are a risk factor for sexual dysfunction. Also patients with eating disorders may suffer from sexual difficulties. So far, research into psychotropic-induced sexual side-effects suffers from substantial methodologic limitations. Patients tend not to talk with their clinician about their sexual life. Psychiatrists and other doctors need to take the initiative to talk about the patient's sexual life in order to become informed about potential medication-induced sexual difficulties. PMID:26003261

  6. French perspectives on psychiatric classification

    PubMed Central

    Crocq, Marc-Antoine

    2015-01-01

    This article reviews the role of the French schools in the development of psychiatric nosology. Boissier de Sauvages published the first French treatise on medical nosology in 1763. Until the 1880s, French schools held a pre-eminent position in the development of psychiatric concepts. From the 1880s until World War I, German-speaking schools exerted the most influence, featuring the work of major figures such as Emil Kraepelin and Eugen Bleuler. French schools were probably hampered by excessive administrative and cultural centralization. Between the 1880s and the 1930s, French schools developed diagnostic categories that set them apart from international classifications. The main examples are Bouffée Délirante, and the complex set of chronic delusional psychoses (CDPs), including chronic hallucinatory psychosis. CDPs were distinguished from schizophrenia by the lack of cognitive deterioration during evolution. Modern French psychiatry is now coming into line with international classification, such as DSM-5 and the upcoming ICD-11. PMID:25987863

  7. Psychiatric rehabilitation education for physicians.

    PubMed

    Rudnick, Abraham; Eastwood, Diane

    2013-06-01

    As part of a rapidly spreading reform toward recovery-oriented services, mental health care systems are adopting Psychiatric/Psychosocial Rehabilitation (PSR). Accordingly, PSR education and training programs are now available and accessible. Although psychiatrists and sometimes other physicians (such as family physicians) provide important services to people with serious mental illnesses and may, therefore, need knowledge and skill in PSR, it seems that the medical profession has been slow to participate in PSR education. Based on our experience working in Canada as academic psychiatrists who are also Certified Psychiatric Rehabilitation Practitioners (CPRPs), we offer descriptions of several Canadian initiatives that involve physicians in PSR education. Multiple frameworks guide PSR education for physicians. First, guidance is provided by published PSR principles, such as the importance of self-determination (www.psrrpscanada.ca). Second, guidance is provided by adult education (andragogy) principles, emphasizing the importance of addressing attitudes in addition to knowledge and skills (Knowles, Holton, & Swanson, 2011). Third, guidance in Canada is provided by Canadian Medical Education Directives for Specialists (CanMEDS) principles, which delineate the multiple roles of physicians beyond that of medical expert (Frank, 2005) and have recently been adopted in Australia (Boyce, Spratt, Davies, & McEvoy, 2011). PMID:23750768

  8. Epigenetic Signaling in Psychiatric Disorders

    PubMed Central

    Peña, Catherine J; Bagot, Rosemary C; Labonté, Benoit; Nestler, Eric J

    2014-01-01

    Psychiatric disorders are complex multifactorial illnesses involving chronic alterations in neural circuit structure and function. While genetic factors are important in the etiology of disorders such as depression and addiction, relatively high rates of discordance among identical twins clearly indicate the importance of additional mechanisms. Environmental factors such as stress or prior drug exposure are known to play a role in the onset of these illnesses. Such exposure to environmental insults induces stable changes in gene expression, neural circuit function, and ultimately behavior, and these maladaptations appear distinct between developmental and adult exposures. Increasing evidence indicates that these sustained abnormalities are maintained by epigenetic modifications in specific brain regions. Indeed, transcriptional dysregulation and associated aberrant epigenetic regulation is a unifying theme in psychiatric disorders. Aspects of depression and addiction can be modeled in animals by inducing disease-like states through environmental manipulations (e.g., chronic-stress, drug administration). Understanding how environmental factors recruit the epigenetic machinery in animal models is revealing new insight into disease mechanisms in humans. PMID:24709417

  9. Purinergic receptors in psychiatric disorders.

    PubMed

    Krügel, Ute

    2016-05-01

    Psychiatric disorders describe different mental or behavioral patterns, causing suffering or poor coping of ordinary life with manifold presentations. Multifactorial processes can contribute to their development and progression. Purinergic neurotransmission and neuromodulation in the brain have attracted increasing therapeutic interest in the field of psychiatry. Purine nucleotides and nucleosides are well recognized as signaling molecules mediating cell to cell communication. The actions of ATP are mediated by ionotropic P2X and metabotropic P2Y receptor subfamilies, whilst the actions of adenosine are mediated by P1 (A1 or A2) adenosine receptors. Purinergic mechanisms and specific receptor subtypes have been shown to be linked to the regulation of many aspects of behavior and mood and to dysregulation in pathological processes of brain function. In this review the recent knowledge on the role of purinergic receptors in the two most frequent psychiatric diseases, major depression and schizophrenia, as well as on related animal models is summarized. At present the most promising data for therapeutic strategies derive from investigations of the adenosine system emphasizing a unique function of A2A receptors at neurons and astrocytes in these disorders. Among the P2 receptor family, in particular P2X7 and P2Y1 receptors were related to disturbances in major depression and schizophrenia, respectively. This article is part of the Special Issue entitled 'Purines in Neurodegeneration and Neuroregeneration'. PMID:26518371

  10. Psychotherapy in Contemporary Psychiatric Practice

    PubMed Central

    Hadjipavlou, George; Hernandez, Carlos A Sierra; Ogrodniczuk, John S

    2015-01-01

    Objective: American data suggest a declining trend in the provision of psychotherapy by psychiatrists. Nevertheless, the extent to which such findings generalize to psychiatric practice in other countries is unclear. We surveyed psychiatrists in British Columbia to examine whether the reported decline in psychotherapy provision extends to the landscape of Canadian psychiatric practice. Method: A survey was mailed to the entire population of fully licensed psychiatrists registered in British Columbia (n = 623). The survey consisted of 30 items. Descriptive statistics were used to characterize the sample and psychotherapy practice patterns. Associations between variables were evaluated using nonparametric tests. Results: A total of 423 psychiatrists returned the survey, yielding a response rate of 68%. Overall, 80.9% of psychiatrists (n = 342) reported practicing psychotherapy. A decline in the provision of psychotherapy was not observed; in fact, there was an increase in psychotherapy provision among psychiatrists entering practice in the last 10 years. Individual therapy was the predominant format used by psychiatrists. The most common primary theoretical orientation was psychodynamic (29.9%). Regarding actual practice, supportive psychotherapy was practiced most frequently. Professional time constraints were perceived as the most significant barrier to providing psychotherapy. The majority (85%) of clinicians did not view remuneration as a significant barrier to treating patients with psychotherapy. Conclusions: Our findings challenge the prevailing view that psychotherapy is in decline among psychiatrists. Psychiatrists in British Columbia continue to integrate psychotherapy and pharmacotherapy in clinical practice, thus preserving their unique place in the spectrum of mental health services. PMID:26175328

  11. Epigenetic signaling in psychiatric disorders.

    PubMed

    Peña, Catherine J; Bagot, Rosemary C; Labonté, Benoit; Nestler, Eric J

    2014-10-01

    Psychiatric disorders are complex multifactorial illnesses involving chronic alterations in neural circuit structure and function. While genetic factors are important in the etiology of disorders such as depression and addiction, relatively high rates of discordance among identical twins clearly indicate the importance of additional mechanisms. Environmental factors such as stress or prior drug exposure are known to play a role in the onset of these illnesses. Such exposure to environmental insults induces stable changes in gene expression, neural circuit function, and ultimately behavior, and these maladaptations appear distinct between developmental and adult exposures. Increasing evidence indicates that these sustained abnormalities are maintained by epigenetic modifications in specific brain regions. Indeed, transcriptional dysregulation and associated aberrant epigenetic regulation is a unifying theme in psychiatric disorders. Aspects of depression and addiction can be modeled in animals by inducing disease-like states through environmental manipulations (e.g., chronic stress, drug administration). Understanding how environmental factors recruit the epigenetic machinery in animal models reveals new insight into disease mechanisms in humans. PMID:24709417

  12. Healthcare use by children with attention deficit/hyperactivity disorder with and without psychiatric comorbidities.

    PubMed

    DeBar, Lynn L; Lynch, Frances L; Boles, Myde

    2004-01-01

    This study examined healthcare services used by children with attention-deficit/hyperactivity disorder (ADHD), with and without psychiatric comorbidities. The study was conducted in a large health maintenance organization in the Pacific Northwest on all continuously enrolled children aged 5 to 12 from January 1997 through July 1998. The study measured all outpatient medical care, specialty mental health care services, and prescription drug dispensings from computer records. Children with ADHD, with and without other psychiatric comorbidities, use more general medical services than do other groups of children, including outpatient visits, acute care (emergency room [ER] urgent care) visits. ADHD and other psychiatric comorbidities lead to higher use of specialty mental health services and greater use of psychotropic medications. PMID:15263869

  13. Accommodating Faculty and Staff with Psychiatric Disabilities.

    ERIC Educational Resources Information Center

    Lee, Barbara A.; Ruger, Peter H.

    This pamphlet discusses the legal protections for employees with psychiatric disabilities, and analyzes the decisions of federal and state courts in cases where employees who claimed a psychiatric disorder challenged an employment decision under the Americans with Disabilities Act of 1990 (ADA), the Rehabilitation Act of 1973, or state law. It…

  14. Behavioral Interviewing in Psychiatric Rehabilitation Assessment.

    ERIC Educational Resources Information Center

    Davis, Alan

    Psychiatric rehabilitation differs from traditional approaches to mental health, because it places much greater emphasis on the importance of the person's relationship with the environment. In psychiatric rehabilitation, the importance is not placed on finding a cure for the client's mental illness; rather, what matters is the ability to hold a…

  15. Psychiatric Evaluation in Dermatology: An Overview

    PubMed Central

    Ghosh, Sreyoshi; Behere, Rishikesh V; Sharma, PSVN; Sreejayan, K

    2013-01-01

    Psychodermatology is an exciting field which deals with the close relationship that exists between dermatological and psychiatric disorders. A combined bio-psycho-social approach is essential for effective evaluation and treatment of these conditions. This review aims to give the practicing clinician an overview of psychiatric evaluation in patients with dermatological conditions. PMID:23372211

  16. Personal Digital Assistants in Psychiatric Education

    ERIC Educational Resources Information Center

    Luo, John S.; Ton, Hendry

    2006-01-01

    Objective: This article describes the various administrative and clinical applications for PDA use in psychiatric care and review the process for implementation in an academic medical center. Method: The authors reviewed the psychiatric literature and tested various hardware and software products. Results: The literature describes various uses of…

  17. Psychiatric disorders in multiple sclerosis patients.

    PubMed

    Fazzito, Mirella Martins; Jordy, Sérgio Semeraro; Tilbery, Charles Peter

    2009-09-01

    Multiple sclerosis (MS) is a demyelinating disease showing variable clinical presentation. Optic neuritis is the most common symptom, followed by motor and sensitive manifestations. It is known that this disease may be related to several psychiatric disorders, especially depression. In this study we will discribe 5 cases of MS patients harboring psychiatric disorder related or unchained by the disease itself. PMID:19722046

  18. Nursing 302: An Introduction to Psychiatric Nursing.

    ERIC Educational Resources Information Center

    Blaustein, Jenna Rose

    A description is provided of "Introduction to Psychiatric Nursing," a 7-week course offered to juniors and seniors in a bachelor of science nursing program. The first sections present information on curricular placement, time assignments, and the targeted student population, and define psychiatric/mental health nursing. Next, the course…

  19. Teaching Psychiatric Administration to Senior Residents.

    ERIC Educational Resources Information Center

    Talbott, John A.; Sacks, Michael

    1982-01-01

    Describes a course in psychiatric administration which is part of a "standard" psychiatric residency training program. The course combined both didactic and experiential learning for senior residents performing administrative duties for the first time. Includes details of each week's seminar. Discusses course evaluation by both teachers and…

  20. Psychiatric Hospitalization after Deliberate Self-Poisoning

    ERIC Educational Resources Information Center

    Carter, Gregory L.; Safranko, Ivan; Lewin, Terry J.; Whyte, Ian M.; Bryant, Jennifer L.

    2006-01-01

    The decision for psychiatric hospitalization after deliberate self-poisoning (DSP) is not well understood. This study, a longitudinal cohort study of 3,148 consecutive DSP patients found 920 (29.2%) subjects were referred for psychiatric hospitalization, 576 (18.3%) on involuntary basis. A logistic regression analysis showed increased risk for:…

  1. Sleep in Children With Psychiatric Disorders.

    PubMed

    Ramtekkar, Ujjwal; Ivanenko, Anna

    2015-06-01

    Sleep disturbances are common in pediatric psychiatric disorders and constitute key elements in diagnostic symptomatology of various primary psychiatric disorders including bipolar disorder, depression, and anxiety disorder. Although sleep is not included in key defining criteria of some impairing illnesses such as obsessive-compulsive disorder and schizophrenia, these disorders present with a very high prevalence of sleep disturbances. The interaction between sleep and psychopathology is very complex with significant interrelationship in development, severity, and prognosis of psychiatric disorders and comorbid sleep disturbances. The research ranging from small intervention case series to large epidemiologic studies have demonstrated the role of specific sleep complaints in specific psychiatric diagnoses. However, the research using objective instruments such as polysomnography and actigraphy remains limited in youth with psychiatric disorders. The intervention studies using pharmaceutical treatment specifically focusing on sleep disturbances in psychiatric disorders are also sparse in the pediatric literature. Early identification of sleep disturbances and behavioral management using cognitive behavior therapy-based tools appear to be the most effective approach for treatment. The use of psychotropic medications such as selective serotonin reuptake inhibitors for the treatment of primary psychiatric disorder often alleviate the psychological barriers for sleep but may lead to emergence of other sleep issues such as restless leg syndrome. The safety and efficacy data of hypnotics for primary sleep disorders are limited in pediatrics and should be avoided or used with extreme caution in children with comorbid sleep and psychiatric problems. PMID:26072345

  2. Communication elements supporting patient safety in psychiatric inpatient care.

    PubMed

    Kanerva, A; Kivinen, T; Lammintakanen, J

    2015-06-01

    Communication is important for safe and quality health care. The study provides needed insight on the communication elements that support patient safety from the psychiatric care view. Fluent information transfer between the health care professionals and care units is important for care planning and maintaining practices. Information should be documented and implemented accordingly. Communication should happen in an open communication culture that enables discussion, the opportunity to have debriefing discussions and the entire staff can feel they are heard. For effective communication, it is also important that staff are active themselves in information collecting about the essential information needed in patient care. In mental health nursing, it is important to pay attention to all elements of communication and to develop processes concerning communication in multidisciplinary teams and across unit boundaries. The study aims to describe which communication elements support patient safety in psychiatric inpatient care from the viewpoint of the nursing staff. Communication is an essential part of care and one of the core competencies of the psychiatric care. It enables safe and quality patient care. Errors in health care are often connected with poor communication. The study brings needed insight from the psychiatric care view to the topic. The data were gathered from semi-structured interviews in which 26 nurses were asked to describe the elements that constitute patient safety in psychiatric inpatient care. The data were analysed inductively from the viewpoint of communication. The descriptions connected with communication formed a main category of communication elements that support patient safety; this main category was made up of three subcategories: fluent information transfer, open communication culture and being active in information collecting. Fluent information transfer consists of the practical implementation of communication; open communication

  3. Sequelae of Aggression in Acutely Suicidal Adolescents

    ERIC Educational Resources Information Center

    Kerr, David C. R.; Washburn, Jason J.; Feingold, Alan; Kramer, Anne C.; Ivey, Asha Z.; King, Cheryl A.

    2007-01-01

    The consequences of aggression on problem course and suicide risk were examined in 270 acutely suicidal adolescents (ages 12-17 years; 184 girls). Participants were assessed during psychiatric hospitalization (T1), 6-months post-hospitalization (T2), and 15 or more months post-hospitalization (T3). Study variables included self- and…

  4. Psychiatric diagnosis: the indispensability of ambivalence

    PubMed Central

    Callard, Felicity

    2014-01-01

    The author analyses how debate over the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders has tended to privilege certain conceptions of psychiatric diagnosis over others, as well as to polarise positions regarding psychiatric diagnosis. The article aims to muddy the black and white tenor of many discussions regarding psychiatric diagnosis by moving away from the preoccupation with diagnosis as classification and refocusing attention on diagnosis as a temporally and spatially complex, as well as highly mediated process. The article draws on historical, sociological and first-person perspectives regarding psychiatric diagnosis in order to emphasise the conceptual—and potentially ethical—benefits of ambivalence vis-à-vis the achievements and problems of psychiatric diagnosis. PMID:24515564

  5. Paternal psychiatric disorders and children's psychosocial development.

    PubMed

    Ramchandani, Paul; Psychogiou, Lamprini

    2009-08-22

    Psychiatric disorders of parents are associated with an increased risk of psychological and developmental difficulties in their children. Most research has focused on mothers, neglecting psychiatric disorders affecting fathers. We review findings on paternal psychiatric disorders and their effect on children's psychosocial development. Most psychiatric disorders that affect fathers are associated with an increased risk of behavioural and emotional difficulties in their children, similar in magnitude to that due to maternal psychiatric disorders. Some findings indicate that boys are at greater risk than girls, and that paternal disorders, compared with maternal disorders, might be associated with an increased risk of behavioural rather than emotional problems. Improved paternal mental health is likely to improve children's wellbeing and life course. PMID:19411102

  6. Maternal mortality and psychiatric morbidity in the perinatal period: challenges and opportunities for prevention in the Australian setting.

    PubMed

    Austin, Marie-Paule; Kildea, Susan; Sullivan, Elizabeth

    2007-04-01

    Maternal mortality associated with psychiatric illness in the perinatal period (pregnancy to the end of the first year postpartum) has until recently been under-reported in Australia due to limitations in the scope of the data collection and methods of detection. The recent United Kingdom report Why mothers die 2000-2002 identified psychiatric illness as the leading cause of maternal death in the UK. Findings from the last three reports on maternal deaths in Australia (covering the period 1994-2002) suggest that maternal psychiatric illness is one of the leading causes of maternal death, with the majority of suicides occurring by violent means. Such findings strengthen the case for routine perinatal psychosocial screening programs, with clear referral guidelines and assertive perinatal treatment of significant maternal psychiatric morbidity. Data linkage studies are needed to measure the full extent of maternal mortality associated with psychiatric illness in Australia. PMID:17407434

  7. Association of Vitamin D Status and Acute Rhinosinusitis: Results From the United States National Health and Nutrition Examination Survey 2001-2006.

    PubMed

    Khalid, Ayesha N; Ladha, Karim S; Luong, Amber U; Quraishi, Sadeq A

    2015-10-01

    Although vitamin D status may be a modifiable risk factor for various respiratory ailments, limited data exists regarding its role in sinonasal infections. Our goal was to investigate the association of 25-hydroxyvitamin D (25OHD) levels with acute rhinosinusitis (ARS) in a large, nationally representative sample of non-institutionalized individuals from the United States. In this cross-sectional study of individuals ≥ 17 years from the National Health and Nutrition Examination Survey 2001-2006, we used multivariable regression analysis to investigate the association of 25OHD levels with ARS, while adjusting for season, demographics (age, sex, race, and poverty-to-income ratio), and clinical data (smoking, asthma, chronic obstructive pulmonary disease, diabetes mellitus, and neutropenia). A total of 3921 individuals were included in our analyses. Median 25OHD level was 22 (interquartile range 16-28) ng/mL. Overall, 15.8% (95% confidence interval [CI] 14.4-17.7) of participants reported ARS within the 24 hours leading up to their survey participation. After adjusting for season, demographics, and clinical data, 25OHD levels were associated with ARS (odds ratio 0.88, 95% CI 0.78-0.99 per 10 ng/mL). When vitamin D status was dichotomized, 25OHD levels < 20 ng/mL were associated with 33% higher odds of ARS (odds ratio 1.33, 95% CI 1.03-1.72) compared with levels ≥ 20 ng/mL. Our analyses suggest that 25OHD levels are inversely associated with ARS. Randomized, controlled trials are warranted to determine the effect of optimizing vitamin D status on the risk of sinonasal infections. PMID:26447998

  8. Effect of diabetes and acute rejection on liver transplant outcomes: An analysis of the organ procurement and transplantation network/united network for organ sharing database.

    PubMed

    Kuo, Hung-Tien; Lum, Erik; Martin, Paul; Bunnapradist, Suphamai

    2016-06-01

    The effects of diabetic status and acute rejection (AR) on liver transplant outcomes are largely unknown. We studied 13,736 liver recipients from the United Network for Organ Sharing/Organ Procurement Transplant Network database who underwent transplantation between 2004 and 2007 with a functioning graft for greater than 1 year. The association of pretransplant diabetes mellitus (PDM), new-onset diabetes after transplant (NODAT), and AR rates on allograft failure, all-cause mortality, and cardiovascular mortality were determined. To determine the differential and joint effects of diabetic status and AR on transplant outcomes, recipients were further stratified into 6 groups: neither (reference, n = 6600); NODAT alone (n = 2054); PDM alone (n = 2414); AR alone (n = 1448); NODAT and AR (n = 707); and PDM and AR (n = 513). An analysis with hepatitis C virus (HCV) serostatus was also performed (HCV recipients, n = 6384; and non-HCV recipient, n = 5934). The median follow-up was 2537 days. The prevalence of PDM was 21.3%. At 1 year after transplant, the rates of NODAT and AR were 25.5% and 19.4%, respectively. Overall, PDM, NODAT, and AR were associated with increased risks for graft failure (PDM, hazard ratio [HR] = 1.31, P < 0.01; NODAT, HR = 1.11, P = 0.02; AR, HR = 1.28, P < 0.01). A multivariate Cox regression analysis of the 6 recipient groups demonstrated that NODAT alone was not significantly associated with any study outcomes. The presence of PDM, AR, NODAT and AR, and PDM and AR were associated with higher overall graft failure risk and mortality risk. The presence of PDM was associated with higher cardiovascular mortality risk. The analyses in both HCV-positive and HCV-negative cohorts showed a similar trend as in the overall cohort. In conclusion, PDM and AR, but not NODAT, is associated with increased mortality and liver allograft failure. Liver Transplantation 22 796-804 2016 AASLD. PMID:26850091

  9. Initial Sequential Organ Failure Assessment score versus Simplified Acute Physiology score to analyze multiple organ dysfunction in infectious diseases in Intensive Care Unit

    PubMed Central

    Nair, Remyasri; Bhandary, Nithish M.; D’Souza, Ashton D.

    2016-01-01

    Aims: To investigate initial Sequential Organ Failure Assessment (SOFA) score of patients in Intensive Care Unit (ICU), who were diagnosed with infectious disease, as an indicator of multiple organ dysfunction and to examine if initial SOFA score is a better mortality predictor compared to Simplified Acute Physiology Score (SAPS). Materials and Methods: Hospital-based study done in medical ICU, from June to September 2014 with a sample size of 48. Patients aged 18 years and above, diagnosed with infectious disease were included. Patients with history of chronic illness (renal/hepatic/pulmonary/  cardiovascular), diabetes, hypertension, chronic obstructive pulmonary disease, heart disease, those on immunosuppressive therapy/chemoradiotherapy for malignancy and patients in immunocompromised state were excluded. Blood investigations were obtained. Six organ dysfunctions were assessed using initial SOFA score and graded from 0 to 4. SAPS was calculated as the sum of points assigned to each of the 17 variables (12 physiological, age, type of admission, and three underlying diseases). The outcome measure was survival status at ICU discharge. Results: We categorized infectious diseases into dengue fever, leptospirosis, malaria, respiratory tract infections, and others which included undiagnosed febrile illness, meningitis, urinary tract infection and gastroenteritis. Initial SOFA score was both sensitive and specific; SAPS lacked sensitivity. We found no significant association between age and survival status. Both SAPS and initial SOFA score were found to be statistically significant as mortality predictors. There is significant association of initial SOFA score in analyzing organ dysfunction in infectious diseases (P < 0.001). SAPS showed no statistical significance. There was statistically significant (P = 0.015) percentage of nonsurvivors with moderate and severe dysfunction, based on SOFA score. Nonsurvivors had higher SAPS but was not statistically significant (P

  10. The delay in transfer between the emergency department and the critical care unit for patients with an acute cardiac event--in hospital factors.

    PubMed

    Grech, C; Pannell, D; Smith-Sparrow, T

    2001-11-01

    The Lyell McEwin Health Service (LMHS) is a major public hospital located in the northern suburbs of Adelaide, a region where the death rate from ischaemic heart disease (IHD) is higher than the expected death rate in the population. A retrospective case note study conducted at this hospital investigated the duration that patients with unstable angina pectoris (UA) or acute myocardial infarction (AMI) spent in the emergency department (ED) before admission to the critical care unit (CCU) and the factors that contributed to delays of greater than 70 minutes. All patients admitted to the LMHS over an 18 month period with a discharge diagnosis related group (DRG) for AMI and UA were included in the study. A total of 667 case notes were examined; 403 of these cases met the inclusion criteria for the study. The mean duration between arrival in the ED and subsequent admission to the CCU was found to be 161 minutes. DRG was a major factor in the length of time spent in the ED. The mean duration for patients with AMI was 124 minutes, whilst for UA the duration was 190 minutes (difference = 66 minutes, p<0.001). Other factors that were significant were gender (females = mean duration 29 minutes > males, p=0.015), and mode of transport to the ED (arrival by ambulance mean duration 30 minutes < private transport, Recommendations arising from this study included that a system be established to enable the rapid assessment of all patients suspected of suffering AMI and UA, inclusive of their expeditious transfer to the CCU. In addition, a staff development programme was proposed to ensure medical and nursing staff became aware of a bias in this hospital toward transferring male patients in a shorter timeframe than females with the same DRG. PMID:11806510

  11. Prolactin monitoring in the acute psychiatry setting.

    PubMed

    Perry, Benjamin I; Goldring, Katie J; Menon, Sharmila J

    2016-01-30

    Hyperprolactinaemia is a common side effect associated with psychotropic medication. Limited guidance on its monitoring and management results in inconsistency in practice due to individual clinical variability. A retrospective service evaluation study was conducted on all patients admitted to an acute psychiatric assessment unit in South Wales, United Kingdom, over one calendar year (n=524), to assess the prevalence and possible causes of hyperprolactinaemia, correlation with symptomatology and monitoring and management by clinicians. The prevalence of hyperprolactinaemia in this population (n=67, 13%) was higher than in the general population. The most common association was medication (n=39, 58%), particularly Risperidone (n=19). Illicit substance use (n=10, 15%), and physical conditions (n=12, 18%) may also have contributed. However, only 44 (66%) received follow-up for their hyperprolactinaemia. There was a statistically significant difference in the sample means of those that did receive follow-up and those who did not, suggesting a degree of bias in patients selected to receive follow-up. These findings suggest that hyperprolactinaemia is relatively common in patients with mental illness, and that comprehensive guidelines need to be established for the monitoring and management thereof. PMID:26631582

  12. Data mining in psychiatric research.

    PubMed

    Tovar, Diego; Cornejo, Eduardo; Xanthopoulos, Petros; Guarracino, Mario R; Pardalos, Panos M

    2012-01-01

    Mathematical sciences and computational methods have found new applications in fields like medicine over the last few decades. Modern data acquisition and data analysis protocols have been of great assistance to medical researchers and clinical scientists. Especially in psychiatry, technology and science have made new computational methods available to assist the development of predictive modeling and to identify diseases more accurately. Data mining (or knowledge discovery) aims to extract information from large datasets and solve challenging tasks, like patient assessment, early mental disease diagnosis, and drug efficacy assessment. Accurate and fast data analysis methods are very important, especially when dealing with severe psychiatric diseases like schizophrenia. In this paper, we focus on computational methods related to data analysis and more specifically to data mining. Then, we discuss some related research in the field of psychiatry. PMID:22231840

  13. Computer Consultation for Psychiatric Diagnosis

    PubMed Central

    Erdman, Harold P.; Jefferson, James W.; Greist, John H.; Olson, Warren; Klein, Marjorie H.; Salinger, Robert

    1980-01-01

    Psychiatric diagnosis has traditionally been unreliable. A new classification system (DSM-III) has been introduced, but its increased complexity places a greater burden on the clinician. We argue that computer diagnostic programs can be useful training and consultative tools, since computers can apply diagnostic logic consistently and demonstrate diagnostic principles in regard to a particular patient. A program that collects information from clinicians to make DSM-III diagnoses is described. It also performs several teaching functions, e.g. explaining branching logic during data collection, indicating criteria necessary to make any specific diagnosis, and indicating which were not met if the diagnosis was not made. Preliminary data are reported on agreement between computer and clinician diagnosis.

  14. Ethical issues in psychiatric genetics.

    PubMed

    Appelbaum, Paul S

    2004-11-01

    As knowledge grows regarding the genetic bases of psychiatric disorders, a variety of ethical issues will need to be confronted. Current evidence suggests that the etiology of most psychiatric disorders rests on a combination of multiple genes and environmental factors. As tests for the genes involved become more easily available, pressures will arise to use them for prenatal testing, screening of children and adults, selection of potential adoptees, and pre-marital screening. Common problems that will need to be addressed include popular misunderstanding of the consequences of possessing an affected allele, impact of knowledge of one's genetic make-up on one's sense of self, and the discriminatory use of genetic information to deny persons access to insurance and employment. Although most states have some legislation aimed at preventing discrimination, the laws' coverage is spotty and federal rules are lacking. Physicians may find that newly available genetic information creates new duties for them, including warning third parties who may share the patient's genetic endowment. And genetics research itself has raised questions about when to disclose information to subjects and their family members about the genes that are being studied, and how to define the subjects of the research when information is collected about family members other than the proband. Knowledge of these dilemmas is a first step to resolving them, something that the medical profession will need to attend to in the near-term. Neglect will lead others to set the rules that will control medical practice, including the practice of psychiatry, in the new world of genetic medicine. PMID:15583515

  15. Effectiveness of psychiatric inpatient care.

    PubMed

    Sonesson, Ove; Arvidsson, Hans; Tjus, Tomas

    2013-06-01

    There is a growing demand for evaluating the process and outcome of mental health care. Most healthcare providers routinely collect and register data related to the process of treatment, and it is important to acquire more knowledge about how to make use of these databases. The aim of this study was to investigate the outcome of psychiatric inpatient care in relation to different clinical factors, using the Global Assessment of Functioning Scale (GAF) as a measure of outcome. Another objective was to explore the ability of routinely collected and registered data to provide valuable information about patients and their care. The studied psychiatric inpatient sample consisted of 816 care episodes with GAF ratings made both at admission and at discharge for 648 patients. Variables used in the study included GAF score at admission and at discharge, age, gender, diagnosis, length of stay and ward affiliation. The overall mean GAF change was 20.74, and the overall effect size Cohen's d 1.67, which corresponds to a large effect. The mean GAF change for women was 21.6, with an effect size of 1.80, and for men 19.4 with an effect size of 1.52. The effect size spectra including all groups of diagnoses ranged from 1.03 (substance-related disorders) to 2.33 (other mood disorders). Length of stay and ward affiliation also showed significant results concerning GAF change. Some limitations in this study could depend on the absence of randomization procedures and a control group. Another limitation concerns the insufficient control of the inpatient care interventions performed. The results support the capacity of the GAF to function as a measure of outcome in relation to different clinical factors, such as length of stay and diagnosis. Support was also found for the importance and usefulness of routinely collected and registered data. PMID:22775246

  16. Psoriasis and Associated Psychiatric Disorders

    PubMed Central

    Abreu, José Luís Pio Da Costa; Reis, José Pedro Gaspar Dos; Figueiredo, Américo Manuel Da Costa

    2016-01-01

    Introduction and objective: Psoriasis is a chronic skin disease with a high impact on self-esteem and patients’ health-related quality of life. In the last decades some studies have pointed out mental disorders associated with psoriasis and the etiopathogenic mechanisms behind that co-existence. This work compiles psychopathology associated with psoriasis and further analyzes the etiopathogenesis of psoriasis and mental disorders. Methods: A systematic review of the literature was conducted based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and using the “5S” levels of organization of evidence from healthcare research, as previously described. Results: Psoriasis is linked with many mental disorders, both in the psychotic and neurotic sprectrum. Chronic stress diminishes hypothalamic-pituitary-adrenal axis and upregulates sympathetic-adrenal-medullary responses, stimulating pro-inflammatory cytokines. Then, it maintains and exacerbates psoriasis and some of its mental disorders. High levels of pro-inflammatory cytokines connect psoriasis, psychiatric conditions, and other comorbidities of psoriasis (such as atherosclerosis) within a vicious cycle. Furthermore, the etiopathogenesis of the link between each psychiatric comorbidity and psoriasis has its own subtleties, including the cooccurrence of other comorbidities, the parts of the body affected by psoriasis, treatments, and biological and psychosocial factors. Conclusion: The study of psychopathology can amplify our understanding about the etiopathogenesis of psoriasis and associated mental disorders. Patients would benefit from a psychodermatologic approach. The adequate treatment should take into account the mental disorders associated with psoriasis as well as the circumstances under which they occur. PMID:27386050

  17. A Computational Analysis of Aberrant Delay Discounting in Psychiatric Disorders.

    PubMed

    Story, Giles W; Moutoussis, Michael; Dolan, Raymond J

    2015-01-01

    Impatience for reward is a facet of many psychiatric disorders. We draw attention to a growing literature finding greater discounting of delayed reward, an important aspect of impatience, across a range of psychiatric disorders. We propose these findings are best understood by considering the goals and motivation for discounting future reward. We characterize these as arising from either the opportunity costs of waiting or the uncertainty associated with delayed reward. We link specific instances of higher discounting in psychiatric disorder to heightened subjective estimates of either of these factors. We propose these costs are learned and represented based either on a flexible cognitive model of the world, an accumulation of previous experience, or through evolutionary specification. Any of these can be considered suboptimal for the individual if the resulting behavior results in impairments in personal and social functioning and/or in distress. By considering the neurochemical and neuroanatomical implementation of these processes, we illustrate how this approach can in principle unite social, psychological and biological conceptions of impulsive choice. PMID:26793131

  18. A Computational Analysis of Aberrant Delay Discounting in Psychiatric Disorders

    PubMed Central

    Story, Giles W.; Moutoussis, Michael; Dolan, Raymond J.

    2016-01-01

    Impatience for reward is a facet of many psychiatric disorders. We draw attention to a growing literature finding greater discounting of delayed reward, an important aspect of impatience, across a range of psychiatric disorders. We propose these findings are best understood by considering the goals and motivation for discounting future reward. We characterize these as arising from either the opportunity costs of waiting or the uncertainty associated with delayed reward. We link specific instances of higher discounting in psychiatric disorder to heightened subjective estimates of either of these factors. We propose these costs are learned and represented based either on a flexible cognitive model of the world, an accumulation of previous experience, or through evolutionary specification. Any of these can be considered suboptimal for the individual if the resulting behavior results in impairments in personal and social functioning and/or in distress. By considering the neurochemical and neuroanatomical implementation of these processes, we illustrate how this approach can in principle unite social, psychological and biological conceptions of impulsive choice. PMID:26793131

  19. Use of mobile assessment technologies in inpatient psychiatric settings.

    PubMed

    Kimhy, David; Vakhrusheva, Julia; Liu, Ying; Wang, Yuanjia

    2014-08-01

    Mobile electronic devices (i.e., PDAs, cellphones) have been used successfully as part of research studies of individuals with severe mental illness living in the community. More recently, efforts have been made to incorporate such technologies into outpatient treatments. However, few attempts have been made to date to employ such mobile devices among hospitalized psychiatric patients. In this article, we evaluate the potential use of such devices in inpatient psychiatric settings using 33 hospitalized patients with schizophrenia. Employing an Experience Sampling Method approach, we provide support for the feasibility of using such devices, along with examples of potentially clinically-relevant information that can be obtained using such technologies, including assessment of fluctuations in the severity of psychotic symptoms and negative mood in relation to social context, unit location, and time of day. Following these examples, we discuss issues related to the potential use of mobile electronic devices by patients hospitalized at inpatient psychiatric settings including issues related to patients' compliance, assessment schedules, questionnaire development, confidentiality issues, as well as selection of appropriate software/hardware. Finally, we delineate some issues and areas of inquiry requiring additional research and development. PMID:25042959

  20. Psychiatric Disorders in Children and Adolescents Attending Pediatric Out Patient Departments of Tertiary Hospitals

    PubMed Central

    Jesmin, Akhter; Rahman, Khan Muhammad Zillur; Muntasir, Maruf Mohammad

    2016-01-01

    Objectives Psychiatric disorders are increasingly recognized among children and adolescents in Bangladesh. Psychiatric disorders are more common in children with chronic and acute pediatric disorders. Our study was designed to determine the psychiatric disorders among children and adolescents attending pediatric outpatient departments of tertiary care hospitals. Methods This cross-sectional study was carried out from July 2012 to February 2013 in pediatric outpatient departments of three prime tertiary level hospitals of Dhaka, Bangladesh. A purposive sampling technique was used. A total of 240 male and female children aged 5 to 16 years old were included in the study. We used a semi-structured questionnaire to obtain sociodemographic and other relevant clinical information about the children and their families from their parents or caregivers and a validated parent version of the Bangla Development and Well-Being Assessment (DAWBA) for measuring psychopathology. Results The mean age of the children was 9.0± 2.6 years. The majority (71%) of children were in the 5–10 year age group. The male/female ratio was 1.2:1. Among the respondents, 18% were found to have a psychiatric disorder. Behavioral disorders, emotional disorders, and developmental disorders were found in 9.0%, 15.0% and 0.4% respectively. Hyperkinetic disorder was the single most frequent (5.0%) psychiatric disorder. Conclusions A significant number of children were found to have psychiatric disorders. Our study indicates the importance of identification and subsequent management of psychiatric conditions among the pediatric population. PMID:27403237

  1. What proportion of primary psychiatric interventions are based on evidence from randomised controlled trials?

    PubMed Central

    Geddes, J R; Game, D; Jenkins, N E; Peterson, L A; Pottinger, G R; Sackett, D L

    1996-01-01

    OBJECTIVES: To estimate the proportion of psychiatric inpatients receiving primary interventions based on randomised controlled trials or systematic reviews of randomised controlled trials. DESIGN: Retrospective survey. SETTING: Acute adult general psychiatric ward. SUBJECTS: All patients admitted to the ward during a 28 day period. MAIN OUTCOME MEASURES: Primary interventions were classified according to whether or not they were supported by evidence from randomised controlled trials or systematic reviews. RESULTS: The primary interventions received by 26/40 (65%; 95% confidence interval (95% CI) 51% to 79%) of patients admitted during the period were based on randomised trials or systematic reviews. CONCLUSIONS: When patients were used as the denominator, most primary interventions given in acute general psychiatry were based on experimental evidence. The evidence was difficult to locate; there is an urgent need for systematic reviews of randomised controlled trials in this area. PMID:10164145

  2. Psychiatric medevacs during a 6-month aircraft carrier battle group deployment to the Persian Gulf: a Navy Force Health Protection preliminary report.

    PubMed

    Wood, Dennis Patrick; Koffman, Robert L; Arita, Anthony A

    2003-01-01

    When a U.S. Navy Aircraft Carrier battle group deploys overseas, the aircraft carrier's medical department is responsible for the medical needs of over 12,000 personnel with their indigenous developmental, stress, family, alcohol, drug, and interpersonal and intrapersonal relationship difficulties. This article reviews the effectiveness of having a U.S. Navy clinical psychologist and a psychiatric technician onboard the USS Carl Vinson, the flag ship of Vinson's battle group, during this battle group's 1998/1999 Persian Gulf deployment (i.e., Western Pacific Deployment). Importantly, these two individuals reported to the USS Vinson as permanent members of the ship's company. The clinical psychologist logged 448 individual outpatient-care consults and 79 individual consults with sailors who had a history of overusing or abusing alcohol. Additionally, nine sailors with acute disabling psychiatric diagnoses were hospitalized on the ship's medical ward, and four sailors were medically evacuated (medevaced), by fixed wing aircraft, from USS Vinson to a Navy Hospital in the United States for definitive evaluation, treatment, and disposition. These four medevacs were less than the number of medevacs from two previous Aircraft Carrier Battle Group Persian Gulf deployments. Importantly, these two previous WESTPAC deployments were made without having a clinical psychologist as a full-time member of the respective aircraft carrier's medical department. Providing clinical psychology/mental health services at the "tip of the spear" is an effective, beneficial, and cost-saving landmark improvement in providing quality medical care to the fleet. PMID:12546245

  3. Assessing and Treating the Patient with Acute Psychotic Disorders.

    PubMed

    Jensen, Lisa; Clough, Rebecca

    2016-06-01

    Patients with acute psychosis often present to emergency departments. Management of acute agitation and psychosis can be a challenge for the staff. Medical stabilization, appropriate assessment, and diagnosis are important. Verbal de-escalation and other psychosocial interventions are helpful in creating a safe and therapeutic environment. Psychiatric and emergency room nurses are poised to treat patients presenting with acute psychosis and must be knowledgeable of evidence-based approaches to treat these complex disorders. PMID:27229275

  4. Potentially inappropriate prescriptions in patients admitted to a psychiatric hospital.

    PubMed

    Soerensen, Ann Lykkegaard; Nielsen, Lars Peter; Poulsen, Birgitte Klindt; Lisby, Marianne; Mainz, Jan

    2016-07-01

    Background Very little is known about the general appropriateness of prescribing for psychiatric patients. Aims To identify prevalence and types of potentially inappropriate prescribing (PIP) of psychotropic and somatic medications, to assess the severity of potential clinical consequences and to identify possible predictive factors of PIP in a sample of adult psychiatric in-patients. Methods A descriptive, cross-sectional design using medication reviews by clinical pharmacologists to identify PIP during a 3-month period. The setting was in-patient units in a psychiatric department of a Danish university hospital during a 3-month period (September 2013-November 2013). Patients medication lists (n = 207) were reviewed at the time of admission and all identified PIPs were assessed for potential consequences by clinical pharmacologists. Results There were 349 PIP identified in 1291 prescriptions. The proportion of patients found to have at least one PIP was 123/207 (59%) and the proportions of patients with at least one PIP assessed to be potentially serious or fatal was 69/207 (33%) and 24/207 (12%), respectively. Interactions between drugs 125/207 (36%) and too high doses of drugs 56/207 (16%) were the most frequent PIP. Predictive factors for PIP were polypharmacy (>5 prescriptions) and having one or more somatic diagnoses. Conclusion PIP is common in psychiatric patients and potentially fatal. Particularly polypharmacy (>5 prescriptions) and concomitant somatic illness were associated with the probability of PIP. Improving the quality of prescribing might benefit from an interprofessional approach and thus better training of physicians and nurses is needed in order to minimize PIP. PMID:26824679

  5. The Psychiatric Emergency Research Collaboration-01: methods and results

    PubMed Central

    Boudreaux, Edwin D.; Allen, Michael H.; Claassen, Cindy; Currier, Glenn W.; Bertman, Louise; Glick, Rachel; Park, Jennifer; Feifel, David; Camargo, Carlos A.

    2010-01-01

    Objective To describe the Psychiatric Emergency Research Collaboration (PERC), the methods used to create a structured chart review tool and the results of our multicenter study. Method Members of the PERC Steering Committee created a structured chart review tool designed to provide a comprehensive picture of the assessment and management of psychiatric emergency patients. Ten primary indicators were chosen based on the Steering Committee’s professional experience, the published literature and existing consensus panel guidelines. Eight emergency departments completed data abstraction of 50 randomly selected emergency psychiatric patients, with seven providing data from two independent raters. Inter-rater reliability (Kappas) and descriptive statistics were computed. Results Four hundred patient charts were abstracted. Initial concordance between raters was variable, with some sites achieving high agreement and others not. Reconciliation of discordant ratings through re-review of the original source documentation was necessary for four of the sites. Two hundred eighty-five (71%) subjects had some form of laboratory test performed, including 212 (53%) who had urine toxicology screening and 163 (41%) who had blood alcohol levels drawn. Agitation was present in 220 (52%), with 98 (25%) receiving a medication to reduce agitation and 22 (6%) being physically restrained. Self-harm ideation was present in 226 (55%), while other-harm ideation was present in 82 (20%). One hundred seventy-nine (45%) were admitted to an inpatient or observation unit. Conclusion Creating a common standard for documenting, abstracting and reporting on the nature and management of psychiatric emergencies is feasible across a wide range of health care institutions. PMID:19892209

  6. Respect in forensic psychiatric nurse-patient relationships: a practical compromise.

    PubMed

    Rose, Donald N; Peter, Elizabeth; Gallop, Ruth; Angus, Jan E; Liaschenko, Joan

    2011-03-01

    The context of forensic psychiatric nursing is distinct from other psychiatric settings as, it involves placement of patients in secure environments with restrictions determined by the courts. Previous literature has identified that nurses morally struggle with respecting patients who have committed heinous offences, which can lead to the patient being depersonalized and dehumanized. Although respect is fundamental to ethical nursing practice, it has not been adequately explored conceptually or empirically. As a result, little knowledge exists that identifies how nurses develop, maintain, and express respect for patients. The purpose of this study is to analyze the concept of respect systematically, from a forensic psychiatric nurse's perspective using the qualitative methodology of focused ethnography. Forensic psychiatric nurses were recruited from two medium secure forensic rehabilitation units. In the first interview, 13 registered nurses (RNs) and two registered practical nurses (RPNs) participated, and although all informants were invited to the second interview, six RNs were lost to follow-up. Despite this loss, saturation was achieved and the data were interpreted through a feminist philosophical lens. Respect was influenced by factors categorized into four themes: (1) emotive-cognitive reactions, (2) nonjudgmental approach, (3) social identity and power, and (4) context. The data from the themes indicate that forensic psychiatric nurses strike a practical compromise, in their understanding and enactment of respect in therapeutic relationships with forensic psychiatric patients. PMID:21348929

  7. Psychiatric comorbidities in dystonia: emerging concepts.

    PubMed

    Zurowski, Mateusz; McDonald, William M; Fox, Susan; Marsh, Laura

    2013-06-15

    Psychiatric disorders are highly prevalent in patients with dystonia and have a profound effect on quality of life. Patients with dystonia frequently meet criteria for anxiety disorders, especially social phobia, and major depressive disorder. Deficits in emotional processing have also been demonstrated in some dystonia populations. Onset of psychiatric disturbances in patients with dystonia often precedes onset of motor symptoms, suggesting that the pathophysiology of dystonia itself contributes to the genesis of psychiatric disturbances. This article examines the hypothesis that mood and anxiety disorders are intrinsic to the neurobiology of dystonia, citing the available literature, which is derived mostly from research on focal isolated dystonias. Limitations of studies are identified, and the role of emotional reactivity, especially in the context of pain secondary to dystonia, is recognized. Available evidence underscores the need to develop dystonia assessment tools that incorporate psychiatric measures. Such tools would allow for a better understanding of the full spectrum of dystonia presentations and facilitate research on the treatment of dystonia as well as the treatment of psychiatric illnesses in the context of dystonia. This article, solicited for a special Movement Disorders issue on novel research findings and emerging concepts in dystonia, addresses the following issues: (1) To what extent are psychiatric disturbances related to the pathophysiology of dystonia? (2) What is the impact of psychiatric disturbances on outcome measures of current assessment tools for dystonia? (3) How do psychiatric comorbidities influence the treatment of dystonia? Answers to these questions will lead to an increased appreciation of psychiatric disorders in dystonia, a better understanding of brain physiology, more nuanced research questions pertaining to this population, better clinical scales that can be used to further patient management and research, and improved

  8. Influencing behavior to improve attendance at occupational therapy in a psychiatric setting.

    PubMed

    Zschokke, J; Freeberg, M R; Errickson, E

    1975-01-01

    In order to increase attendance at occupational therapy of acute psychiatric patients, two reinforcement procedures were tried: Procedure 1 used prompting and social reinforcement, where Procedure 2, in addition, used a positive reinforcer. The two procedures increased both the attendance and the percentage of time used significantly when compared to baseline. The results are discussed in terms of applications and consistency with other findings. PMID:1181939

  9. Psychiatric consultation to a rehabilitation program for amputees.

    PubMed

    Freeman, A M; Applegate, W R

    1976-01-01

    Staff on the rehabilitation unit for amputees at the Navy Regional Medical Center in Oakland, California, requested psychiatric consultation after a group of young patients had shown destructive behavior and resistance to the rehabilitation program. After two unsuccessful attempts at consultation, an approach was adopted in which a psychiatrist functions as a training consultant in group therapy to the orthopedic staff. The primary therapists are two orthopedic nurses, who conduct two weekly therapy sessions for the amputees under the consultant's supervision. The sessions have given amputees a chance to ventilate their feelings of alienation, powerlessness, and boredom, and have been effective in halting destructive behavior and increasing self-esteem. PMID:1245314

  10. Fluid accumulation threshold measured by acute body weight change after admission in general surgical intensive care units: how much should be concerning?

    PubMed Central

    Chittawatanarat, Kaweesak; Pichaiya, Todsaporn; Chandacham, Kamtone; Jirapongchareonlap, Tidarat; Chotirosniramit, Narain

    2015-01-01

    Background The objective of this study (ClinicalTrials.gov: NCT01351506) was to identify the threshold level of fluid accumulation measured by acute body weight (BW) change during the first week in a general surgical intensive care unit (ICU), which is associated with ICU mortality and other adverse outcomes. Methods Four hundred sixty-five patients were prospectively followed for a 28-day period. The maximum BW change threshold during the first week was evaluated by the maximum percentage change in BW from the ICU admission weight (Max%ΔBW). Daily screening of adverse events in the ICU were recorded. The cutoff point of Max%ΔBW on ICU mortality was defined by considering the area under the receiver operating characteristic (ROC) curve, intersection of the sensitivity and specificity, and the Youden Index. Univariable and multivariable regression analyses were used to demonstrate the associations. Statistical significance was defined as P<0.05. Results The appropriate cutoff value of Max%ΔBW threshold was 5%. Regarding the multivariable regression model, in overall patients, the occurrence of the following adverse events (expressed as adjusted odds ratio [95% confidence interval]) were significantly associated with a Max%ΔBW of >5%: ICU mortality (2.38 [1.25–4.54]) (P=0.008), ICU mortality in patients without renal replacement therapy (RRT) (2.47 [1.21–5.06]) (P=0.013), reintubation within 72 hours (2.51 [1.04–6.00]) (P=0.039), RRT requirement (2.67 [1.13–6.33]) (P=0.026), and delirium (1.97 [1.08–3.57]) (P=0.025). Regarding the postoperative subgroup, a Max%ΔBW value of more than 5% was significantly associated with: ICU mortality (3.87 [1.38–10.85]) (P=0.010), ICU mortality in patients without RRT (6.32 [1.85–21.64]) (P=0.003), reintubation within 72 hours (4.44 [1.30–15.16]) (P=0.017), and vasopressor requirement (2.04 [1.04–4.01]) (P=0.037). Conclusion Fluid accumulation, measured as acute BW change of more than the threshold of 5% during

  11. Technological Advances in Psychiatric Nursing: An update.

    PubMed

    Bostrom, Andrea C

    2016-06-01

    Understanding and treating mental illness has improved in many ways as a result of the fast pace of technological advances. The technologies that have the greatest potential impact are those that (1) increase the knowledge of how the brain functions and changes based on interventions, (2) have the potential to personalize interventions based on understanding genetic factors of drug metabolism and pharmacodynamics, and (3) use information technology to provide treatment in the absence of an adequate mental health workforce. Technologies are explored for psychiatric nurses to consider. Psychiatric nurses are encouraged to consider the experiences of psychiatric patients, including poor health, stigmatization, and suffering. PMID:27229272

  12. Psychiatric disorder in the general hospital.

    PubMed

    Mayou, R; Hawton, K

    1986-08-01

    There have been many reports of psychiatric disorder in medical populations, but few have used standard methods on representative patient groups. Even so, there is consistent evidence for considerable psychiatric morbidity in in-patient, out-patient and casualty department populations, much of which is unrecognised by hospital doctors. We require a better classification of psychiatric disorder in the general hospital, improved research measures, and more evidence about the nature and course of the many different types of problem so that we can provide precise advice for their management of routine clinical practice. PMID:3535978

  13. Psychiatric nurses' self-rated competence.

    PubMed

    Ewalds-Kvist, Beatrice; Algotsson, Martina; Bergström, Annelie; Lützén, Kim

    2012-07-01

    This study explored the self-rated competence of 52 Swedish psychiatric nurses in three clinical environments: forensic psychiatry, general psychiatric inpatient care, and clinical non-residential psychiatric care. A questionnaire wtih 56 statements from nine areas of expertise was completed. Forensic nurses were more skilled in safety and quality and in dealing with violence and conflicts. Non-specialist nurses appreciated their skills more so than specialist nurses in health promotion and illness prevention and conduct, information, and education. Women were inclined to invite patients' relatives for education and information. Men attended to a patients' spiritual needs; they also coped with violence and managed conflicts. PMID:22757599

  14. Psychiatric morbidity and depressive symptomatology in patients with permanent pacemakers.

    PubMed

    Aydemir, O; Ozmen, E; Küey, L; Kültür, S; Yeşil, M; Postaci, N; Bayata, S

    1997-06-01

    Implantation of a permanent pacemaker requires a psychological effort on the patient's part for adaptation in the acute term, and chronically, it restricts activities of the patient and may cause some psychiatric disturbances. To investigate psychiatric morbidity and depressive symptomatology of the patients with permanent pacemakers, 84 pacemaker patients were diagnosed using the DSM-III-R criteria and depressive symptoms were determined by modified Hamilton Depression Rating Scale (mHDRS). Sixteen (19.1%) patients had been given a psychiatric diagnosis. The most frequent diagnoses were adjustment disorder (5.9%) and major depressive episode (4.7%). Nine patients (10.7%) were diagnosed as having clinical depression (mHDRS > or = 17). The mean score of mHDRS was 7.57 +/- 7.46, and the severity of depression was significantly higher in females. The most frequent symptoms are difficulties in work and activities (53.6%), psychic anxiety (48.8%), loss of energy (42.9%), and hypochondriasis and insomnia (39.3%). Depressed mood, psychic anxiety, loss of energy, loss of interest, insomnia, and hypochondriasis were significantly more frequent in females. Uneducated patients had a more significant loss of energy than educated patients. Depressed mood, psychic anxiety, and somatic concerns and symptoms were more frequent in patients with permanent pacemakers than in the general population. These symptoms, resembling mixed anxiety-depression disorder, were related to fears of having a permanent pacemaker, since our series were composed of uneducated patients who did not have enough knowledge about the device. PMID:9227759

  15. Affective responses across psychiatric disorders-A dimensional approach.

    PubMed

    Hägele, Claudia; Friedel, Eva; Schlagenhauf, Florian; Sterzer, Philipp; Beck, Anne; Bermpohl, Felix; Stoy, Meline; Held-Poschardt, Dada; Wittmann, André; Ströhle, Andreas; Heinz, Andreas

    2016-06-01

    Studying psychiatric disorders across nosological boundaries aims at a better understanding of mental disorders by identifying comprehensive signatures of core symptoms. Here, we studied neurobiological correlates of emotion processing in several major psychiatric disorders. We assessed differences between diagnostic groups, and investigated whether there is a psychopathological correlate of emotion processing that transcends disorder categories. 135 patient with psychiatric disorders (alcohol dependence, n=29; schizophrenia, n=37; major depressive disorder (MDD), n=25; acute manic episode of bipolar disorder, n=12; panic disorder, n=12, attention deficit/hyperactivity disorder (ADHD), n=20) and healthy controls (n=40) underwent an functional magnetic resonance imaging (fMRI) experiment with affectively positive, aversive and neutral pictures from the International Affective Picture System (IAPS). Between-group differences were assessed with full-factorial ANOVAs, with age, gender and smoking habits as covariates. Self-ratings of depressed mood and anxiety were correlated with activation clusters showing significant stimulus-evoked fMRI activation. Furthermore, we examined functional connectivity with the amygdala as seed region during the processing of aversive pictures. During the presentation of pleasant stimuli, we observed across all subjects significant activation of the ventromedial prefrontal cortex (vmPFC), bilateral middle temporal gyrus and right precuneus, while a significant activation of the left amygdala and the bilateral middle temporal gyrus was found during the presentation of aversive stimuli. We did neither find any significant interaction with diagnostic group, nor any correlation with depression and anxiety scores at the activated clusters or with amygdala connectivity. Positive and aversive IAPS-stimuli were consistently processed in limbic and prefrontal brain areas, irrespective of diagnostic category. A dimensional correlate of these

  16. "Auctoritas" psychiatric expert system shell.

    PubMed

    Kovács, M; Juranovics, J

    1995-01-01

    We present a short description of a complex psychiatric computer expert system, including functions that help the physicians and the hospital staff in the administrative, diagnostic, therapeutic, statistical, and scientific work. There are separate data-storing, health insurance-supporting, or simple advisory programs, but we can not avail a system--in our country--that provides us with all these functions together. Hence the aim of our program is to produce a universal computer system that makes the patients' long distance follow-up possible. Our diagnostic expert system shell, which is appropriate for using the symptoms and criteria scheme of the internationally accepted diagnostic systems such as DSM and ICD, helps to archive homogeneous, up-to-date psychiatric nosology; this is essential for the correct diagnostic, statistical, and scientific work. Let us introduce our expert system. It consists of four parts: administration, diagnostic decision support system, activities concerning treatment, and statistics. The part called "Administration" contains all data about actual and emitted in-patients and out-patients, including their particulars and data necessary for health insurance (duration of treatment, diagnosis); here we find and edit medical documents. The most important part of the "Auctoritas" system is the "Diagnostic decision support system." In practice, expert systems use decision trees with yes-no logic, fuzzy logic, and pattern matching on the basis of the method of deduction; and backward chaining or forward chaining on the basis of the direction of deduction. Our system uses the methods of fuzzy logic and backward chaining. In other medical disciplines, good results are achieved by applying the pattern matching method; to make validity and verification researches, however, these systems are inappropriate. The diagnoses relying on the up-to-date psychiatric diagnostic systems--DSM-IV and ICD-X--are based on classical logic and can be correctly

  17. Acute Bronchitis

    MedlinePlus

    ... or though physical contact (for example, on unwashed hands). Being exposed to tobacco smoke, air pollution, dusts, vapors, and fumes can also cause acute bronchitis. Less often, bacteria can also cause acute bronchitis. To diagnose acute ...

  18. Cystitis - acute

    MedlinePlus

    Uncomplicated urinary tract infection; UTI - acute; Acute bladder infection; Acute bacterial cystitis ... control. Menopause also increases the risk for a urinary tract infection. The following also increase your chances of having ...

  19. [Breach of secrecy by handing out psychiatric certificates].

    PubMed

    Dieckhöfer, K; Riemer, M

    2011-06-01

    The article reports about a medical malpractice case against the director of a psychiatric University Hospital, who was convicted for breach of secrecy by the Oberlandesgericht in Munich. The court found him guilty of issuing and giving to the plaintiff's wife an unauthorised psychiatric certificate, stating that the plaintiff, a carpet dealer for oriental rugs, who was caught in a war of roses with his wife at this time and was never a patient of the psychiatrist, let alone properly examined by him or his staff, suffered from an acute and severe psychosis with immediate need for compulsory admission. This all happened behind his back and enabled the wife to spread rumors of the alleged mental illness of her husband. Banks and trading partners therefore shunned him, which nearly caused his bankruptcy. This is why this unusual case led to the decision that the psychiatrist had to reimburse Euro 15000 for pain and suffering and additionally cover all material damages resulting from the tort. PMID:21698947

  20. Different characteristics associated with intensive care unit transfer from the medical ward between patients with acute exacerbations of chronic obstructive pulmonary disease with and without pneumonia

    PubMed Central

    Shin, Hong-Joon; Park, Cheol-Kyu; Kim, Tae-Ok; Ban, Hee-Jung; Oh, In-Jae; Kim, Yu-Il; Kwon, Yong-Soo; Kim, Young-Chul

    2016-01-01

    Background The rate of hospitalization due to acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is increasing. Few studies have examined the clinical, laboratory and treatment differences between patients in general wards and those who need transfer to an intensive care unit (ICU). Methods We retrospectively reviewed clinical, laboratory, and treatment characteristics of 374 patients who were initially admitted to the general ward at Chonnam National University Hospital in South Korea due to AECOPD (pneumonic, 194; non-pneumonic, 180) between January 2008 and March 2015. Of these patients, 325 were managed at the medical ward during their hospitalization period (ward group), and 49 required ICU transfer (ICU group). We compared the clinical, laboratory, and treatment characteristics associated with ICU transfer between patients with AECOPD with and without pneumonia. Results Male patients were 86.5% in the ward group and 79.6% in the ICU group. High glucose levels [median 154.5 mg/dL, interquartile range (IQR) 126.8–218.3 in ICU group vs. median 133.0, IQR 109.8–160.3 in ward group], high pneumonia severity index scores (median 100.5, IQR 85.5–118.5 vs. median 86.0, IQR 75.0–103.5), low albumin levels (median 2.9 g/dL, IQR 2.6–3.6 vs. median 3.4, IQR 3.0–3.7), and anemia (73.3% vs. 43.3%) independently increased the risk of ICU transfer in the pneumonic AECOPD group. High PaCO2 levels (median 53.1 mmHg in ICU group, IQR 38.5–84.6 vs. median 39.7, IQR 34.2–48.6 in ward group) independently increased the risk of ICU transfer in the non-pneumonic AECOPD group. Treatment with systemic corticosteroids (≥30 mg of daily prednisolone) during hospitalization in the medical ward independently reduced the risk of ICU transfer in both groups. Conclusions The characteristics associated with ICU transfer differed between the pneumonic and non-pneumonic AECOPD groups, and systemic corticosteroids use was associated with lower rate of ICU

  1. Effect of acupressure with valerian oil 2.5% on the quality and quantity of sleep in patients with acute coronary syndrome in a cardiac intensive care unit

    PubMed Central

    Bagheri-Nesami, Masoumeh; Gorji, Mohammad Ali Heidari; Rezaie, Somayeh; Pouresmail, Zahra; Cherati, Jamshid Yazdani

    2015-01-01

    The purpose of this three-group double-blind clinical trial study was to investigate the effect of acupressure (指壓 zhǐ yā) with valerian (纈草 xié cǎo) oil 2.5% on the quality and quantity of sleep in patients with acute coronary syndrome (ACS) in a coronary intensive care unit (CCU). This study was conducted on 90 patients with ACS in Mazandaran Heart Center (Sari, Iran) during 2013. The patients were randomly assigned to one of three groups. Patients in the acupressure with valerian oil 2.5% group (i.e., valerian acupressure group) received bilateral acupoint (穴位 xué wèi) massage with two drops of valerian oil for 2 minutes for three nights; including every point this treatment lasted in total 18 minutes. Patients in the acupressure group received massage at the same points with the same technique but without valerian oil. Patients in the control group received massage at points that were 1–1.5 cm from the main points using the same technique and for the same length of time. The quality and quantity of the patients' sleep was measured by the St. Mary's Hospital Sleep Questionnaire (SMHSQ). After the intervention, there was a significant difference between sleep quality and sleep quantity in the patients in the valerian acupressure group and the acupressure group, compared to the control group (p < 0.05). Patients that received acupressure with valerian oil experienced improved sleep quality; however, this difference was not statistically significant in comparison to the acupressure only group. Acupressure at the ear spirit gate (神門 shén mén), hand Shenmen, glabella (印堂 yìn táng), Wind Pool (風池 fēng chí), and Gushing Spring (湧泉 yǒng quán) acupoints can have therapeutic effects and may improve the quality and quantity of sleep in patients with ACS. Using these techniques in combination with herbal medicines such valerian oil can have a greater impact on improving sleep and reducing waking during the night. PMID:26587395

  2. Effect of acupressure with valerian oil 2.5% on the quality and quantity of sleep in patients with acute coronary syndrome in a cardiac intensive care unit.

    PubMed

    Bagheri-Nesami, Masoumeh; Gorji, Mohammad Ali Heidari; Rezaie, Somayeh; Pouresmail, Zahra; Cherati, Jamshid Yazdani

    2015-10-01

    The purpose of this three-group double-blind clinical trial study was to investigate the effect of acupressure ( zhǐ yā) with valerian ( xié cǎo) oil 2.5% on the quality and quantity of sleep in patients with acute coronary syndrome (ACS) in a coronary intensive care unit (CCU). This study was conducted on 90 patients with ACS in Mazandaran Heart Center (Sari, Iran) during 2013. The patients were randomly assigned to one of three groups. Patients in the acupressure with valerian oil 2.5% group (i.e., valerian acupressure group) received bilateral acupoint ( xué wèi) massage with two drops of valerian oil for 2 minutes for three nights; including every point this treatment lasted in total 18 minutes. Patients in the acupressure group received massage at the same points with the same technique but without valerian oil. Patients in the control group received massage at points that were 1-1.5 cm from the main points using the same technique and for the same length of time. The quality and quantity of the patients' sleep was measured by the St. Mary's Hospital Sleep Questionnaire (SMHSQ). After the intervention, there was a significant difference between sleep quality and sleep quantity in the patients in the valerian acupressure group and the acupressure group, compared to the control group (p < 0.05). Patients that received acupressure with valerian oil experienced improved sleep quality; however, this difference was not statistically significant in comparison to the acupressure only group. Acupressure at the ear spirit gate ( shén mén), hand Shenmen, glabella ( yìn táng), Wind Pool ( fēng chí), and Gushing Spring ( yǒng quán) acupoints can have therapeutic effects and may improve the quality and quantity of sleep in patients with ACS. Using these techniques in combination with herbal medicines such valerian oil can have a greater impact on improving sleep and reducing waking during the night. PMID:26587395

  3. [Psychiatric drugs as risk factor in fatal heat stroke].

    PubMed

    Fijnheer, R; van de Ven, P J; Erkelens, D W

    1995-07-01

    Two men aged 33 and 31 years suffered a fatal heat stroke on a warm summer day. One of them used pimozide and clomipramine, the other zuclopenthixol, dexetimide, droperidol, promethazine and propranolol as psychiatric medication. Both of them had a body temperature > 42.3 degrees C, without perspiring. At first only a comatose situation with practically normal laboratory values existed; this was rapidly followed by massive liver damage, disseminated intravascular coagulation, anaemia, thrombopenia and acute renal failure. In spite of adequate and rapid treatment these complications were fatal. Both patients used medication with an antidopaminergic and anticholinergic (side) effect. The set point of the temperature regulation centre can be elevated by the antidopaminergic activity of antipsychotics. Use of anticholinergic medication can disturb the thermoregulation via inhibition of the parasympathicomimetically mediated sweat secretion. It is recommended to point out the danger of unusually high outdoor temperatures to patients using this medication. PMID:7617062

  4. Concurrent Medical and Psychiatric Disorders among Schizophrenic and Neurotic Outpatients.

    ERIC Educational Resources Information Center

    Lima, Bruno R.; Pai, Shaila

    Although the occurrence of medical illnesses in psychiatric patients is quite high, medical illnesses manifested by psychiatric symptoms are often overlooked. The higher mortality rates among psychiatric patients when compared to the general population may be a reflection of neglect or inadequate treatment of the psychiatric patients' medical…

  5. 42 CFR 456.482 - Medical, psychiatric, and social evaluations.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 4 2010-10-01 2010-10-01 false Medical, psychiatric, and social evaluations. 456..., psychiatric, and social evaluations. If a facility provides inpatient psychiatric services to a recipient under age 21, the medical, psychiatric, and social evaluations required by §§ 456.170, and 456.370...

  6. 42 CFR 456.482 - Medical, psychiatric, and social evaluations.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 4 2011-10-01 2011-10-01 false Medical, psychiatric, and social evaluations. 456..., psychiatric, and social evaluations. If a facility provides inpatient psychiatric services to a recipient under age 21, the medical, psychiatric, and social evaluations required by §§ 456.170, and 456.370...

  7. Cultural Competence in Child Psychiatric Practice

    ERIC Educational Resources Information Center

    Jellinek, Michael S.; Henderson, Schuyler W.

    2009-01-01

    The U.S. faces a changing demographic landscape that is increasingly multiracial. The application of a cultural competence model for assessing and treating the psychiatric disorders of minority youths in light of this demographic change is discussed.

  8. Chromosomal abnormalities in a psychiatric population

    SciTech Connect

    Lewis, K.E.; Lubetsky, M.J.; Wenger, S.L.; Steele, M.W.

    1995-02-27

    Over a 3.5 year period of time, 345 patients hospitalized for psychiatric problems were evaluated cytogenetically. The patient population included 76% males and 94% children with a mean age of 12 years. The criteria for testing was an undiagnosed etiology for mental retardation and/or autism. Cytogenetic studies identified 11, or 3%, with abnormal karyotypes, including 4 fragile X positive individuals (2 males, 2 females), and 8 with chromosomal aneuploidy, rearrangements, or deletions. While individuals with chromosomal abnormalities do not demonstrate specific behavioral, psychiatric, or developmental problems relative to other psychiatric patients, our results demonstrate the need for an increased awareness to order chromosomal analysis and fragile X testing in those individuals who have combinations of behavioral/psychiatric, learning, communication, or cognitive disturbance. 5 refs., 1 fig., 2 tabs.

  9. Security at a "model" psychiatric center.

    PubMed

    Camacho, H S; Cottrell, P A

    1997-01-01

    The security problems faced by a recently opened psychiatric center located on the campus of a hospital--including staffing, fire safety, access control, patient restraints, and budget cuts--and how they are being dealt with. PMID:10173429

  10. The effectiveness of anticonvulsants in psychiatric disorders.

    PubMed

    Grunze, Heinz C R

    2008-01-01

    Anticonvulsant drugs are widely used in psychiatric indications. These include mainly alcohol and benzodiazepine withdrawal syndromes, panic and anxiety disorders, dementia, schizophrenia, affective disorders, bipolar affective disorders in particular, and, to some extent, personality disorders. A further area in which neurology and psychiatry overlap is pain conditions, in which some anticonvulsants, and also typical psychiatric medications such as antidepressants, are helpful. From the beginning of their psychiatric use, anticonvulsants have also been used to ameliorate specific symptoms of psychiatric disorders independently of their causality and underlying illness, eg, aggression, and, more recently, cognitive impairment, as seen in affective disorders and schizophrenia. With new anticonvulsants currently under development, it is likely that their use in psychiatry will further increase, and that psychiatrists need to learn about their differential efficacy and safety profiles to the same extent as do neurologists. PMID:18472486

  11. Excited delirium: A psychiatric review.

    PubMed

    Lipsedge, Maurice

    2016-04-01

    The term 'excited delirium' (ED) is used to explain sudden and unexpected restraint-related deaths. Since the 1990s, ED has often been identified as the principal cause of death in restrained individuals, rather than the restraint procedure itself. Forensic pathologists and psychiatrists attach different meanings to the term delirium. For psychiatrists, delirium is a specific technical term, which implies a grave and potentially life-threatening underlying physical illness. If a patient dies during a bout of delirium, psychiatrists assume that there will be autopsy evidence to demonstrate the primary underlying organic cause. Conversely, pathologists appear to be using the term ED to refer to restraint-related deaths in either highly disturbed cocaine users or psychiatric patients in a state of extreme agitation. In these cases, there is no underlying physical disorder other than a terminal cardiac arrhythmia. As the term ED has different meanings for psychiatrists and for pathologists, it would be helpful for these two professional groups to develop a mutually agreed terminology. PMID:26055153

  12. Subjectivity and Severe Psychiatric Disorders

    PubMed Central

    Strauss, John

    2011-01-01

    To have a complete human science in the mental health field it is essential to give adequate attention to both the objective and the subjective data related to people with psychiatric disorders. The tendency in the past has been to ignore or discount one or the other of these data sources. Subjective data are particularly neglected, sometimes considered (only) part of the “art” of medicine since the usual methodologies of the physical sciences in themselves are not adequate to reflect the nature, elusiveness, and complexity of human subjective experience. The complete experience of hallucinated voices, for instance, often includes not only the voices themselves but also terrible anguish and terrifying inability to concentrate. But even such descriptors fall unnecessarily short of reflecting the data of the experience, thus leaving research, theory, and treatment with incomplete information. To represent adequately the subjective data it is essential to recognize that besides the usual discursive knowledge and methods of traditional physical science, a second kind of knowledge and method is required to reflect the depth of human experience. To accomplish this, we must employ approaches to narrative and the arts that are uniquely capable of capturing the nature of these experiences. Only by attending seriously in our research, training, theory, and practice to the unique nature of subjective data is it possible to have a true human science for our field. PMID:20961994

  13. Psychiatric resilience: longitudinal twin study†

    PubMed Central

    Amstadter, Ananda B.; Myers, John M.; Kendler, Kenneth S.

    2014-01-01

    Background The source of variability in people’s response to stressful life events is poorly understood. Aims We examine the genetic and environmental underpinning of resilience (i.e. the difference between the twins’ internalising symptoms and their predicted symptoms based on cumulative stressful life events). Method Stressful life event exposure and internalising symptoms were assessed at two time points in 7500 adult twins. Using the residual between actual and predicted internalising symptom total score, twin modelling was conducted for each wave separately and longitudinally. Results Resilience was found to have a moderate genetic heritability at each wave (∼31%). Qualitative gender effects were found. Incorporating error of measurement into the model increased the estimated heritability for the latent construct of resilience (∼50%). When measurement error and occasion-specific effects were removed, environmental influences contributed roughly equally to level of resilience. Conclusions Both genes and environment influence level of psychiatric resilience, and are largely stable over time. Environmental influences can have an enduring effect on resilience. PMID:24723629

  14. Add grace to psychiatric practice

    PubMed Central

    Patkar, Shobha V.

    2013-01-01

    Background: The uniqueness of mindset of an individual makes psychiatric practice interesting, sensitive, and at times subjective. The practice in setup of an organization makes the situation more complex in view of administrative regulations, existing work culture, and issues like confidentiality, etc., Dilemmas are often faced while balancing loyalty between an organization and the patients, values of the therapist and the patient, and different dimension of justice coming from different cultural backgrounds of the patients and the treating doctors. A lot of mental work needs to be put in by the practitioner to consistently adhere to medical ethics and professional approach for taking key decisions despite of contradictory external forces from within and without. Aims: I thought of sharing my experiences especially in setup of an organization with my colleagues so that the decision-taking process becomes somewhat easy and balancing for them. Settings and Design: I have to try to interpret my clinical experiences gathered while working with my patients from the Department of Atomic Energy as well as from my private practice. Conclusion: The need of psycho education to self and others from time to time never ceases simply to make the practice more objective, justified, and graceful. PMID:23825861

  15. Psychiatric Disorders in Extremely Preterm Children: Longitudinal Finding at Age 11 Years in the EPICure Study

    ERIC Educational Resources Information Center

    Johnson, Samantha; Hollis, Chris; Kochhar, Puja; Hennessy, Enid; Wolke, Dieter; Marlow, Neil

    2010-01-01

    Objective: To investigate the prevalence and risk factors for psychiatric disorders in extremely preterm children. Method: All babies born less than 26 weeks gestation in the United Kingdom and Ireland from March through December 1995 were recruited to the EPICure Study. Of 307 survivors at 11 years of age, 219 (71%) were assessed alongside 153…

  16. Adult Basic Education Curriculum Guide for ABE Programs Serving Psychiatrically Ill Adult Students.

    ERIC Educational Resources Information Center

    Collier, Ezma V.

    This curriculum guide is designed for use in adult basic education (ABE) programs serving psychiatrically ill adult students. Covered in the individual units are the following topics: personal hygiene and grooming, nutrition and health, money and money management, transportation and safety, government and law, values clarification, and…

  17. Traumatization in Deaf and Hard-of-Hearing Adult Psychiatric Outpatients

    ERIC Educational Resources Information Center

    Øhre, Beate; Uthus, Mette Perly; von Tetzchner, Stephen; Falkum, Erik

    2015-01-01

    Deaf and hard-of-hearing persons are at risk for experiencing traumatic events and such experiences are associated with symptoms of mental disorder. We investigated the prevalence of traumatic events and subsequent traumatization in adults referred to specialized psychiatric outpatient units for deaf and hard-of-hearing patients. Sixty-two…

  18. Socioeconomic Circumstances and Risk of Psychiatric Disorders among Parents of Children with Early Cognitive Delay

    ERIC Educational Resources Information Center

    Emerson, Eric; McCulloch, Andrew; Graham, Hilary; Blacher, Jan; Llwellyn, Gwynnyth M.; Hatton, Chris

    2010-01-01

    Results of previous research suggest that parents of children with intellectual disabilities are at increased risk of psychological distress and psychiatric disorder. Secondary analysis of the Millennium Cohort Study in the United Kingdom indicated that controlling for between-group differences in socioeconomic circumstances reduced the…

  19. Psychiatrically hospitalized college students: a pilot study.

    PubMed

    Rosecan, A S; Goldberg, R L; Wise, T N

    1992-07-01

    This pilot study presents data on an underreported group: college students who require psychiatric hospitalization. Although the study is too small to sustain broad generalizations, the authors found indications of significant correlations between students' hospitalization and the academic cycle, substance abuse, and distance from home. It is hoped that other institutions will undertake similar studies of this group of students to provide a broader body of data from which to draw inferences regarding prevention, intervention, and psychiatric hospitalization. PMID:1506564

  20. Anabolic steroid abuse: psychiatric and physical costs.

    PubMed

    Talih, Farid; Fattal, Omar; Malone, Donald

    2007-05-01

    The psychiatric effects of anabolic-androgenic steroids (i.e., testosterone and its derivatives) have been less well studied than their physical effects but are reported to include depression, mania, psychosis, and aggression. Dependence can also occur, with withdrawal involving psychiatric and physical symptoms. Adverse effects of steroid abuse should be managed by discontinuing the drugs-by tapering if necessary-and by treating the symptoms. PMID:17506239

  1. [The development of psychiatric and mental health nursing in Taiwan].

    PubMed

    Rong, Jiin-Ru; Shiau, Shu-Jen; Su, Shu-Fang

    2014-02-01

    Psychiatric mental health is critical to ensuring the health and wellbeing of individuals, families, and communities. While psychiatric mental health work continues to become increasingly complex and challenging, the demand for psychiatric nurses with evidence-based skills continues to grow. Psychiatric mental health nurses (PMHNs) are the primary providers of professional psychiatric mental health care services. PMFNs emphasize humanistic values and focus on servicing patient and family needs. In Taiwan, the Psychiatric Mental Health Nursing Association constructs the competence-credentialing model for psychiatric mental health nursing that underpins the values, attitudes, and beliefs of PMHNs and ensures that the mental health nursing practice promotes public health and wellbeing. In addition, this association promotes advanced psychiatric nursing education, research, and practice, influences the national health agenda, and discusses and disseminates information on psychiatric mental health care issues in order to influence the direction, nature, and quality of psychiatric and mental health care. PMID:24519338

  2. Migraine: Clinical pattern and psychiatric comorbidity

    PubMed Central

    Bhatia, Manjeet Singh; Gupta, Ravi

    2012-01-01

    Background: Migraine is a common disorder which has psychiatric sequelae. Objective: The objective of this study was to determine the clinical pattern and psychiatric comorbidity of migraine. Materials and Methods: 100 cases of migraine seen over a period of one year were analysed to know the sociodemographic characteristics, clinical pattern and psychiatric morbidity. Results: Maximum patients were between 31-40 years of age group (40%), females (78.0%), married (76%) and housewives (56.0%). Family history of migraine was present in 12% cases. Average age of onset was 22 years. Unilateral and throbbing type of headache was most common. The commonest frequency was one to two per week. Migraine without aura was commonest sub-type (80%). Generalized anxiety disorder (F41.1) was the most common psychiatric disorder (34%), followed by mixed anxiety and depressive disorder (F41.2) (18%) and depressive episode (F32) (14%). In 22% cases, no psychiatric disorder could be elicited. Conclusion: The present study confirms that majority patients with migraine had psychiatric disorders. This needs timely detection and appropriate intervention to treat and control the migraine effectively. PMID:23766573

  3. Connectomics in psychiatric research: advances and applications.

    PubMed

    Cao, Miao; Wang, Zhijiang; He, Yong

    2015-01-01

    Psychiatric disorders disturb higher cognitive functions and severely compromise human health. However, the pathophysiological mechanisms underlying psychiatric disorders are very complex, and understanding these mechanisms remains a great challenge. Currently, many psychiatric disorders are hypothesized to reflect "faulty wiring" or aberrant connectivity in the brains. Imaging connectomics is arising as a promising methodological framework for describing the structural and functional connectivity patterns of the human brain. Recently, alterations of brain networks in the connectome have been reported in various psychiatric disorders, and these alterations may provide biomarkers for disease diagnosis and prognosis for the evaluation of treatment efficacy. Here, we summarize the current achievements in both the structural and functional connectomes in several major psychiatric disorders (eg, schizophrenia, attention-deficit/hyperactivity disorder, and autism) based on multi-modal neuroimaging data. We highlight the current progress in the identification of these alterations and the hypotheses concerning the aberrant brain networks in individuals with psychiatric disorders and discuss the research questions that might contribute to a further mechanistic understanding of these disorders from a connectomic perspective. PMID:26604764

  4. Connectomics in psychiatric research: advances and applications

    PubMed Central

    Cao, Miao; Wang, Zhijiang; He, Yong

    2015-01-01

    Psychiatric disorders disturb higher cognitive functions and severely compromise human health. However, the pathophysiological mechanisms underlying psychiatric disorders are very complex, and understanding these mechanisms remains a great challenge. Currently, many psychiatric disorders are hypothesized to reflect “faulty wiring” or aberrant connectivity in the brains. Imaging connectomics is arising as a promising methodological framework for describing the structural and functional connectivity patterns of the human brain. Recently, alterations of brain networks in the connectome have been reported in various psychiatric disorders, and these alterations may provide biomarkers for disease diagnosis and prognosis for the evaluation of treatment efficacy. Here, we summarize the current achievements in both the structural and functional connectomes in several major psychiatric disorders (eg, schizophrenia, attention-deficit/hyperactivity disorder, and autism) based on multi-modal neuroimaging data. We highlight the current progress in the identification of these alterations and the hypotheses concerning the aberrant brain networks in individuals with psychiatric disorders and discuss the research questions that might contribute to a further mechanistic understanding of these disorders from a connectomic perspective. PMID:26604764

  5. Psychiatric symptoms and disorders in phenylketonuria.

    PubMed

    Brumm, V L; Bilder, D; Waisbren, S E

    2010-01-01

    Psychological and psychiatric problems are well documented across the lifespan of individuals with early-treated phenylketonuria (PKU). Early-treated children and adolescents tend to display attentional problems, school problems, lower achievement motivation, decreased social competence, decreased autonomy, and low-self-esteem. As they enter adulthood, early-treated individuals may carry forward low self-esteem and lack of autonomy but also tend to develop depressed mood, generalized anxiety, phobias, decreased positive emotions, social maturity deficits, and social isolation. The correlation between level of metabolic control and severity of symptoms suggests a biological basis of psychiatric dysfunction. Additionally, psychosocial factors such as the burden of living with a chronic illness may contribute to psychological and psychiatric outcomes in PKU. The lack of a PKU-specific psychiatric phenotype combined with the observation that not everyone with PKU is affected highlights the complexity of the problem. More research on psychiatric and psychological outcomes in PKU is required. Of particular importance is the routine monitoring of emotional, behavioral, and psychosocial symptoms in individuals with this metabolic disorder. Longitudinal studies are required to evaluate the impact of new and emerging therapies on psychiatric and psychosocial functioning in PKU. Unidentified or untreated emotional and behavioral symptoms may have a significant, lifelong impact on the quality of life and social status of patients. PMID:20123472

  6. Norms, Reliability, and Item Analysis of the Hopelessness Scale in General Psychiatric, Forensic Psychiatric, and College Populations.

    ERIC Educational Resources Information Center

    Durham, Thomas W.

    1982-01-01

    Administered the Hopelessness Scale to criminal psychiatric inpatients, general psychiatric inpatients, and college students. Both psychiatric groups endorsed significantly more items in the hopeless direction. Found the scale more reliable with the psychiatric patients. Item analysis of the Hopelessness Scale suggests that three items were not…

  7. Acute Infections, Cost per Infection and Turnaround Time in Three United States Hospital Laboratories Using Fourth-Generation Antigen-Antibody Human Immunodeficiency Virus Immunoassays.

    PubMed

    Wesolowski, Laura G; Nasrullah, Muazzam; Coombs, Robert W; Rosenberg, Eric; Ethridge, Steven F; Hutchinson, Angela B; Dragavon, Joan; Rychert, Jennifer; Nolte, Frederick S; Madory, James E; Werner, Barbara G

    2016-01-01

    Background.  To improve clinical and public health outcomes through early human immunodeficiency virus (HIV) detection, fourth-generation antigen/antibody immunoassay (4IA) and supplemental testing results must be returned rapidly. Methods.  We examined HIV testing data at Harborview Medical Center (HMC), Massachusetts General Hospital (MGH), and the Medical University of South Carolina (MUSC), which used 4IA and supplemental antibody and nucleic acid tests (NATs). At MGH and MUSC, HIV-1 Western blot (WB) and HIV-2 testing were conducted at a reference laboratory. We compared time from specimen collection to laboratory result for established (positive WB) and acute infections (reactive 4IA, negative/indeterminate WB, detectable NAT), and we calculated testing cost per positive-test result. Results.  From 3731 (MUSC) to 19 774 (MGH) tests were conducted; 0.01% (MGH) to 0.05% (HMC) were acute infections. Each laboratory had reactive 4IA, WB-negative, or indeterminate specimens without NAT (ie, potential acute infections). Time to result was 1.5 (HMC) to 5.2 days (MGH) for acute and 1.0 (HMC) to 5.2 days (MGH) for established infections. Costs were $1054 (MGH) to $1521 (MUSC). Conclusions.  Conducting supplemental testing in-house lowered turnaround times, which may be further reduced with rapid HIV-1/HIV-2 differentiation tests. Hospitals may benefit from quantitative NATs not requiring physician orders, so all potential acute infections receive NAT. PMID:26798766

  8. Acute Infections, Cost per Infection and Turnaround Time in Three United States Hospital Laboratories Using Fourth-Generation Antigen-Antibody Human Immunodeficiency Virus Immunoassays

    PubMed Central

    Wesolowski, Laura G.; Nasrullah, Muazzam; Coombs, Robert W.; Rosenberg, Eric; Ethridge, Steven F.; Hutchinson, Angela B.; Dragavon, Joan; Rychert, Jennifer; Nolte, Frederick S.; Madory, James E.; Werner, Barbara G.

    2016-01-01

    Background. To improve clinical and public health outcomes through early human immunodeficiency virus (HIV) detection, fourth-generation antigen/antibody immunoassay (4IA) and supplemental testing results must be returned rapidly. Methods. We examined HIV testing data at Harborview Medical Center (HMC), Massachusetts General Hospital (MGH), and the Medical University of South Carolina (MUSC), which used 4IA and supplemental antibody and nucleic acid tests (NATs). At MGH and MUSC, HIV-1 Western blot (WB) and HIV-2 testing were conducted at a reference laboratory. We compared time from specimen collection to laboratory result for established (positive WB) and acute infections (reactive 4IA, negative/indeterminate WB, detectable NAT), and we calculated testing cost per positive-test result. Results. From 3731 (MUSC) to 19 774 (MGH) tests were conducted; 0.01% (MGH) to 0.05% (HMC) were acute infections. Each laboratory had reactive 4IA, WB-negative, or indeterminate specimens without NAT (ie, potential acute infections). Time to result was 1.5 (HMC) to 5.2 days (MGH) for acute and 1.0 (HMC) to 5.2 days (MGH) for established infections. Costs were $1054 (MGH) to $1521 (MUSC). Conclusions. Conducting supplemental testing in-house lowered turnaround times, which may be further reduced with rapid HIV-1/HIV-2 differentiation tests. Hospitals may benefit from quantitative NATs not requiring physician orders, so all potential acute infections receive NAT. PMID:26798766

  9. Acute Lung Failure

    PubMed Central

    Mac Sweeney, Rob; McAuley, Daniel F.; Matthay, Michael A.

    2013-01-01

    Lung failure is the most common organ failure seen in the intensive care unit. The pathogenesis of acute respiratory failure (ARF) can be classified as (1) neuromuscular in origin, (2) secondary to acute and chronic obstructive airway diseases, (3) alveolar processes such as cardiogenic and noncardiogenic pulmonary edema and pneumonia, and (4) vascular diseases such as acute or chronic pulmonary embolism. This article reviews the more common causes of ARF from each group, including the pathological mechanisms and the principles of critical care management, focusing on the supportive, specific, and adjunctive therapies for each condition. PMID:21989697

  10. [Acute myocarditis].

    PubMed

    Combes, Alain

    2012-06-01

    Myocarditis is defined as inflammation of the myocardium accompanied by myocellular necrosis. Acute myocarditis must be considered in patients who present with recent-onset of cardiac failure or arrhythmia. Fulminant myocarditis is a distinct entity characterized by sudden onset of severe congestive heart failure or cardiogenic shock, usually following a flu-like illness, parvovirus B19, human herpesvirus 6, coxsackievirus and adenovirus being the most frequently viruses responsible for the disease. Treatment of myocarditis remains largely supportive, since immunosuppression has not been proven to be beneficial for acute lymphocytic myocarditis. Trials of antiviral therapies, or immunostimulants such as interferons, suggest a potential therapeutic role but require further investigation. Lastly, early recognition of patients rapidly progressing to refractory cardiac failure and their immediate transfer to a medical-surgical center experienced in mechanical circulatory support is warranted. In this setting, ECMO should be the first-line mechanical assistance. For highly unstable patients, a Mobile Cardiac Assistance Unit, that rapidly travels to primary care hospitals with a portable ECMO system and hooks it up before refractory multiorgan failure takes hold, is the preferred option. PMID:22515999

  11. [Acute myocarditis].

    PubMed

    Combes, Alain

    2013-05-01

    Myocarditis is defined as inflammation of the myocardium accompanied by myocellular necrosis. Acute myocarditis must be considered in patients who present with recent onset of cardiac failure or arrhythmia. Fulminant myocarditis is a distinct entity characterized by sudden onset of severe congestive heart failure or cardiogenic shock, usually following a flu-like illness, parvovirus B19, human herpesvirus 6, coxsackievirus and adenovirus being the most frequently viruses responsible for the disease. Treatment of myocarditis remains largely supportive, since immunosuppression has not been proven to be beneficial for acute lymphocytic myocarditis. Trials of antiviral therapies, or immunostimulants such as interferons, suggest a potential therapeutic role but require further investigation. Lastly, early recognition of patients rapidly progressing to refractory cardiac failure and their immediate transfer to a medical-surgical center experienced in mechanical circulatory support is warranted. In this setting, ECMO should be the first-line mechanical assistance. For highly unstable patients, a Mobile Cardiac Assistance Unit, that rapidly travels to primary care hospitals with a portable ECMO system and hooks it up before refractory multiorgan failure takes hold, is the preferred option. PMID:23789482

  12. Psychiatric manifestations of primary Sjögren's syndrome: a case report and literature review

    PubMed Central

    Wong, John K F; Nortley, Ross; Andrews, Thomasin; D'Cruz, David

    2014-01-01

    A 54-year-old woman diagnosed with primary Sjögren's syndrome in 2007 presented with a 1-year history of visual hallucinations requiring admission to a psychiatric unit. The hallucinations resolved while on olanzapine and hydroxychloroquine but recurred when they were stopped. Despite restarting olanzapine, her visual hallucinations persisted. When she started a tapering dose of prednisolone, all the hallucinations resolved. This report adds to the small literature on psychiatric manifestations of Sjögren's syndrome and provides evidence that low-dose corticosteroids may be an effective treatment for this manifestation. PMID:24859541

  13. A 5-year retrospective study of demographic, anamnestic, and clinical factors related to psychiatric hospitalizations of adolescent patients

    PubMed Central

    Di Lorenzo, Rosaria; Cimino, Nina; Di Pietro, Elena; Pollutri, Gabriella; Neviani, Vittoria; Ferri, Paola

    2016-01-01

    Background Psychiatric emergencies of children and adolescents have greatly increased during the last years, but this phenomenon has not been studied in detail. The aim of this study was to analyze the correlation between acute psychiatric hospitalizations of adolescents and selected variables to highlight risk factors for psychiatric emergencies. Methods This retrospective research was conducted in the acute psychiatric public ward, Service of Psychiatric Diagnosis and Treatment (SPDT), and in the residential facility for adolescents, “The Medlar”, located in Modena. The sample was constituted by all adolescent patients (n=101, age range 14–18) who had acute hospitalizations (n=140) in SPDT and had been successively transferred to “The Medlar” (n=83), from February 2, 2010 to January 31, 2015. From clinical charts, we extracted demographic and anamnestic characteristics of patients and clinical variables related to hospitalizations. Data were statistically analyzed. Results Sixty-one percent of our patients lived with one divorced parent, with adoptive or immigrant family, or in institutions; 51% had experienced stressful events during childhood; 81% had a normal intellective level, but only 6% presented regular school performance. Parental psychiatric illness was negatively related, in a statistically significantly way, with onset age of adolescent mental disorders (coefficient −2.28, 95% confidence interval [CI]: −3.53 to 1.01, P<0.001, single linear regression; odds ratio: 4.39, 95% CI: 1.43–13.47, P<0.010, single logistic regression). The most frequent reasons for admission were aggressive behavior in males and suicide risk in females (P=0.002). The most frequent psychiatric diagnosis at SPDT discharge was “conduct disorder”, more frequent in males, followed by “adjustment disorder”, more frequent in females (P=0.001). In SPDT, the adolescent hospitalizations progressively increased fivefold at the end of the observation period

  14. Rethinking Adolescent Inpatient Psychiatric Care: The Importance of Integrated Interventions for Suicidal Youth With Substance Use Problems

    PubMed Central

    McManama O'Brien, Kimberly H.

    2015-01-01

    Adolescents psychiatrically hospitalized following a suicide attempt are at high risk for a repeat attempt or suicide completion, and substance use is consistently implicated as a risk factor for continued suicidal behavior in adolescents. Despite this knowledge, there have been few studies that have investigated the effectiveness of combined suicidality and substance use interventions within acute psychiatric care settings for suicidal youth with substance use problems. While social workers are well-positioned to deliver such interventions, greater emphasis on teaching integrated therapeutic techniques in social work curriculum and professional training is needed to ensure their implementation. PMID:26674510

  15. Psychiatric Service Use and Psychiatric Disorders in Adults with Intellectual Disability

    ERIC Educational Resources Information Center

    Bhaumik, S.; Tyrer, F. C.; McGrother, C.; Ganghadaran, S. K.

    2008-01-01

    Background: UK policies aim to facilitate access to general psychiatric services for adults with intellectual disability (ID). If this is to be achieved, it is important to have a clear idea of the characteristics and proportion of people with ID who currently access specialist psychiatric services and the nature and extent of psychiatric…

  16. Psychiatric genetics in China: achievements and challenges

    PubMed Central

    Schulze, Thomas G.; Burmeister, Margit; Sham, Pak Chung; Yao, Yong-gang; Kuo, Po-Hsiu; Chen, Chao; An, Yu; Dai, Jiapei; Yue, Weihua; Li, Miao Xin; Xue, Hong; Su, Bing; Chen, Li; Shi, Yongyong; Qiao, Mingqi; Liu, Tiebang; Xia, Kun; Chan, Raymond C.K.

    2016-01-01

    To coordinate research efforts in psychiatric genetics in China, a group of Chinese and foreign investigators have established an annual “Summit on Chinese Psychiatric Genetics” to present their latest research and discuss the current state and future directions of this field. To date, two Summits have been held, the first in Changsha in April, 2014, and the second in Kunming in April, 2015. The consensus of roundtable discussions held at these meetings is that psychiatric genetics in China is in need of new policies to promote collaborations aimed at creating a framework for genetic research appropriate for the Chinese population: relying solely on Caucasian population-based studies may result in missed opportunities to diagnose and treat psychiatric disorders. In addition, participants agree on the importance of promoting collaborations and data sharing in areas where China has especially strong resources, such as advanced facilities for non-human primate studies and traditional Chinese medicine: areas that may also provide overseas investigators with unique research opportunities. In this paper, we present an overview of the current state of psychiatric genetics research in China, with emphasis on genome-level studies, and describe challenges and opportunities for future advances, particularly at the dawn of “precision medicine.” Together, we call on administrative bodies, funding agencies, the research community, and the public at large for increased support for research on the genetic basis of psychiatric disorders in the Chinese population. In our opinion, increased public awareness and effective collaborative research hold the keys to the future of psychiatric genetics in China. PMID:26481319

  17. Fitness to Drive of Psychiatric Patients

    PubMed Central

    De las Cuevas, Carlos; Sanz, Emilio J.

    2008-01-01

    Background: Driving a motor vehicle could be central to the functional autonomy of patients with psychiatric illnesses. For patients, a driver's license could mean independence, the ability to care for themselves, and the freedom to travel when they wish. However, both psychiatric disorders and psychiatric drug treatments can produce changes in perception, information processing and integration, and psychomotor activity that can disturb and/or interfere with the ability to drive safely. Objective: To assess the fitness to drive of psychiatric outpatients in a sample representative of current clinical practice. Method: Cognitive functioning and psychomotor performance of 208 consecutive psychiatric outpatients treated in a community mental health center in the Canary Islands (Spain) were assessed in different clinical situations. The LNDETER 100 battery, an electronic assessment unit–based measurement that consists of 5 screenbased tests, was used to assess concentrated attention and resistance to monotony, multiple discriminative reactions and their correctness, anticipation of speed, bimanual coordination, and the decision making process and tendency to assume risk. The study was conducted from July 2007 to September 2007. Results: Of 208 patients, only 33 had scores compatible with the requirements of a driver's license, and 84% failed at least 1 of the required tests. Of patients with a driver's license who drive almost every day, 79.5% registered scores that would not allow obtaining or renewal of the license. None of the driving patients studied notified the traffic authorities that they had a psychiatric condition that may affect safe driving. No patient stopped driving, although 10% of them recognized that their ability to drive was somehow damaged. Conclusion: Guidance on how best to formulate and deliver recommendations on driving fitness in stable psychiatric patients is lacking and much needed. PMID:19158977

  18. Incidence of Norovirus and Other Viral Pathogens That Cause Acute Gastroenteritis (AGE) among Kaiser Permanente Member Populations in the United States, 2012–2013

    PubMed Central

    Grytdal, Scott P.; Biggs, Christianne; Cameron, Miriam; Schmidt, Mark; Parashar, Umesh D.; Hall, Aron J.

    2016-01-01

    Noroviruses and other viral pathogens are increasingly recognized as frequent causes of acute gastroenteritis (AGE). However, few laboratory-based data are available on the incidence of AGE caused by viral pathogens in the U.S. This study examined stool specimens submitted for routine clinical diagnostics from patients enrolled in Kaiser Permanente (KP) health plans in metro Portland, OR, and the Maryland, District of Columbia, and northern Virginia geographic areas to estimate the incidence of viral enteropathogens in these populations. Over a one-year study period, participating laboratories randomly selected stools submitted for routine clinical diagnostics for inclusion in the study along with accompanying demographic and clinical data. Selected stools were tested for norovirus, rotavirus, sapovirus, and astrovirus using standardized real-time RT-PCR protocols. Each KP site provided administrative data which were used in conjunction with previously published data on healthcare utilization to extrapolate pathogen detection rates into population-based incidence rates. A total of 1,099 specimens collected during August 2012 to September 2013 were included. Mean age of patients providing stool specimens was 46 years (range: 0–98 years). Noroviruses were the most common viral pathogen identified among patients with AGE (n = 63 specimens, 6% of specimens tested). In addition, 22 (2%) of specimens were positive for rotavirus; 19 (2%) were positive for sapovirus; and 7 (1%) were positive for astrovirus. Incidence of norovirus-associated outpatient visits was 5.6 per 1,000 person-years; incidence of norovirus disease in the community was estimated to be 69.5 per 1,000 person-years. Norovirus incidence was highest among children <5 years of age (outpatient incidence = 25.6 per 1,000 person-years; community incidence = 152.2 per 1,000 person-years), followed by older adults aged >65 years (outpatient incidence = 7.8 per 1,000 person-years; community incidence = 75.8 per

  19. A novel syndrome with psychiatric features and review of malformation syndromes with psychiatric disorders.

    PubMed

    du Souich, Christèle; Austin, Jehannine C; Friedlander, Robin; Boerkoel, Cornelius F

    2009-02-15

    Psychiatric disease occurs with increased frequency in a number of malformation syndromes. We hypothesize that the study of these disorders is helpful for understanding the pathophysiology of psychiatric disease. With this objective, we have been screening for individuals with malformations and prominent psychiatric disease. We report on a man with visual and auditory hallucinations and behavioral problems who was the product of an incestuous relationship and had anomalies primarily of his face, hands and feet. His distinctive features define an undescribed acro-auricular malformation syndrome with a psychiatric component. The study of Mendelian syndromes such as the one presented will likely be helpful for isolating novel genes involved in psychiatric illness. PMID:19253384

  20. An overview of the DSM-5: changes, controversy, and implications for psychiatric nursing.

    PubMed

    Halter, Margaret Jordan; Rolin-Kenny, Donna; Dzurec, Laura Cox

    2013-04-01

    Scheduled for publication in May 2013, the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5), will guide clinical diagnoses, treatment plans, medication choices and protocols, insurance reimbursements, and research agendas throughout the United States. It will also serve as a reference manual for clinicians around the world. This primary diagnostic source used by psychiatric and mental health providers is undergoing significant change in organization and content relative to the previous edition. This article provides a general overview of what to expect in the DSM-5, highlighting major aspects of the revision. Included is a list of the proposed diagnostic categories and an overview of some of the debate and discussion accompanying the changes. Implications for psychiatric nurses and psychiatric nursing are presented. PMID:23451735

  1. Levels of the Staff's Exposure to Violence at Locked Psychiatric Clinics: A Comparison by Occupational Groups.

    PubMed

    Bilici, Rabia; Sercan, Mustafa; Izci, Filiz

    2016-07-01

    This study explored the rates of exposure to violence among physicians, nurses, and other health care staff members working at the locked psychiatric clinics, to examine the quantity and types of violence exposed, and to compare occupational groups by the level of exposure to violence. In parallel with the existing literature, the present study supports the proposition that physicians and nurses working at psychiatric units represent a risky group in terms of exposure to violence. The survey found that 87.6% of staff members viewed security measures insufficient. It is considered by the authors that preventive actions should be taken to reduce the risk of exposure to violence against the staff members working at the locked psychiatric clinics. PMID:27104294

  2. Tobacco use treatment in primary care patients with psychiatric illness.

    PubMed

    Cerimele, Joseph M; Halperin, Abigail C; Saxon, Andrew J

    2014-01-01

    The prevalence of smoking is higher in patients with psychiatric illness compared with the general population. Smoking causes chronic illnesses, which lead to premature mortality in those with psychiatric illness, is associated with greater burden of psychiatric symptoms, and contributes to the social isolation experienced by individuals with psychiatric disorders. Most patients with a psychiatric illness present initially to primary care rather than specialty care settings, and some patients receive care exclusively in the primary care setting. Therefore, family physicians and other primary care clinicians have an important role in the recognition and treatment of tobacco use disorders in patients with psychiatric illnesses. In this article we review common myths associated with smoking and psychiatric illness, techniques for implementing evidence-based tobacco use treatments, the evidence base for tobacco use treatment for patients with specific psychiatric diagnoses, and factors to consider when treating tobacco use disorders in patients with psychiatric illness. PMID:24808119

  3. Comorbidity between neurological illness and psychiatric disorders.

    PubMed

    Hesdorffer, Dale C

    2016-06-01

    Psychiatric disorders are common in many neurological disorders, including epilepsy, migraine, Alzheimer's disease, Parkinson's disease, essential tremor, and stroke. These comorbidities increase disease burden and may complicate the treatment of the combined disorders. Initial studies of the comorbidity of psychiatric and neurological disorders were cross-sectional, and time order of the associations was impossible to elucidate. More recent work has clarified time associations between psychiatric disorders and neurological disorders, particularly in epilepsy and stroke where epidemiological evidence suggests that there is a bidirectional relationship. This article takes an epidemiological approach to understanding these relationships and focuses mostly on epilepsy. Although, these relationships are understood in many neurological disorders, routine screening for psychiatric disorders in neurological disorders is infrequent, mostly due to the lack of partnerships between psychiatrists and neurologists and the paucity of neuropsychiatrists. Much more needs to be done to improve the detection and treatment of patients affected by neurological and psychiatric disorders. Understanding the scope of this overlap may inspire collaborations to improve the lives of people affected by both disorders. PMID:26898322

  4. Understanding psychiatric institutionalization: a conceptual review

    PubMed Central

    2013-01-01

    Background Since Goffman’s seminal work on psychiatric institutions, deinstitutionalization has become a leading term in the psychiatric debate. It described the process of closure or downsizing of large psychiatric hospitals and the establishment of alternative services in the community. Yet, there is a lack of clarity on what exactly the concept of institutionalization means in present-day psychiatry. This review aims to identify the meaning of psychiatric institutionalization since the early 1960s to present-day. Method A conceptual review of institutionalization in psychiatry was conducted. Thematic analysis was used to synthesize the findings. Results Four main themes were identified in conceptualizing institutionalization: bricks and mortar of care institutions; policy and legal frameworks regulating care; clinical responsibility and paternalism in clinician-patient relationships; and patients’ adaptive behavior to institutionalized care. Conclusions The concept of institutionalization in psychiatry reflects four distinct themes. All themes have some relevance for the contemporary debate on how psychiatric care should develop and on the role of institutional care in psychiatry. PMID:23773398

  5. Parental psychiatric disorders and autism spectrum disorders

    PubMed Central

    Jokiranta, Elina; Brown, Alan S.; Heinimaa, Markus; Cheslack-Postava, Keely; Partanen, Auli; Sourander, Andre

    2013-01-01

    The present population-based, case-control study examines associations between specific parental psychiatric disorders and autism spectrum disorders (ASD) including childhood autism, Asperger’s syndrome and pervasive developmental disorder (PDD-NOS). The cohort includes 4713 children born between 1987 and 2005 with diagnoses of childhood autism, Asperger’s syndrome or PDD-NOS. Cases were ascertained from the Finnish Hospital Discharge Register, and each was matched to four controls by gender, date of birth, place of birth, and residence in Finland. Controls were selected from the Finnish Medical Birth Register. Parents were identified through the Finnish Medical Birth Register and Finnish Central Population Register. Parental psychiatric diagnoses from inpatient care were collected from the Finnish Hospital Discharge Register. Conditional logistic regression models were used to assess whether parents’ psychiatric disorders predicted ASD after controlling for parents’ age, smoking during pregnancy and weight for gestational age. In summary, parental schizophrenia spectrum disorders and affective disorders were associated with the risk of ASD regardless of the subgroup. PDD-NOS was associated with all parental psychiatric disorders investigated. Further studies are needed to replicate these findings. These results may facilitate the investigation of shared genetic and familial factors between ASD and other psychiatric disorders. PMID:23391634

  6. [Circadian rhythm sleep disorders in psychiatric diseases].

    PubMed

    Bromundt, Vivien

    2014-11-01

    Circadian rhythm sleep disorders are prevalent among psychiatric patients. This is most probable due to a close relationship between functional disturbances of the internal clock, sleep regulation and mental health. Mechanisms on molecular level of the circadian clock and neurotransmitter signalling are involved in the development of both disorders. Moreover, circadian disorders and psychiatric diseases favour each other by accessory symptoms such as stress or social isolation. Actimetry to objectively quantify the rest-activity cycle and salivary melatonin profiles as marker for the circadian phase help to diagnose circadian rhythm sleep disorders in psychiatric patients. Chronotherapeutics such as bright light therapy, dark therapy, melatonin administration, and wake therapy are used to synchronise and consolidate circadian rhythms and help in the treatment of depression and other psychiatric disorders, but are still neglected in medicine. More molecular to behavioural research is needed for the understanding of the development of circadian disorders and their relationship to psychiatric illnesses. This will help to boost the awareness and treatment of circadian rhythm sleep disorders in psychiatry. PMID:25377290

  7. Application of Predictive Nursing Reduces Psychiatric Complications in ICU Patients after Neurosurgery

    PubMed Central

    LIU, Qiong; ZHU, Hui

    2016-01-01

    Background: Our aim was to investigate the effects of clinical application of perioperative predictive nursing on reducing psychiatric complications in Intensive Care Unit (ICU) patients after neurosurgery. Methods: A total of 129 patients who underwent neurosurgery and received intensive care were enrolled in our study from February 2013 to February 2014. These patients were divided into two groups: the experimental group (n=68) receiving predictive nursing before and after operation, and the control group (n=61) with general nursing. Clinical data including length of ICU stay, duration of the patients’ psychiatric symptoms, form and incidence of adverse events, and patient satisfaction ratings were recorded, and their differences between the two groups were analyzed. Results: The duration of psychiatric symptoms and the length of ICU stay for patients in the experimental group were significantly shorter than those in the control group (P<0.05). The incidence of adverse events and psychiatric symptoms, such as sensory and intuition disturbance, thought disturbance, emotional disorder, and consciousness disorder, in the experimental group was significantly lower than that in the control group (P<0.05). Patient satisfaction ratings were significantly higher in the experimental group than those in the control group (P<0.05). Conclusion: Application of predictive nursing on ICU patients who undergo neurosurgery could effectively reduce the incidence of psychiatric symptoms as well as other adverse events. Our study provided clinical evidences to encourage predictive nursing in routine settings for patients in critical conditions. PMID:27252916

  8. Validity and reliability study of the Turkish psychiatric nurses of job motivation scale.

    PubMed

    Engin, E; Cam, O

    2009-06-01

    This methodological study was planned to explore the validity and reliability of the evaluation scale for measuring the job motivation of nurses who work in psychiatric clinics. The sample was composed of 378 nurses who work in all psychiatric units or psychiatric hospitals located in Turkey's four large cities - Ankara, Istanbul, Izmir and Manisa. For testing reliability of 'job motivation scale', the internal consistency tests were executed with split scale analysis, Cronbach's alpha coefficient and item-total score correlation. For construct validity, factor analysis was used. For the first part of scale, Cronbach's alpha was determined to be 0.79. For the second part, Cronbach's alpha was 0.72. Factor analysis was performed in an attempt to establish validity and underlying associations between items in the scale. The first analysis produced nine eigenvalues (>1) and nine factors were extracted. The scree test indicated that a two-factor model would be suitable. The factor structure of the tool for measuring the job motivation of nurses who work in psychiatric clinics was parallel with motivation concepts. Validity and reliability levels of the scale for measuring the job motivation of nurses who work in psychiatric clinics were found to be sufficient in the Turkish population. PMID:19538603

  9. Measuring quality of care in psychiatric emergencies: construction and evaluation of a Bayesian index.

    PubMed Central

    Gustafson, D H; Sainfort, F; Johnson, S W; Sateia, M

    1993-01-01

    OBJECTIVE. This study was conducted to determine whether an index for measuring quality of care for psychiatric emergencies is reliable and valid. DATA SOURCES/STUDY SETTING. The study used primary data collected over a 12-month period from two urban hospitals in the Northeast. One had 700 inpatient beds, an inpatient psychiatric unit, and community mental health personnel located in the emergency department. The other had 300 beds but none of the other hospital's features. STUDY DESIGN. The index was developed by a panel of experts in emergency psychiatry using a subjective Bayesian statistical methodology and was evaluated in terms of its ability to: (1) predict a second panel's judgments of quality; (2) predict a specific quality-related patient outcome, i.e., compliance with follow-up recommendations; (3) provide a reliable measurement procedure; and (4) detect variations in patterns of emergency department practices. DATA COLLECTION/EXTRACTION METHODS. Data were collected on 2,231 randomly selected emergency psychiatric patients (psychiatric diagnosis, alcohol abuse, nonverbal patients experiencing a psychiatric emergency, and patients with somatic complaints such as life crisis) treated in the emergency departments of the two hospitals. PRINCIPAL FINDINGS. The index predicted physician judgments of quality, was reliable, exhibited sufficient variation in scores, and was strongly associated with patient compliance. CONCLUSIONS. The study demonstrated that a subjective Bayesian model can be used to develop a reliable and valid index for measuring quality of care, with potential for practical application in management of health services. PMID:8514497

  10. 42 CFR 483.354 - General requirements for psychiatric residential treatment facilities.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... Psychiatric Residential Treatment Facilities Providing Inpatient Psychiatric Services for Individuals Under Age 21 § 483.354 General requirements for psychiatric residential treatment facilities. A...

  11. 42 CFR 483.354 - General requirements for psychiatric residential treatment facilities.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... Psychiatric Residential Treatment Facilities Providing Inpatient Psychiatric Services for Individuals Under Age 21 § 483.354 General requirements for psychiatric residential treatment facilities. A...

  12. 42 CFR 483.354 - General requirements for psychiatric residential treatment facilities.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... Psychiatric Residential Treatment Facilities Providing Inpatient Psychiatric Services for Individuals Under Age 21 § 483.354 General requirements for psychiatric residential treatment facilities. A...

  13. 42 CFR 483.354 - General requirements for psychiatric residential treatment facilities.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... Psychiatric Residential Treatment Facilities Providing Inpatient Psychiatric Services for Individuals Under Age 21 § 483.354 General requirements for psychiatric residential treatment facilities. A...

  14. 42 CFR 483.354 - General requirements for psychiatric residential treatment facilities.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... Psychiatric Residential Treatment Facilities Providing Inpatient Psychiatric Services for Individuals Under Age 21 § 483.354 General requirements for psychiatric residential treatment facilities. A...

  15. To be strategically struggling against resignation: the lived experience of being cared for in forensic psychiatric care.

    PubMed

    Hörberg, Ulrica; Sjögren, Reet; Dahlberg, Karin

    2012-11-01

    To be referred to care in forensic psychiatric services can be seen as one of the most comprehensive encroachments society can impose upon a person's life, as it entails a limitation of the individual's freedom with no time limit. This study focuses upon patients' experiences of their life situation in forensic psychiatric wards. Using a Reflective Lifeworld Research approach founded in phenomenology, we analysed 11 qualitative interviews with patients cared for on a maximum security unit in a Swedish forensic psychiatric service. Results show how forensic psychiatric care can be non-caring with only moments of good care, from the patient's perspective. By using different strategies, the patients attempt to adapt to the demands of the caregivers in order to gain privileges. At the same time the patients are lacking meaningful and close relationships and long to get away from the system of forensic care. Being cared for entails struggling against an approaching overwhelming sense of resignation. PMID:23146008

  16. Psychiatric morbidity after screening for breast cancer.

    PubMed Central

    Dean, C; Roberts, M M; French, K; Robinson, S

    1986-01-01

    One hundred and thirty two women with normal breast screening results were interviewed six months after their attendance at the Edinburgh Breast Screening Clinic. Eight percent of women said screening had made them more anxious about developing breast cancer. Thirty eight percent said they were more aware of the disease since screening but they regarded this as advantageous. Seventy percent of the women were still practising breast self-examination. There was no difference in the psychiatric morbidity of the screened sample when compared with a matched random sample community control group. Neither was there any difference in the General Health Questionnaire case rates before and after screening. Screening does not appear to increase the prevalence of psychiatric morbidity. Twenty nine percent of the interview sample were examining their breasts more than once a month--21% once a week or more. However, these frequent self-examiners did not have a greater prevalence of psychiatric morbidity than their matched controls. PMID:3711771

  17. Psychiatric aspects of brain tumors: A review

    PubMed Central

    Madhusoodanan, Subramoniam; Ting, Mark Bryan; Farah, Tara; Ugur, Umran

    2015-01-01

    Infrequently, psychiatric symptoms may be the only manifestation of brain tumors. They may present with mood symptoms, psychosis, memory problems, personality changes, anxiety, or anorexia. Symptoms may be misleading, complicating the clinical picture. A comprehensive review of the literature was conducted regarding reports of brain tumors and psychiatric symptoms from 1956-2014. Search engines used include PubMed, Ovid, Psych Info, MEDLINE, and MedScape. Search terms included psychiatric manifestations/symptoms, brain tumors/neoplasms. Our literature search yielded case reports, case studies, and case series. There are no double blind studies except for post-diagnosis/-surgery studies. Early diagnosis is critical for improved quality of life. Symptoms that suggest work-up with neuroimaging include: new-onset psychosis, mood/memory symptoms, occurrence of new or atypical symptoms, personality changes, and anorexia without body dysmorphic symptoms. This article reviews the existing literature regarding the diagnosis and management of this clinically complex condition. PMID:26425442

  18. DNA Damage in Major Psychiatric Diseases.

    PubMed

    Raza, Muhammad Ummear; Tufan, Turan; Wang, Yan; Hill, Christopher; Zhu, Meng-Yang

    2016-08-01

    Human cells are exposed to exogenous insults and continuous production of different metabolites. These insults and unwanted metabolic products might interfere with the stability of genomic DNA. Recently, many studies have demonstrated that different psychiatric disorders show substantially high levels of oxidative DNA damage in the brain accompanied with morphological and functional alterations. It reveals that damaged genomic DNA may contribute to the pathophysiology of these mental illnesses. In this article, we review the roles of oxidative damage and reduced antioxidant ability in some vastly studied psychiatric disorders and emphasize the inclusion of treatment options involving DNA repair. In addition, while most currently used antidepressants are based on the manipulation of the neurotransmitter regulation in managing different mental abnormalities, they are able to prevent or reverse neurotoxin-induced DNA damage. Therefore, it may be plausible to target on genomic DNA alterations for psychiatric therapies, which is of pivotal importance for future antipsychiatric drug development. PMID:27126805

  19. Delivering difficult news in psychiatric settings.

    PubMed

    Cleary, Michelle; Hunt, Glenn E; Horsfall, Jan

    2009-01-01

    Communication research and investigations into the delivery of bad news are uncommon in psychiatry versus other medical specialties. The question of delivering "bad" diagnostic news in psychiatry has been focused on dementia rather than actual psychiatric disorders and their sequelae. Common problems are that psychiatrists avoid dealing with patients' emotional reactions to bad news and that they avoid providing a clear diagnosis for fear that patients or carers will be distressed. This article aims to provide an overview of key elements of the "breaking bad news" literature, teasing out factors that are relevant to psychiatric practice. Topics explored include: definitions; clinical considerations for delivering difficult news within medical and psychiatric settings; protocols and guidelines; evidence about patient information needs and communication preferences; research into actual delivery of such news; and areas for future education and research. PMID:19832045

  20. Indian – American contributions to psychiatric research

    PubMed Central

    Pandurangi, Anand K.

    2010-01-01

    The Indian Diaspora, especially in North America, is a visible force in the field of psychiatric medicine. An estimated 5000 persons of Indian origin practice psychiatry in the USA and Canada, and an estimated 10% of these are in academic psychiatry. Wide ranging contributions, from molecular biology of psychiatric disorders to community and cultural psychiatry, are being made by this vibrant group of researchers. This article is a brief summary and work-in-progress report of the contributions by Indian – American psychiatric researchers. Although not exhaustive in coverage, it is meant to give the reader an overview of the contributions made by three waves of researchers over a span of 50 years. PMID:21836715