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
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
Koivunen, Marita; Anttila, Minna; Kuosmanen, Lauri; Katajisto, Jouko; Välimäki, Maritta
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
Bowers, Len; James, Karen; Quirk, Alan; Simpson, Alan; Stewart, Duncan; Hodsoll, John
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
Jones, J; Nolan, P; Bowers, L; Simpson, A; Whittington, R; Hackney, D; Bhui, K
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
4. FIRE BREAK BETWEEN PSYCHIATRIC WARD AND NEXT WARD TO THE SOUTH - Fort Randall, Neuro-Psychiatric Ward, Northeast of intersection of California Boulevard & Nurse Drive, Cold Bay, Aleutian Islands, AK
Bowers, L; Flood, C; Brennan, G; Allan, T
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
Radcliffe, Jonathan; Bird, Laura
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
Radcliffe, Jonathan; Bird, Laura
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
Gerace, Adam; Oster, Candice; Mosel, Krista; O'Kane, Deb; Ash, David; Muir-Cochrane, Eimear
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
Di Lorenzo, Rosaria; Sagona, Marco; Landi, Giulia; Martire, Lisa; Piemonte, Chiara; Del Giovane, Cinzia
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
Maes, M.; de Meyer, F.; Peeters, D.; Meltzer, H.; Schotte, C.; Scharpe, S.; Cosyns, P.
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.
3. PSYCHIATRIC WARD IN 24' X 60' QUONSET HUT, VIEW OF SOUTH FACE - Fort Randall, Neuro-Psychiatric Ward, Northeast of intersection of California Boulevard & Nurse Drive, Cold Bay, Aleutian Islands, AK
Csipke, Emese; Papoulias, Constantina; Vitoratou, Silia; Williams, Paul; Rose, Diana; Wykes, Til
Abstract Background: Psychiatric ward design may make an important contribution to patient outcomes and well-being. However, research is hampered by an inability to assess its effects robustly. This paper reports on a study which deployed innovative methods to capture service user and staff perceptions of ward design. Method: User generated measures of the impact of ward design were developed and tested on four acute adult wards using participatory methodology. Additionally, inpatients took photographs to illustrate their experience of the space in two wards. Data were compared across wards. Results: Satisfactory reliability indices emerged based on both service user and staff responses. Black and minority ethnic (BME) service users and those with a psychosis spectrum diagnosis have more positive views of the ward layout and fixtures. Staff members have more positive views than service users, while priorities of staff and service users differ. Inpatient photographs prioritise hygiene, privacy and control and address symbolic aspects of the ward environment. Conclusions: Participatory and visual methodologies can provide robust tools for an evaluation of the impact of psychiatric ward design on users. PMID:26886239
Ahmadzadeh, Gholamhossain; Shahin, Ali
Background: Having pleasurable sexual intercourses plays a major role in marital life satisfaction. Many of the medical and psychiatric disorders may affect the sexual function of the patients. The present study aims to investigate the relative frequency of sexual dysfunctions in the patients hospitalized in psychiatric wards and that of the patients in other specialized wards. Materials and Methods: This study is a descriptive-analytical, cross-sectional one, carried out on 900 patients hospitalized in psychiatric, cardiac, orthopedic, ophthalmology, and dermatology and plastic surgery wards of 5 hospitals in Isfahan. Data collection tools included demographic questionnaire and Arizona Sexual Experiences Scale (ASEX). Results: Sexual dysfunction in the patients hospitalized in psychiatric wards (38%) was significantly higher than in the patients in other wards (27%), (P = 0.00). Among the patients hospitalized in psychiatric wards, those with bipolar disorder (37.3%) had the highest prevalence rate of sexual dysfunction. The patients with schizophrenia, major depression, substance abuse, and anxiety disorders had the following rates respectively. Among the patients in non-psychiatric wards, those in cardiac wards (37.1%) had the highest prevalence rate of sexual dysfunction. There was a significant relationship between the drug uses, mostly psychiatric drugs especially anti-psychotics, and the occurrence of sexual dysfunction. Conclusion: Considering the significant relative frequency of sexual dysfunction in psychiatric patients and undesired effects of simultaneous occurrence of both of these disorders in the patients, more emphasis is recommended to be placed on the prevention and proper treatment of these disorders in the patients. PMID:26623400
Background Community prescribing of medication to treat psychiatric illness in children is increasing. However, details about medication prescribed at discharge from psychiatric inpatient services for children are scarce. Objectives Characterise the nature of psychotropic medication prescribed on discharge from a children's psychiatric ward over a 15-year period. Method Retrospective analysis of discharge summary letters of all discharges occurring between Jan 1997 to Dec 2012. Results 234 children (152 males and 82 females) were discharged with 117 (50%) prescribed psychotropic medication at discharge. 133 medicines were prescribed (stimulants n = 49, antipsychotics n = 31, antidepressants n = 22, mood stabilisers n = 1, other ADHD medication n = 11, melatonin n = 10, benzodiazepines n = 7, other n = 2). Risperidone was the most popular antipsychotic at a mean daily dose of 1 mg (range 0.25-4 mg). Fifty per cent were given an unlicensed medicine or a licensed drug was used in an unlicensed manner, of which risperidone was the most common (n = 14). Sleep disturbance and tics were most often treated using unlicensed/off label medication (n = 10). Conclusion Psychotropic medication is routinely used in inpatient children's services, with the majority of use confined to stimulants and atypical antipsychotics. Much of the antipsychotic use is for unlicensed indications or at unlicensed doses. PMID:25893488
Müller, Matthias J; Schlösser, Ralf; Kapp-Steen, Gisela; Schanz, Benno; Benkert, Otto
The study compared patients' satisfaction with psychiatric inpatient treatment between an open and a closed ward. During a six-month period, all voluntarily participating patients on two wards of a psychiatric University hospital were investigated anonymously at admission and/or before discharge. A self-rating questionnaire (SATQ-98) was used to assess satisfaction with several domains of psychiatric inpatient treatment. In total, 135 questionnaires were received (retrieval rate 49%). The general level of satisfaction with treatment was high. General satisfaction, satisfaction with medication, ward equipment, visiting opportunities, and regulations for going out were significantly lower at discharge on the closed ward. Dissatisfaction with medication was related to low actual mood, and to low satisfaction with the frequency of psychotherapeutic interventions, visiting opportunities, and with the treating doctor. The results thus far strongly support the need for patients' satisfaction with treatment to be taken into account in order to improve psychiatric inpatient services, particularly on closed wards. PMID:12025725
Zarea, K; Nikbakht-Nasrabadi, A; Abbaszadeh, A; Mohammadpour, A
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
Lau, Wai-Chi; Choi, Kup-Sze; Chung, Wai-Yee
Misconceptions about psychiatric wards frequently cause newly admitted mental patients to stay away from these wards despite their need for treatment. Although ward orientation is typically conducted by nurses in an attempt to help patients to adapt to the new environment, it is considered time-consuming, and the method of orientation and the explanations given may vary among different nurses. This situation calls for a more effective and standardized approach to orientating mental patients on their first admission. To this end, a computer-based interactive virtual environment was developed based on a real psychiatric ward by using virtual reality (VR) technologies. It enables the patient to navigate around to gain understanding about the ward through a virtual guided tour. The effectiveness of this VR orientation approach was investigated by a randomized controlled trial with consecutive sampling. Fifty-four Chinese participants were randomly assigned to undergo ward orientation by either using the VR-based approach or reading text-based electronic information sheets about the ward with a computer. Subjective and objective measures were obtained respectively using the Chinese version of the State-Trait Anxiety Inventory questionnaire and the heart-rate variability measurement before and after the intervention. In addition, a test on the level of understanding about the ward was administered at the end of the session. The results showed that the VR orientation approach is helpful in reducing patients' anxiety while also improving their level of understanding about the ward. PMID:21142988
Barekatain, Majid; Maracy, Mohammad Reza; Hassannejad, Razeyeh; Hosseini, Reihane
Objectives. Readmission has a major role in the reduction of the quality of life and the increase in the years of lost life. The main objectives of this study were to answer to the following research questions. (a) What was the readmission rate? (b) What were the social, demographic, and clinical characteristics of patients admitted to the Psychiatric Emergency Service at Nour University Hospital, affiliated to Isfahan University of Medical Sciences, Isfahan, Iran? (c) What were the effective factors on readmission? Method. This cross-sectional study was conducted on a total number of 3935 patients who were admitted to Isfahan University Hospital Psychiatric Ward in Isfahan, Iran, from 2004 to 2010. Gender, age, marital status, education, self-report history of previous admission, type of psychiatric disorder, substance misuse, suicide, and the length of the current psychiatric disorder were collected from the registered medical files of patients. The data were analysed using the negative binomial regression model. Results. We found that factors such as psychiatric anxiety disorder, bipolar I, bipolar II, psychotic disorder, depression, and self report history of previous admission were statistically significant in the number of readmissions using the negative binomial model. Conclusion. Readmission to the psychiatric ward is mainly predictable by the type of diagnosis and psychosocial supports. PMID:24236285
Warner, James; Pitts, Nicola; Crawford, Mike J; Serfaty, Marc; Prabhakaran, Pramod; Amin, Rizkar
In psychiatric hospitals, sexual activity between patients raises special difficulties regarding consent. We undertook a questionnaire survey of inpatients in the mental health units of three hospitals to identify the nature and frequency of sexual activity. A contemporaneous staff questionnaire was used in an attempt to validate the patient reports. Of the 100 patients who participated (response rate 60%), 30 reported engaging in some form of sexual activity including 10 who had sexual intercourse. All sexual intercourse was consensual, but only 2 respondents used condoms. Staff questionnaires suggested levels of sexual activity congruent with patient reports. This survey underlines the conflict between an individual's right to sexual expression and the need to protect vulnerable patients. PMID:15459258
Hanes, Michael J.
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.…
Koukia, Evmorfia; Madianos, Michael G; Katostaras, Theofanis
The objective of this research was to explore the "on-the spot" clinical interventions mental health nurses make in critical incidents on inpatient psychiatric wards. Mental health nurses play a key role in the management of psychiatric critical incidents. Nurses' autonomy, decision-making, and training in clinical interventions are important issues in psychiatric nursing practice. A descriptive study was conducted among mental health nurses working on inpatient wards of three major psychiatric hospitals in the greater Athens area, using semi-structured interviews. Nurses' personal views also were documented. Semi-structured interviews were conducted with 103 mental health nurses, who were encouraged to make personal remarks. The results of this study show that in the majority of critical incidents, the nurses were found to be in contact with the psychiatrist on call; physical restraints were used frequently in violent episodes; reassurance and support were common interventions; the majority of nurses would have preferred not to intervene with critical incidents; and nurses expressed a need for skills training and higher autonomy. The nurses implemented a specific number of interventions in confronting the various types of crises. The need for specialized training was noticed and problems like accountability, autonomy, and medication administration, were considered crucial by the mental heath nurses. PMID:19437252
Accessible summary Rates of violence, self-harm, absconding and other incidents threatening patients and staff safety vary a great deal by hospital ward. Some wards have high rates, other low. The same goes for the actions of staff to prevent and contain such incidents, such as manual restraint, coerced medication, etc. The Safewards Model provides a simple and yet powerful explanation as to why these differences in rates occur. Six features of the inpatient psychiatric system have the capacity to give rise to flashpoints from which adverse incidents may follow. The Safewards Model makes it easy to generate ideas for changes that will make psychiatric wards safer for patients and staff. Abstract Conflict (aggression, self-harm, suicide, absconding, substance/alcohol use and medication refusal) and containment (as required medication, coerced intramuscular medication, seclusion, manual restraint, special observation, etc.) place patients and staff at risk of serious harm. The frequency of these events varies between wards, but there are few explanations as to why this is so, and a coherent model is lacking. This paper proposes a comprehensive explanatory model of these differences, and sketches the implications on methods for reducing risk and coercion in inpatient wards. This Safewards Model depicts six domains of originating factors: the staff team, the physical environment, outside hospital, the patient community, patient characteristics and the regulatory framework. These domains give risk to flashpoints, which have the capacity to trigger conflict and/or containment. Staff interventions can modify these processes by reducing the conflict-originating factors, preventing flashpoints from arising, cutting the link between flashpoint and conflict, choosing not to use containment, and ensuring that containment use does not lead to further conflict. We describe this model systematically and in detail, and show how this can be used to devise strategies for promoting
Thew, Graham R; MacCallam, Jackie; Salkovskis, Paul M; Suntharalingam, Jay
Objectives: Psychological difficulties are a common complication among patients with respiratory disease, and are associated with poorer health outcomes and increased use of healthcare. As prevalence studies typically sample patients from community settings, this study aimed to explore the extent and nature of psychological difficulties during acute hospital admission. Methods: A case example of an acute respiratory ward is presented. In total, 41 acute respiratory inpatients completed standardised measures of depression, anxiety, and health anxiety. Results: Rates of clinically significant depression, anxiety, and health anxiety were 71%, 40%, and 21%, respectively, with 76% of participants showing clinically significant scores on at least one measure. Comparison to existing literature suggests depression rates may be elevated in the acute inpatient context. The difficulties experienced encompassed both contextual factors related to being in hospital and broader health concerns. Conclusion: We suggest that psychological distress may be particularly prevalent in inpatient settings and that larger-scale studies are warranted. PMID:27508081
Stanley, Jack L; Mogford, Daniel V; Lawrence, Rebecca J; Lawrie, Stephen M
Objectives Non-illicit alternatives to controlled drugs, known as novel psychoactive substances (NPS), have recently risen to prominence. They are readily available, with uncertain pharmacology and no widely available assay. Given that psychiatric patients are at risk of comorbid substance abuse, we hypothesised that NPS use would be present in the psychiatric population, and sought to determine its prevalence and investigate the characteristics of those who use these drugs with a retrospective review of discharge letters. Setting General adult inpatient wards of a psychiatric hospital in a Scottish city. Participants All adult inpatients (18–65) discharged from general psychiatric wards between 1 July 2014 and 31 December 2014. Of the 483 admissions identified, 46 were admissions for maintenance electroconvulsive therapy (ECT) and were excluded. Of the remaining 437 admissions, 49 discharge letters were unobtainable, leaving 388 admissions to analyse. Primary outcome measure The mention, or lack thereof, of NPS use in discharge letters was our planned primary outcome measure and was also the primary outcome measure we used in our analysis. Results NPS use was identified in 22.2% of admissions, contributing to psychiatric symptoms in 59.3%. In comparison to non-users, NPS users were younger (p<0.01), male and more likely to have a forensic history ((p<0.001) for both). The diagnosis of drug-induced psychosis was significantly more likely in NPS users (p<0.001, OR 18.7, 95% CI 8.1 to 43.0) and the diagnosis of depression was significantly less likely (p<0.005, OR 0.133, CI 0.031 to 0.558). Use of cannabis was significantly more likely in NPS users (p<0.001, OR 4.2, CI 2.5 to 7.1), as was substitute opiate prescribing (p<0.001, OR 3.7, CI 1.8 to 7.4). Conclusions NPS use was prevalent among young, male psychiatric inpatients, in particular those with drug-induced psychosis and often occurred alongside illicit drug use. PMID:27165643
Morgan, R.; Turnbull, C. J.; King, D.
An audit of 150 patients on five acute geriatric wards found that 28 (19%) still drove. Forty-three (28%) used to drive but had given up, whilst 79 (53%) (76 of whom were female) had never driven. Former drivers gave the main reason for stopping as cost. No driver could recall being advised about driving by a doctor. Twenty-two drivers (79%) had a significant clinical condition that could affect driving, ranging from blackouts to arthritis. It is recommended that all elderly patients should be asked if they drive and any clinical conditions they might have that would adversely affect their driving be sought. Appropriate advice should be given by doctors to their elderly patients in order to safeguard them and the public from road traffic accidents. PMID:8545286
Patients with anorexia nervosa (AN) exhibit physical and psychiatric symptoms, in addition to their behavioral problems, and often require admission to a general hospital with a psychiatric ward. There are only a few general hospitals with psychiatric wards available, and patients with AN tend to be concentrated in a small number of such institutions. Thus, it is difficult to provide adequate support for the treatment of patients with AN. In Kyoto, the number of general hospitals with a psychiatric ward is small. Patients with AN tend to be treated at the two university hospitals. However, our University Hospital cannot accept all patients with AN, especially the emergency admissions. Therefore, with respect to the inpatient treatment of AN, we established a cooperation agreement with other psychiatric hospitals. We are planning to divide the inpatient treatment of AN between our university hospital and other psychiatric hospitals, depending on the stage of AN and the severity of the patients' physical condition. With respect to the treatment of AN, it is necessary to establish a treatment system with each hospital playing a role. PMID:26502711
Alexiou, Eirini; Degl' Innocenti, Alessio; Kullgren, Anette; Wijk, Helle
In recent years, large groups of forensic psychiatric patients have been relocated into new medium- and maximum-security forensic psychiatric facilities in Sweden, where a psychosocial care approach is embedded. From this perspective and on the assumption that physical structures affect the therapeutic environment, a prospective longitudinal study was designed to investigate the impact of the facility relocation of three forensic psychiatric hospitals on patients' perceptions of ward atmosphere and quality of received forensic psychiatric care. Participants were patients over 18 years of age sentenced to compulsory forensic psychiatric treatment. Data were obtained by validated questionnaires. Overall, 58 patients (78%) answered the questionnaires at baseline with a total of 25 patients (34%) completing follow-up 1 at six months and 11 patients (15%) completing follow-up 2, one year after relocation. Approximately two-thirds of the participants at all time-points were men and their age range varied from 18 to 69. The results of this study showed that poor physical environment features can have a severe impact on care quality and can reduce the possibilities for person-centered care. Furthermore, the study provides evidence that the patients' perceptions of person-centered care in forensic psychiatric clinics are highly susceptible to factors in the physical and psychosocial environment. Future work will explore the staff's perception of ward atmosphere and the possibilities to adapt a person-centered approach in forensic psychiatric care after facility relocation. PMID:27213839
Springham, Neil; Robert, Glenn
An acute mental health triage ward at Oxleas NHS Foundation Trust was attracting high levels of formal service user and family complaints. The Trust used experience based co-design to examine the issues and redesign procedures. This resulted in an immediate eradication of formal complaints for a period of 23 months. This paper describes two outcomes: firstly, the successful adaptations made to the experience based co-design methodology from its origins in physical care, in order to ensure it was safe and effective in an acute mental health setting; and, secondly, the changes made to the ward as a result of this quality improvement intervention. PMID:26734433
Veale, David; Akyüz, Elvan U; Hodsoll, John
The aim of this study was to estimate the prevalence of body dysmorphic disorder (BDD) on an inpatient ward in the UK with a larger sample than previously studied and to investigate the value of a simple screening question during an assessment interview. Four hundred and thirty two consecutive admissions were screened for BDD on an adult psychiatric ward over a period of 13 months. Those who screened positive had a structured diagnostic interview for BDD. The prevalence of BDD was estimated to be 5.8% (C.I. 3.6-8.1%). Our screening question had a slightly low specificity (76.6%) for detecting BDD. The strength of this study was a larger sample size and narrower confidence interval than previous studies. The study adds to previous observations that BDD is poorly identified in psychiatric inpatients. BDD was identified predominantly in those presenting with depression, substance misuse or an anxiety disorder. The screening question could be improved by excluding those with weight or shape concerns. Missing the diagnosis is likely to lead to inappropriate treatment. PMID:26404769
Bonner, Gwen; McLaughlin, Sue
This article shares findings of work undertaken with a group of mental health ward managers to consider their roles through workshops using an action learning approach. The tensions between the need to balance the burden of administrative tasks and act as clinical role models, leaders and managers are considered in the context of providing recovery-focused services. The group reviewed their leadership styles, broke down the administrative elements of their roles using activity logs, reviewed their working environments and considered how recovery focused they believed their wards to be. Findings support the notion that the ward manager role in acute inpatient settings is at times unmanageable. Administration is one aspect of the role for which ward managers feel unprepared and the high number of administrative tasks take them away from front line clinical care, leading to frustration. Absence from clinical areas reduces opportunities for role modeling good clinical practice to other staff. Despite the frustrations of administrative tasks, overall the managers thought they were supportive to their staff and that their wards were recovery focused. PMID:24779763
Zgaljardic, Dennis J; Seale, Gary S; Schaefer, Lynn A; Temple, Richard O; Foreman, Jack; Elliott, Timothy R
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
Kibble, Sharon; Gray, Debra; Prat-Sala, Merce; Ross, Kirsty; Johnson, Karen; Packer, Jane; Shire, Elizabeth; Cross, Rhian; Harden, Beverley
Our patient, carer, and staff feedback clearly tells us that elderly patients are frequently disempowered by acute care provision, environments, and attitudes. This debilitates individuals mentally and physically, reducing their independent functioning, and may mean that they require prolonged care or are unfit to return home. We developed the concept of “recovery coaching” to support acute inpatient elderly care rehabilitation. We designed a training intervention to achieve “coaching conversations” between our staff and our patients. Data were collected from 46 participants; 22 in the pre-intervention stage and 24 in the post-intervention stage. For the post-intervention patients, mean scores indicated that there was slightly higher increase in the patient's independence in terms of their Barthel (ADL) scores and that they reported higher feelings of self-efficacy. For this patient group it was also found that more returned home with the same level of care as on their admission, and that fewer patients required residential care placements at discharge. This innovative intervention allowed us to challenge the fundamental basis of “I do it for you” to “I will do it with you”, allowing the patient to become an integral partner in their health care. PMID:27493732
Conflict (aggression, self-harm, suicide, absconding, substance/alcohol use and medication refusal) and containment (as required medication, coerced intramuscular medication, seclusion, manual restraint, special observation, etc.) place patients and staff at risk of serious harm. The frequency of these events varies between wards, but there are few explanations as to why this is so, and a coherent model is lacking. This paper proposes a comprehensive explanatory model of these differences, and sketches the implications on methods for reducing risk and coercion in inpatient wards. This Safewards Model depicts six domains of originating factors: the staff team, the physical environment, outside hospital, the patient community, patient characteristics and the regulatory framework. These domains give risk to flashpoints, which have the capacity to trigger conflict and/or containment. Staff interventions can modify these processes by reducing the conflict-originating factors, preventing flashpoints from arising, cutting the link between flashpoint and conflict, choosing not to use containment, and ensuring that containment use does not lead to further conflict. We describe this model systematically and in detail, and show how this can be used to devise strategies for promoting the safety of patients and staff. PMID:24548312
Matthews, W B
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
Pewter, Stephen M; Williams, W Huw; Haslam, Catherine; Kay, Janice M
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
There are many macrosocial studies of the political organisation of health and mental health care in South Africa, and the maldistribution of resources by race is well known. Little attention, however, has been given to the minutiae of the negotiation of power in the clinical setting. This article, which reports on part of a larger study of aspects of culture in South African psychiatry, focuses on interactions in ward-rounds on the 'Black side' of a South African psychiatric hospital. Through analysis of cases, the complexity of interpreting what transpires in such a setting and the central role that the concept of culture has in debates amongst staff members are demonstrated. Close analysis demonstrates the inadequacy of models which seek to locate the institutional racism of apartheid psychiatry in the motives of individual clinicians. Clinicians may simultaneously reproduce and subvert aspects of apartheid practice. A consideration of the social positioning of the clinician both as a South African and as a practitioner of psychiatry is central to the development of psychiatry in a post-apartheid South Africa. PMID:1874004
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
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
Falcone, Marco; Concia, Ercole; Giusti, Massimo; Mazzone, Antonino; Santini, Claudio; Stefani, Stefania; Violi, Francesco
Skin and soft tissue infections (SSTIs) are a common cause of hospital admission among elderly patients, and traditionally have been divided into complicated and uncomplicated SSTIs. In 2010, the FDA provided a new classification of these infections, and a new category of disease, named acute bacterial skin and skin structure infections (ABSSSIs), has been proposed as an independent clinical entity. ABSSSIs include three entities: cellulitis and erysipelas, wound infections, and major cutaneous abscesses This paper revises the epidemiology of SSTIs and ABSSSIs with regard to etiologies, diagnostic techniques, and clinical presentation in the hospital settings. Particular attention is owed to frail patients with multiple comorbidities and underlying significant disease states, hospitalized on internal medicine wards or residing in nursing homes, who appear to be at increased risk of infection due to multi-drug resistant pathogens and treatment failures. Management of ABSSSIs and SSTIs, including evaluation of the hemodynamic state, surgical intervention and treatment with appropriate antibiotic therapy are extensively discussed. PMID:27084183
Marshall, Max; Crowther, Ruth; Sledge, William Hurt; Rathbone, John; Soares-Weiser, Karla
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
Di Lorenzo, Rosaria; Miani, Fiorenza; Formicola, Vitantonio; Ferri, Paola
Background: The purpose of this study was to describe the frequency of mechanical restraint use in an acute psychiatric ward and to analyze which variables may have significantly influenced the use of this procedure. Methods: This retrospective study was conducted in the Servizio Psichiatrico di Diagnosi e Cura (SPDC) of Modena Centro. The following variables of our sample, represented by all restrained patients admitted from 1-1-2005 to 31-12-2012, were analyzed: age, gender, nationality, psychiatric diagnoses, organic comorbidity, state and duration of admission, motivation and duration of restraints, nursing shift and hospitalization day of restraint, number of patients admitted at the time of restraint and institutional changes during the observation period. The above variables were statistically compared with those of all other non-restrained patients admitted to our ward in the same period. Results: Mechanical restraints were primarily used as a safety procedure to manage aggressive behavior of male patients, during the first days of hospitalization and night shifts. Neurocognitive disorders, organic comorbidity, compulsory state and long duration of admission were statistically significantly related to the increase of restraint use (p<.001, multivariate logistic regression). Institutional changes, especially more restricted guidelines concerning restraint application, were statistically significantly related to restraint use reduction (p<.001, chi2 test, multivariate logistic regression). Conclusion: The data obtained highlight that mechanical restraint use was influenced not only by clinical factors, but mainly by staff and policy factors, which have permitted a gradual but significant reduction in the use of this procedure through a multidimensional approach. PMID:25320635
Drory, Y; Shapira, I; Goldbourt, U; Fisman, E Z; Villa, Y; Tenenbaum, A; Pines, A
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
Mosel, Krista A; Gerace, Adam; Muir-Cochrane, Eimear
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
Chiu, Chui-De; Tseng, Mei-Chih Meg; Chien, Yi-Ling; Liao, Shih-Cheng; Liu, Chih-Min; Yeh, Yei-Yu; Hwu, Hai-Gwo
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
Bjørk, Marte Helene; Sand, Trond; Bråthen, Geir; Linaker, Olav M; Morken, Gunnar; Nilsen, Brigt M; Vaaler, Arne Einar
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
Abe, Yuichiro; Nishimura, Go; Endo, Takuro
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
Bobdey, C S; Sandhu, M S; Urmil, A C; Dayakar, T
A study was conducted in a 43 bedded subacute family ward of a large hospital to find out the adequacy and efficiency of its nursing service. Activity analysis in respect of nurses was carried out by Activity Sampling Technique. The study revealed that out of 334 activities, observed, 78 (23.3%) were non-productive, whereas 256 (76.7%) were productive. Out of the productive activities, 148 (44.3%) were for direct patient care mainly comprising of 46 (31.1% for carrying out technical procedures, 36 (24.32%) for determining patients' needs, 20 (13.15%) for preparing patients for various procedures and 15 (10.14%) for assisting in technical procedures. Number wise the nurses were found to be adequate. PMID:10130935
Woo, J.; Mak, Y. T.; Lau, J.; Swaminathan, R.
The value of anthropometric and biochemical indices in predicting short-term mortality among patients in general medical wards was assessed in 294 patients admitted consecutively to a district hospital over a one month period. Using a stepwise logistic regression model and supported by the linear discriminant analysis method, mortality within 3 months could be predicted with sensitivity of 83% and specificity of 84% using the following variables: sex, functional ability, urea, total protein, alkaline phosphatase and albumin-adjusted calcium. Addition of anthropometric values and biochemical nutritional indices did little to improve the accuracy of the prediction, contrary to previous findings among surgical patients and elderly residents of long-term care institutions. PMID:1494524
Wang, Xudong; Zhang, Chao; Huang, Guangsu; Han, Dahe; Meng, Xiaoyan; Guo, Yi; Kan, Chen
The aim of the study was to investigate the therapeutic effect of chloride-restrictive fluid to prevent acute kidney injury (AKI) in cardiovascular patients in intensive care unit (ICU) wards. Between January 2013 and September 2014, 456 patients admitted to ICU wards following diagnosis of cardiovascular disease were recruited and randomized to receive chloride-rich (232 patients) or chloride-restrictive (224 patients) fluid. The baseline characteristics and incidence of Kidney Disease Improving Global Outcomes (KDIGO)-defined AKI was then compared. No significant difference was identified in the baseline characteristics between the two groups. The incidence of moderate-to-severe KDIGO-defined AKI was significantly decreased in patients who received chloride-restrictive fluid. In conclusion, chloride-restrictive may be a novel effective intervention in preventing KDIGO-defined AKI in cardiovascular patients in ICU wards.
de Vries, Meike Godelieve; Brazil, Inti Angelo; Tonkin, Matthew; Bulten, Berend Hendrik
Within this study the relationship between patient characteristics (age, length of stay, risk, psychopathy) and individual perceived ward climate (n=83), and differences between staff's and patient perceptions of climate (n=185) was investigated within a high secure forensic hospital. Results show that therapeutic hold was rated higher among staff compared to patients, while patients held a more favorable view on patient cohesion and experienced safety. Furthermore, patient characteristics (age, risk and psychopathy) were found to be related with individual ratings of ward climate. The findings underline the importance of assessing ward climate among both patients and staff in clinical practice. PMID:27256939
This study compared two acute psychiatric ward nursing regimes, focusing on ward rules as a means of investigating the relationship between the flexibility/inflexibility of the regimes and patient outcomes. Previous studies identified an association between ward rules and patient aggression. A link between absconding and nurses' attitudes towards rule enforcement has also been explored. However, an in-depth exploration of ward rules from the perspective of nurses and patients had not been undertaken previously. The study aimed to discover the content of rules within acute psychiatric wards; to explore patients' responses to the rules; to evaluate the impact of rules and rule enforcement on nurse-patient relationships and on ward events; and to investigate the relationship between ward rules, ward atmosphere and ward design. The relevance of sociological theory emerged from the data analysis. During this process, the results were moved up to another conceptual level to represent the meaning of lived experience at the level of theory. For example, nurses' descriptions of their feelings in relation to rule enforcement were merged as role ambivalence. This concept was supported by examples from the transcripts. Other possible explanations for the data and the connections between them were checked by returning to each text unit in the cluster and ensuring that it fitted with the emergent theory. The design centred on a comparative interview study of 30 patients and 30 nurses within two acute psychiatric wards in different hospitals. Non-participant observations provided a context for the interview data. Measures of the Ward Atmosphere Scale, the Hospital-Hostel Practices Profile, ward incidents and levels of as required (PRN) medication were obtained. The analysis of the quantitative data was assisted by spss, and the qualitative analysis by QSR *NUDIST. Thematic and interpretative phenomenological methods were used in the analysis of the qualitative data. A series of
Gleeson, Erica; Carryer, Jenny
Over the last 20 years significant advances in the management of pain have been made. Specifically, establishment during the 1990s of Acute Pain Services (APS) within hospitals both nationally and internationally resulted in improved awareness and management of pain. However there has been little research into staff satisfaction with the service, and no studies have been undertaken at a local hospital level. Nurses play a major role in the assessment and treatment of acute pain; therefore it is useful to determine the level of their satisfaction following introduction of APS. The purpose of the present study was to explore, by means of a survey, the level of nursing staff satisfaction with the APS in a large hospital in New Zealand (NZ). Questionnaires, predominantly quantitative in form, were distributed to 58 nursing staff who worked alongside the APS. Thirty six (62%) responded. The findings showed that while, overall, respondents were very satisfied, or satisfied with the APS, responses to open-ended section of the questionnaire brought to light areas that the researchers see as warranting further attention. PMID:20518440
Loch, Alexandre Andrade
Before psychiatry emerged as a medical discipline, hospitalizing individuals with mental disorders was more of a social stigmatizing act than a therapeutic act. After the birth of the mental health disciplines, psychiatric hospitalization was legitimized and has proven to be indispensable, preventing suicides and helping individuals in need. However, despite more than a century passing since this legitimization occurred, psychiatric hospitalization remains a controversial issue. There is the question of possible negative outcomes after a psychiatric admission ceases to take its protective effect, and even of whether the psychiatric admission itself is related to a negative setback after discharge. This review aims to summarize some of the most important negative outcomes after discharge from a psychiatric institution. These experiences were organized into two groups: those after a brief psychiatric hospitalization, and those after a long-stay admission. The author further suggests possible ways to minimize these adversities, emphasizing the need of awareness related to this important issue. PMID:24812527
Laurila, Jouko V; Pitkala, Kaisu H; Strandberg, Timo E; Tilvis, Reijo S
Detection of cognitive impairment among hospitalized older individuals has shown to be insufficient. A point prevalence study in two geriatric hospitals in Helsinki, Finland, was performed among 219 acutely ill individuals over 70 years to assess the detection of dementia and delirium. Documentation of dementia and delirium in medical records, and recordings of confusional symptoms in nurses' notes were compared with the researchers' diagnosis made after a detailed assessment of cognitive status. The cognitive decline was mentioned in medical records in 70/88 (79.5%) of the cases. Cognitive testing was performed on 42/88 (47.7%) of the dementia patients, and the diagnosis of dementia was recorded in 47/88 (53.4%) of them. A specific etiological diagnosis was recorded in only 4/88 (4.5%) cases. Cognitive impairment in at least one of these four means was recorded in 80/88 (90.9%) of cases (sensitivity 0.93). Eight patients had a false-positive diagnosis of dementia (specificity 0.94). Delirium was diagnosed in 77 (35.2%) patients by the researchers, but it was recorded in only 31/77 (40.3%) in medical records. In 64/77 (83.1%) cases signs of confusion were recorded in nurses' notes. Poor detection and documentation may lead to undertreatment of both disorders. PMID:14757300
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
Shin, Hong-Joon; Park, Cheol-Kyu; Kim, Tae-Ok; Ban, Hee-Jung; Oh, In-Jae; Kim, Yu-Il; Kwon, Yong-Soo; Kim, Young-Chul
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
Carr, Catherine; Odell-Miller, Helen; Priebe, Stefan
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
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
Stanley, Ian H; Rufino, Katrina A; Rogers, Megan L; Ellis, Thomas E; Joiner, Thomas E
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
Capri, Charlotte; Buckle, Chanellé
Background: Migrating nursing labour inadvertently reinforces South Africa's care drain, contributes to a global care crisis and forces us to reconsider migration motivation. This paper highlights issues that complicate psychiatric intellectual disability nursing care and identifies loci for change in an attempt to redress this care challenge.…
Kwak, Yee Gyung; Moon, Chisook; Kim, Eu Suk; Kim, Baek-Nam
Background Antibiotics are often administered to terminally ill patients until death, and antibiotic use contributes to the emergence of multidrug-resistant organisms (MDROs). We investigated antibiotic use and the isolation of MDROs among patients who died in general medical wards. Methods All adult patients who died in the general internal medicine wards at four acute care hospitals between January and June 2013 were enrolled. For comparison with these deceased patients, the same number of surviving, discharged patients was selected from the same divisions of internal medicine subspecialties during the same period. Results During the study period, 303 deceased patients were enrolled; among them, 265 (87.5%) had do-not-resuscitate (DNR) orders in their medical records. Antibiotic use was more common in patients who died than in those who survived (87.5% vs. 65.7%, P<0.001). Among deceased patients with DNR orders, antibiotic use was continued in 59.6% of patients after obtaining their DNR orders. Deceased patients received more antibiotic therapy courses (two [interquartile range (IQR) 1–3] vs. one [IQR 0–2], P<0.001). Antibiotics were used for longer durations in deceased patients than in surviving patients (13 [IQR 5–23] vs. seven days [IQR 0–18], P<0.001). MDROs were also more common in deceased patients than in surviving patients (25.7% vs. 10.6%, P<0.001). Conclusions Patients who died in the general medical wards of acute care hospitals were exposed to more antibiotics than patients who survived. In particular, antibiotic prescription was common even after obtaining DNR orders in patients who died. The isolation of MDROs during the hospital stay was more common in these patients who died. Strategies for judicious antibiotic use and appropriate infection control should be applied to these patient populations. PMID:26761461
Veltri, Carlo O C; Graham, John R; Sellbom, Martin; Ben-Porath, Yossef S; Forbey, Johnathan D; O'Connell, Carol; Rogers, Robert; White, Robert S
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
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
Vance, M V; Curry, S C; Bradley, J M; Kunkel, D B; Gerkin, R D; Bond, G R
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
Hanrahan, Nancy P.; Aiken, Linda H.; McClaine, Lakeetra; Hanlon, Alexandra L
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
Delivering dementia care differently—evaluating the differences and similarities between a specialist medical and mental health unit and standard acute care wards: a qualitative study of family carers’ perceptions of quality of care
Spencer, Karen; Foster, Pippa; Whittamore, Kathy H; Goldberg, Sarah E; Harwood, Rowan H
Objectives To examine in depth carers’ views and experiences of the delivery of patient care for people with dementia or delirium in an acute general hospital, in order to evaluate a specialist Medical and Mental Health Unit (MMHU) compared with standard hospital wards. This qualitative study complemented the quantitative findings of a randomised controlled trial. Design Qualitative semistructured interviews were conducted with carers of patients with cognitive impairment admitted to hospital over a 4-month period. Setting A specialist MMHU was developed in an English National Health Service acute hospital aiming to deliver the best-practice care. Specialist mental health staff were integrated with the ward team. All staff received enhanced training in dementia, delirium and person-centred care. A programme of purposeful therapeutic and leisure activities was introduced. The ward environment was optimised to improve patient orientation and independence. A proactive and inclusive approach to family carers was encouraged. Participants 40 carers who had been recruited to a randomised controlled trial comparing the MMHU with standard wards. Results The main themes identified related closely to family carers’ met or unmet expectations and included activities and boredom, staff knowledge, dignity and fundamental care, the ward environment and communication between staff and carers. Carers from MMHU were aware of, and appreciated, improvements relating to activities, the ward environment and staff knowledge and skill in the appropriate management of dementia and delirium. However, communication and engagement of family carers were still perceived as insufficient. Conclusions Our data demonstrate the extent to which the MMHU succeeded in its goal of providing the best-practice care and improving carer experience, and where deficiencies remained. Neither setting was perceived as neither wholly good nor wholly bad; however, greater satisfaction (and less dissatisfaction
Prohovnik, I.; Alderson, P.O.; Sackheim, H.A.; Decina, P.; Kahn, D.
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.
Yalcinsoy, Murat; Salturk, Cuneyt; Oztas, Selahattin; Gungor, Sinem; Ozmen, Ipek; Kabadayi, Feyyaz; Oztim, Aysem Askim; Aksoy, Emine; Adıguzel, Nalan; Oruc, Ozlem; Karakurt, Zuhal
Purpose Noninvasive mechanical ventilation (NIMV) usage outside of intensive care unit is not recommended in patients with COPD for severe acute respiratory failure (ARF). We assessed the factors associated with failure of NIMV in patients with ARF and severe acidosis admitted to the emergency department and followed on respiratory ward. Patients and methods This is a retrospective observational cohort study conducted in a tertiary teaching hospital specialized in chest diseases and thoracic surgery between June 1, 2013 and May 31, 2014. COPD patients who were admitted to our emergency department due to ARF were included. Patients were grouped according to the severity of acidosis into two groups: group 1 (pH=7.20–7.25) and group 2 (pH=7.26–7.30). Results Group 1 included 59 patients (mean age: 70±10 years, 30.5% female) and group 2 included 171 patients (mean age: 67±11 years, 28.7% female). On multivariable analysis, partial arterial oxygen pressure to the inspired fractionated oxygen (PaO2/FiO2) ratio <200, delta pH value <0.30, and pH value <7.31 on control arterial blood gas after NIMV in the emergency room and peak C-reactive protein were found to be the risk factors for NIMV failure in COPD patients with ARF in the ward. Conclusion NIMV is effective not only in mild respiratory failure but also with severe forms of COPD patients presenting with severe exacerbation. The determination of the failure criteria of NIMV and the expertise of the team is critical for treatment success. PMID:27330283
Dratcu, Luiz; McKay, Gavin; Singaravelu, Vinod; Krishnamurthy, Venkat
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
Heydari, Behrooz; Khalili, Hossein; Karimzadeh, Iman; Emadi-Kochak, Hamid
In this study demographic, clinical, paraclinical, microbiological, and therapeutic features of patients with community-acquired acute bacterial meningitis admitted to a referral center for infectious diseases in Iran, have been evaluated. Medical records of adult (> 18 years) individuals with confirmed diagnosis of community-acquired bacterial meningitis during a 4-year period were retrospectively reviewed. All required data were obtained from patients' medical charts. Available findings about antimicrobial susceptibility of isolated bacteria from CSF and/or blood were also collected. Kirby-Bauer disc diffusion method was used to determine their antimicrobial susceptibility profile. Details of medical management including antibiotic regimen, duration, patients' outcome, and possible sequelae of meningitis were recorded. The most commonly isolated microorganism from CSF or blood of patients was Streptococcus pneumonia (33.33%) followed by Neisseria meningitidis (27.78%) and Haemophilus influenza (16.67%). The most common antimicrobial regimen was ceftriaxone plus vancomycin (69.44%) followed by ceftriaxone plus vancomycin plus ampicillin (11.11%). Neurological sequelae of meningitis including cranial nerve palsy, deafness, and hemiparesis were identified in 4 (11.11%), 2 (5.56%), and 1 (2.78%) subjects, respectively. Regarding mortality, only 3 (8.33%) patients died from bacterial meningitis and the remaining 33 individuals discharged from the hospital. In conclusion, findings of the current study demonstrated that the mean incidence of acute bacterial meningitis in a referral infectious diseases ward in Iran was 9 episodes per year. The majority cases of community-acquired acute bacterial meningitis admitted to our center had negative CSF culture and classic triad of meningitis was absent in them. PMID:27610176
Heydari, Behrooz; Khalili, Hossein; Karimzadeh, Iman; Emadi-Kochak, Hamid
In this study demographic, clinical, paraclinical, microbiological, and therapeutic features of patients with community-acquired acute bacterial meningitis admitted to a referral center for infectious diseases in Iran, have been evaluated. Medical records of adult (> 18 years) individuals with confirmed diagnosis of community-acquired bacterial meningitis during a 4-year period were retrospectively reviewed. All required data were obtained from patients’ medical charts. Available findings about antimicrobial susceptibility of isolated bacteria from CSF and/or blood were also collected. Kirby-Bauer disc diffusion method was used to determine their antimicrobial susceptibility profile. Details of medical management including antibiotic regimen, duration, patients’ outcome, and possible sequelae of meningitis were recorded. The most commonly isolated microorganism from CSF or blood of patients was Streptococcus pneumonia (33.33%) followed by Neisseria meningitidis (27.78%) and Haemophilus influenza (16.67%). The most common antimicrobial regimen was ceftriaxone plus vancomycin (69.44%) followed by ceftriaxone plus vancomycin plus ampicillin (11.11%). Neurological sequelae of meningitis including cranial nerve palsy, deafness, and hemiparesis were identified in 4 (11.11%), 2 (5.56%), and 1 (2.78%) subjects, respectively. Regarding mortality, only 3 (8.33%) patients died from bacterial meningitis and the remaining 33 individuals discharged from the hospital. In conclusion, findings of the current study demonstrated that the mean incidence of acute bacterial meningitis in a referral infectious diseases ward in Iran was 9 episodes per year. The majority cases of community-acquired acute bacterial meningitis admitted to our center had negative CSF culture and classic triad of meningitis was absent in them. PMID:27610176
Gray, Debra; Ross, Kirsty; Prat-Sala, Merce; Kibble, Sharon; Harden, Beverley
Previous research has highlighted that acute care provision can lead to a loss of confidence, control, and independent functioning in older adult patients. In addition, it is recognized that interactions between patients and health care staff are central to the prevention of functional decline in patients. In this study, we aimed to affect the staff-patient relationship by implementing a coaching intervention in an older adult acute care setting. Here, we report on staff experiences of this coaching approach. Data were collected from 16 members of staff via semi-structured interviews, which were analyzed using thematic analysis. Four themes were identified: Putting a Label on It, Stepping Back and Listening, Identifying the Opportunities, and Working as Team. Our findings show that a coaching approach can be successful in getting staff to reconsider their interactions with patients and to focus on strategies that foster the independence and autonomy of older adult patients. PMID:26481943
Guinchat, Vincent; Cravero, Cora; Diaz, Lautaro; Périsse, Didier; Xavier, Jean; Amiet, Claire; Gourfinkel-An, Isabelle; Bodeau, Nicolas; Wachtel, Lee; Cohen, David; Consoli, Angèle
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
Geddes, J R; Game, D; Jenkins, N E; Peterson, L A; Pottinger, G R; Sackett, D L
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
Sullivan, P J
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
Lotan, Itay; Fireman, Liora; Benninger, Felix; Weizman, Abraham; Steiner, Israel
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
Burton, M Caroline; Warren, Mark; Cha, Stephen S; Stevens, Maria; Blommer, Megan; Kung, Simon; Lapid, Maria I
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
van der Merwe, M; Bowers, L; Jones, J; Simpson, A; Haglund, K
Many acute inpatient psychiatric wards in the UK are permanently locked, although this is contrary to the current Mental Health Act Code of Practice. To conduct a literature review of empirical articles concerning locked doors in acute psychiatric inpatient wards, an extensive literature search was performed in SAGE Journals Online, EBM Reviews, British Nursing Index, CINAHL, EMBASE Psychiatry, International Bibliography of the Social Sciences, Ovid MEDLINE, PsycINFO and Google, using the search terms 'open$', 'close$', '$lock$', 'door', 'ward', 'hospital', 'psychiatr', 'mental health', 'inpatient' and 'asylum'. A total of 11 empirical papers were included in the review. Both staff and patients reported advantages (e.g. preventing illegal substances from entering the ward and preventing patients from absconding and harming themselves or others) and disadvantages (e.g. making patients feel depressed, confined and creating extra work for staff) regarding locked doors. Locked wards were associated with increased patient aggression, poorer satisfaction with treatment and more severe symptoms. The limited literature available showed the urgent need for research to determine the real effects of locked doors in inpatient psychiatry. PMID:19291159
Weller, Jennifer; Levitt, Gwen; Myers, Robert; Riley, Aaron; Gesmundo, Celsius-Kit
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
'You're kidding,' I thought, having just realised the special care baby unit where I intended to work was next to the ward where they performed terminations of pregnancy. To make matters worse, women who had miscarried were on the same ward. PMID:26982847
Youkilis, Hildreth D.; Bootzin, Richard R.
Examines the longitudinal relationship between internal-external locus of control and adjustment using independent measures within two dissimilar treatment environments: a traditional ward and a token economy ward. Subjects were 65 female psychiatric inpatients. (CM)
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
Wheat, Santina; Dschida, Dorothy; Talen, Mary R
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
Walton, Victoria; Hogden, Anne; Johnson, Julie; Greenfield, David
Purpose - The purpose of this paper is to classify and describe the purpose of ward rounds, who attends each round and their role, and participants' perception of each other's role during the respective ward rounds. Design/methodology/approach - A literature review of face-to-face ward rounds in medical wards was conducted. Peer reviewed journals and government publications published between 2000 and 2014 were searched. Articles were classified according to the type of round described in the study. Purposes were identified using keywords in the description of why the round was carried out. Descriptions of tasks and interactions with team members defined participant roles. Findings - Eight round classifications were identified. The most common were the generalised ward; multidisciplinary; and consultant rounds. Multidisciplinary rounds were the most collaborative round. Medical officers were the most likely discipline to attend any round. There was limited reference to allied health clinicians and patient involvement on rounds. Perceptions attendees held of each other reiterated the need to continue to investigate teamwork. Practical implications - A collaborative approach to care planning can occur by ensuring clinicians and patients are aware of different ward round processes and their role in them. Originality/value - Analysis fulfils a gap in the literature by identifying and analysing the different ward rounds being undertaken in acute medical wards. It identifies the complexities in the long established routine hospital processes of the ward round. PMID:27142947
Coombs, M A; Nelson, K; Psirides, A J; Suter, N; Pedersen, A
A third of patients reviewed by rapid response teams (RRT) require end-of-life care. However, little is known about the characteristics and management of these patients following RRT review. This paper presents results of a retrospective, descriptive audit that explored the dying trajectory of adult ward inpatients who died outside of intensive care following RRT review. The study setting was a 430-bed tertiary New Zealand hospital during 2013. RRT, inpatient databases and hospital notes were used to identify 100 consecutive adult inpatients who died subsequent to RRT review. Outcome measures included time from RRT review to death, place of death, pre-existing co-morbidities and frequency of medical review. Results demonstrated that patients were old (median 77 years, IQR 63-85years), emergency admissions (n=100) and admitted under a medical specialty (n=71). All but one of the cohort had pre-existing co-morbidities (mean 3.2, SD 1.7), almost a third (n=31) had cancer and 51% had 1-4 previous inpatient admissions within the previous 12 months. The mean length of stay prior to RRT review was 4.9 days (SD 5.5) during which patients were frequently reviewed by senior medical staff (mean 6.8 times, SD 6.9, range 0-44). Twenty per cent of patients died after their first RRT review with a further 40% receiving treatment limitation/palliation. Fifty-two per cent of patients had a pre-existing DNAR. Eighty per cent of patients died in hospital. Whilst the RRT fulfils an unmet need in decision-making at end of life, there is a need to understand what RRT, instead of ward-based or palliative care teams, offers dying patients. PMID:27029659
With the development of community care, the number of National Health Service psychiatric beds in England has been reduced to between one-fifth and one-quarter of those provided in the mid-1950s. Psychiatric bed numbers are close to the irreducible minimum if they have not already reached it. The problems facing today's acute psychiatric admission wards include: poor design, maintenance and ambience; a lack of therapeutic and leisure activities for patients leading to inactivity and boredom; frequent incidents of aggression and low-level violence and problems with staffing. It is suggested that there are a number of underlying causes: First, there has been failure to plan inpatient services, or to define their role, as attention has focused on new developments in community care. Second, the reduction in bed numbers has led to a change in the casemix of inpatients with a concentration on admission wards of a more challenging group of patients. Third, admission ward environments are permeable to the adverse effects of local street life, including drug taking. After years of neglect, acute inpatient psychiatric services in England are now high on the UK Government agenda. The paper lists a number of national initiatives designed to improve their quality and safety. A recent review of qualitative research suggests that acute psychiatric wards in other countries face similar problems to those reported in England. It is suggested that there might be a need for joint action which might take the form either of international research about acute inpatient care or the development of international standards and a common quality improvement system. PMID:16865927
Silverman, Michael J
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
Greenfield, Thomas K; Stoneking, Beth C; Humphreys, Keith; Sundby, Evan; Bond, Jason
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
Creighton, F J; Hyde, C E; Farragher, B
Of 24 residents of a ten-bed, community-based hostel ward suffering chronic psychiatric illness, nine have been resettled in the community, with four more expected to follow them. Five residents have made Douglas House their home but another six have manifested behavioural disturbance necessitating return to hospital wards. We found community discharge to be associated with illnesses having good prognostic features, while organic illness militated against such placement. Indicators of a prior history of behavioural disturbance seem to predict difficulties in managing a patient in this environment. PMID:1751859
Hamilton, Bridget; Manias, Elizabeth
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
Singh, Ranbir; Verdolini, Norma; Agius, Mark; Moretti, Patrizia; Quartesan, Roberto
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
Berger, D M
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
Davydow, Dimitry S.; Hough, Catherine L.; Zatzick, Douglas; Katon, Wayne J.
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
15. New York Connecting Railroad: Wards Island Viaduct. Wards Island, New York Co., NY. Sec. 4207, MP 7.65. - Northeast Railroad Corridor, Amtrak Route between New Jersey/New York & New York/Connecticut State Lines, New York County, NY
Powell, Natalie; Bruce, Christopher G; Redfern, Oliver
Ward rounds are a vital part of hospital medicine and junior doctors play a key role in their delivery. Despite the importance of ward rounds to patient care and experience, we believe that junior doctors may lack the training and skills to carry them out most effectively. We designed a simulation-based training session focusing on ward round skills themed to key patient safety issues and have delivered the training to over 100 learners (medical students and foundation year one doctors). Few learners had any prior training in ward rounds. The session was highly valued by all participants and surveys completed both before and after the session showed statistically significant improvements in confidence in leading and documenting ward rounds. In addition, 94% of final year medical students and 93% of doctors felt such training should be included in the undergraduate curriculum. We believe there is a current gap in training around ward round skills and would strongly encourage simulation-based ward round training to be developed for undergraduates. Further sessions following qualification may then consolidate and develop ward round skills adapted to the level of the doctor. PMID:25824064
Ranieri, Veronica; Madigan, Kevin; Roche, Eric; Bainbridge, Emma; McGuinness, David; Tierney, Kevin; Feeney, Larkin; Hallahan, Brian; McDonald, Colm; O'Donoghue, Brian
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
Abbondanza, D M; Puskar, K R; Wilkinson, B; Welch, C; Rudert, S; Gallippi, B
Clients in long-term facilities carry a wide array of psychiatric diagnoses, often with equally diverse medical problems. This "back ward" population requires a specialized area of psychiatric mental health nursing practice. The need for comprehensive assessment and adequate interventions, and the various frustrations of nursing staff, are discussed using a case example. PMID:7862514
Chisti, Mohammod Jobayer; Salam, Mohammed Abdus; Ashraf, Hasan; Faruque, Abu S. G.; Bardhan, Pradip Kumar; Hossain, Md Iqbal; Shahid, Abu S. M. S. B.; Shahunja, K. M.; Das, Sumon Kumar; Imran, Gazi; Ahmed, Tahmeed
Background Risks of death are high when children with pneumonia also have severe acute malnutrition (SAM) as a co-morbidity. However, there is limited published information on risk factors of death from pneumonia in SAM children. We evaluated clinically identifiable factors associated with death in under-five children who were hospitalized for the management of pneumonia and SAM. Methods For this unmatched case-control design, SAM children of either sex, aged 0–59 months, admitted to the Dhaka Hospital of the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) during April 2011 to July 2012 with radiological pneumonia were studied. The SAM children with pneumonia who had fatal outcome constituted the cases (n = 35), and randomly selected SAM children with pneumonia who survived constituted controls (n = 105). Results The median (inter-quartile range) age (months) was comparable among the cases and the controls [8.0 (4.9, 11.0) vs. 9.7 (5.0, 18.0); p = 0.210)]. In logistic regression analysis, after adjusting for potential confounders, such as vomiting, abnormal mental status, and systolic hypotension (<70 mm of Hg) in absence of dehydration, fatal cases of severely malnourished under-five children with pneumonia were more often hypoxemic (OR = 23.15, 95% CI = 4.38–122.42), had clinical dehydration (some/severe) (OR = 9.48, 95% CI = 2.42–37.19), abdominal distension at admission (OR = 4.41, 95% CI = 1.12–16.52), and received blood transfusion (OR = 5.50, 95% CI = 1.21–24.99) for the management of crystalloid resistant systolic hypotension. Conclusion and Significance We identified hypoxemia, clinical dehydration, and abdominal distension as the independent predictors of death in SAM children with pneumonia. SAM children with pneumonia who required blood transfusion for the management of crystalloid resistant systolic hypotension were also at risk for death. Thus, early identification and
Hayes, Joseph; Gibbons, Rachel; Outim, Faizal; Tang, Sylvia; Chakraborty, Apu
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
Gerace, Adam; Mosel, Krista; Oster, Candice; Muir-Cochrane, Eimear
Restraint of older persons in inpatient and residential care is used to control aggression, and prevent falls and other adverse outcomes. Initiatives to reduce these practices are being implemented worldwide. However, there has been little examination of restraint practice in psychiatric services for older persons. This paper reports a retrospective comparative analysis of restraint use in three acute and two extended care psychiatric inpatient wards in Australia. The analysis involved examination of restraint incidents and comparison of restrained and non-restrained patients. There was significant variation in restraint use between wards. On one acute ward, 12.74% of patients were restrained, although restraint use declined during the data collection period. Patients with dementia were restrained at higher rates than patients with other diagnoses, and restrained patients stayed in hospital for a longer duration. Restraint occurred early in admission, and few differences emerged between those restrained once or multiple times. Mechanical restraint was more prevalent than physical restraint, with restraint predominantly used to manage aggression and falls. Findings provide new data on restraint in older persons' psychiatric services. Greater conceptual understandings of behaviours associated with dementia and the unique needs of patients with these disorders may assist in reducing restraint use in these settings. PMID:23009335
Gunnell, D. J.; Peters, T. J.; Kammerling, R. M.; Brooks, J.
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
Noblett, Joanne; Roberts, Emmert
A 66-year-old Caucasian man was admitted to an acute psychiatric ward under section 2 of the Mental Health Act after presenting with auditory hallucinations and partition delusions. He had been known to mental health services since 2005 but had never been treated with psychotropic medication or given a formal psychiatric diagnosis. He was also diagnosed with hypopituitarism of unknown aetiology in 2002. In light of this presentation, his medical history was reviewed in full, hormone levels and a full delirium screen including blood borne virus and syphilis serology was completed to ensure no organic cause had been missed. The treponemal antibody was positive, and he reported no previous syphilis treatment, as such a diagnosis of neurosyphilis was performed. This case demonstrates a patient presenting with two potential complications of syphilis; psychosis and hypopituitarism where screening for this infection had not been previously considered. PMID:25716037
Höglund, Pontus; Levander, Sten; Anckarsäter, Henrik; Radovic, Susanna
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
Khankeh, Hamidreza; Khorasani-Zavareh, Davoud; Hoseini, Seyaid-Ali; Khodai-Ardekandi, Mohammad-Reza; Ekman, Sirkka-Liisa; Bohm, Katarina; Nakhaie, Maryam; Ranjbar, Maryam; Castrén, Maaret
Background: Understanding how novice nurses perceive their career in the psychiatric ward can be helpful for nurse educators and managers to gain insight into psychiatric nursing care and adding applicable knowledge to the development of support strategies for this group. The aim of this study was to describe and illuminate experiences of new graduated nurses working at a psychiatric ward in an Iranian context. Materials and Methods: A descriptive phenomenology has been chosen. Participants with baccalaureate degrees in nursing were selected purposefully and they all had less than 6 months of work experience in psychiatric wards beforehand. The study was conducted at the Razi Hospital in Iran. Data were collected through unstructured individual in-depth interviews and analyzed according to the Colaizzi method by means of Husserlian phenomenology. Results: Three main themes were found in this study, of which six sub-themes were constructed as follows: Being in the world of fear and complaint, which has been abstracted by having mixed feelings of conflict and compliant on entry to the psychiatric ward, doubt about adequacy of being a psychiatric nurse and working in psychiatric ward and a frightening and non-supportive environment; A sense of imprisoned and confined, which has been constructed by different experience with different environmental milieu in psychiatric ward, as a lock sense; Becoming a psychiatric nurse, which has been constructed as a sense of usefulness, a sense of sympathy and compassion for patients and a sense of professional identity. Conclusions: This study identified areas that require modification by providing insight into lived experiences of beginners’ nurses as the value in psychiatric ward. New graduated nurses may face negative perceptions and feelings due to confrontation with a new environment, patients and colleagues as well as shortcomings in the preparation. PMID:25183982
Williamson, David J.; May, Roberta S.; Bruer, Emily H.; Sheehan, David V.; Alphs, Larry D.
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
Krumm, Silvia; Kilian, Reinhold; Becker, Thomas
There is an increasing awareness of gender-related issues in psychiatry. However, empirical findings on attitudes of psychiatric staff towards patient gender are limited. Gender-related issues are particularly relevant in the debate about mixed versus segregated sex wards, yet while the appropriateness of mixed-sex wards is questioned in Great Britain this is not the case in Germany. To investigate attitudes of psychiatric staff towards both patient gender and mixed versus segregated sex wards, we conducted a case study using focus groups with members of professional teams. We evaluated the transition process from two single-sex wards to two mixed-sex wards in a 330-bed psychiatric hospital in a rural area in south Germany. Staff described female patients as more externally oriented, motivating of others, demanding, and even sexually aggressive. Male patients, on the other hand, were described as more quiet, modest, or lazy. Furthermore, participants described the mixing process as a positive development whereas they did not see a need for gender-separated wards in order to protect vulnerable female patients. Some gender descriptions by professionals are "reversed" in comparison with gender stereotypes supposed to be present in wider society. The perception of crossed gender norms may affect staff attitudes towards the vulnerability of female patients in psychiatric settings and the provision of single-sex wards in in-patient psychiatric care. Practical implications are discussed against the background of a high rate of female patients with sexual abuse histories. PMID:16157434
Di Lorenzo, Rosaria; Cimino, Nina; Di Pietro, Elena; Pollutri, Gabriella; Neviani, Vittoria; Ferri, Paola
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
Brown, Juliette; Fawzi, Waleed; McCarthy, Cathy; Stevenson, Carmel; Kwesi, Solomon; Joyce, Maggie; Dusoye, Jenny; Mohamudbucus, Yasin; Shah, Amar
Through the Safer Wards project we aimed to reduce the number of incidents of physical violence on older people's mental health wards. This was done using quality improvement methods and supported by the Trust's extensive programme of quality improvement, including training provided by the Institute for Healthcare Improvement. Violence can be an indicator of unmet needs in this patient population, with a negative effect on patient care and staff morale. Reducing harm to patients and staff is a strategic aim of our Trust. We established a multi-disciplinary group who led on the project on each ward and used a Pareto diagram to establish the focus of our work. We established a dashboard of measures based on our incident reporting system Datix, including number of incidents of violence, days between incidents, days of staff sickness, days between staff injury, use of restraint, and use of rapid tranquilisation (the last two being balancing measures in the reduction of violence). Each team identified factors driving physical violence on the wards, under headings of unmet patient needs, staff needs and staff awareness, which included lack of activity and a safe and therapeutic environment. Using driver diagrams, we identified change ideas that included hourly rounding (proactive checks on patient well-being), the addition of sensory rooms, flexible leave for patients, and a structured activity programme. We also introduced exercise to music, therapeutic groups led by patients, and focused on discharge planning and pet therapy, each of which starting sequentially over the course of a one year period from late 2013 and subject to a cycle of iterative learning using PDSA methods. The specific aim was a 20% decrease in violent incidents on three wards in City and Hackney, and Newham. Following our interventions, days between violent incidents increased from an average of three to an average of six. Days between staff injury due to physical violence rose from an average of
Brown, Juliette; Fawzi, Waleed; McCarthy, Cathy; Stevenson, Carmel; Kwesi, Solomon; Joyce, Maggie; Dusoye, Jenny; Mohamudbucus, Yasin; Shah, Amar
Through the Safer Wards project we aimed to reduce the number of incidents of physical violence on older people's mental health wards. This was done using quality improvement methods and supported by the Trust's extensive programme of quality improvement, including training provided by the Institute for Healthcare Improvement. Violence can be an indicator of unmet needs in this patient population, with a negative effect on patient care and staff morale. Reducing harm to patients and staff is a strategic aim of our Trust. We established a multi-disciplinary group who led on the project on each ward and used a Pareto diagram to establish the focus of our work. We established a dashboard of measures based on our incident reporting system Datix, including number of incidents of violence, days between incidents, days of staff sickness, days between staff injury, use of restraint, and use of rapid tranquilisation (the last two being balancing measures in the reduction of violence). Each team identified factors driving physical violence on the wards, under headings of unmet patient needs, staff needs and staff awareness, which included lack of activity and a safe and therapeutic environment. Using driver diagrams, we identified change ideas that included hourly rounding (proactive checks on patient well-being), the addition of sensory rooms, flexible leave for patients, and a structured activity programme. We also introduced exercise to music, therapeutic groups led by patients, and focused on discharge planning and pet therapy, each of which starting sequentially over the course of a one year period from late 2013 and subject to a cycle of iterative learning using PDSA methods. The specific aim was a 20% decrease in violent incidents on three wards in City and Hackney, and Newham. Following our interventions, days between violent incidents increased from an average of three to an average of six. Days between staff injury due to physical violence rose from an average of
Struble, Laura M; Sullivan, Barbara J; Hartman, Laurie S
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
... Protections for Children Involved as Subjects in Research § 46.409 Wards. (a) Children who are wards of the state or any other agency, institution, or entity can be included in research approved under § 46.406 or § 46.407 only if such research is: (1) Related to their status as wards; or (2) Conducted in...
White, Donald E
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
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
Valevski, Avi; Ratzoni, Gideon; Sever, Jonathan; Apter, Alan; Zalsman, Gil; Shiloh, Roni; Weizman, Abraham; Tyano, Sam
Outcome according to diagnosis and stability of diagnosis were investigated in a follow-back study, with a duration of 15-19 years, of 351 adolescents with various psychiatric disorders hospitalized in a closed psychiatric ward. Findings indicated that transient adolescent psychosis is associated with a relatively good prognosis and should…
Cavanaugh, S V
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
Cameron, Ian D; Kurrle, Susan
Geriatric consultation teams are one of the models for bringing comprehensive geriatric assessment to vulnerable and frail older people in the acute care hospital setting. While ward-based comprehensive geriatric assessment has been established as effective with reference to improving functional status and other outcomes, the team-based variant remains unproven for outcomes other than mortality in the medium term, as shown in a recent study published in BMC Medicine by Deschodt and colleagues. Further research might establish the effectiveness of the team-based model but, for current clinical practice, the emphasis should be on streaming older people with complex problems needing multidisciplinary assessment and treatment to ward-based models of comprehensive geriatric assessment. PMID:23433506
Brandejs, J. F.
After many years of extensive research of computerized information systems for nursing, inpatient care, clinics and HMOs, laboratories, diagnostic imaging, pharmacy and other services, an integrated Ward Patient Management system was developed. A mature, relational data base management system (RDBMS) ORACLE was selected as the design tool. The system is running under VMS, DOS and UNIX operating systems and ORACLE version 6 on nearly all computer platforms, although multiprocessors are preferred. A host of potentials and pitfalls is associated with the implementation of this new approach to Patient Management. PMID:1807662
Testa, A; Giannuzzi, R; Sollazzo, F; Petrongolo, L; Bernardini, L; Daini, S
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
Ward, Ryan D; Winiger, Vanessa; Higa, Kerin K; Kahn, Julia B; Kandel, Eric R; Balsam, Peter D; Simpson, Eleanor H
Reports an error in "The impact of motivation on cognitive performance in an animal model of the negative and cognitive symptoms of schizophrenia" by Ryan D. Ward, Vanessa Winiger, Kerin K. Higa, Julia B. Kahn, Eric R. Kandel, Peter D. Balsam and Eleanor H. Simpson (Behavioral Neuroscience, 2015[Jun], Vol 129, 292-299). There is a text error in the 4th paragraph of the Discussion section. The explanation for the abbreviation OFC was incorrectly listed as occipitofrontal circumference. It should have been orbitofrontal cortex. (The following abstract of the original article appeared in record 2015-18639-001.) Interactions between motivation and cognition are implicated in producing functional impairments and poor quality of life in psychiatric patients. This interaction, however, is not well understood at either the behavioral or neural level. We developed a procedure for mice in which a cognitive measure, sustained attention, is modulated by a motivationally relevant signal that predicts reward probability on a trial-by-trial basis. Using this paradigm, we tested the interaction between motivation and cognition in mice that model the increased striatal D2 receptor activity observed in schizophrenia patients (D2R-OE mice). In control mice, attention was modulated by signaled-reward probability. In D2R-OE mice, however, attention was not modulated by reward-related cues. This impairment was not due to any global deficits in attention or maintenance of the trial-specific information in working memory. Turning off the transgene in D2R-OE mice rescued the motivational modulation of attention. These results indicate that deficits in motivation impair the ability to use reward-related cues to recruit attention and that improving motivation improves functional cognitive performance. These results further suggest that addressing motivational impairments in patients is critical to achieving substantive cognitive and functional gains. PMID:26214211
Kobayashi, Masayoshi; Fukushmima, Sachie; Kawano, Koujiro; Ohnishi, Ayumi; Ogiwara, Tomomi; Hagiwara, Tetsuya; Takahashi, Toru; Washizuka, Shinsuke; Amano, Naoji
This report describes psychiatric occupational therapy practice and collaboration between occupational therapists and psychiatrists at Shinshu University Hospital. Collaboration with psychiatrists enables us to provide the following occupational therapy programs. (1) Individual occupational therapy approaches for patients at the early recovery stage in the psychiatric ward. (2) Psychoeducational interventions by a multi-disciplinary team (MDs, nurses, OTRs, PSWs, CPs). (3) Occupational therapy approaches used in combination with m-ECT for severe psychiatric disorders. (4) Recovery support programs for psychiatric outpatients. It is suggested that occupational therapists should collaborate with psychiatrists in order to facilitate rehabilitation services for people with psychiatric disorders. PMID:21591406
... Are Subjects in Research § 97.409 Wards. (a) Children who are wards of the State or any other agency, institution, or entity may be included in research approved under § 97.406 or § 97.407 only if that research... research is approved under paragraph (a) of this section, the IRB shall require appointment of an...
Silverman, Michael J.
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…
PHOTOCOPY OF A 1942 ARCHITECTURAL DRAWING TITLED: "STANDARD WARD, WARD-J-H. FLOOR, FOUNDATION AND FRAMING PLANS." OCTOBER 31, 1942. - Madigan Hospital, Standard & Combination Wards, Bounded by Wilson & McKinley Avenues & Garfield & Lincoln Streets, Tacoma, Pierce County, WA
Sonesson, Ove; Arvidsson, Hans; Tjus, Tomas
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
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
Sollberger, D; Lang, U E
Despite the reform efforts of the last decades modern acute psychiatry still stands between conflicting priorities in everyday practice. The protection of patient autonomy might conflict with a regulatory mandate of psychiatry in societal contexts and the necessity of coercive measures and involuntary treatment might become problematic with respect to presumed but contentious interests of the patient. The conflicts particularly concern questions of involuntary commitment, door closing, coercive and isolation measures. Research on the topic of therapeutic effectiveness of these practices is rare. Accordingly, the practice depends on the federal state, hospital and ward and is very heterogeneous. Epidemiological prognosis predicts an increase of psychiatric disorders; however, simultaneously in terms of medical ethics the warranty of patient autonomy, shared decision-making and informed consent in psychiatry become increasingly more important. This challenges structural and practical changes in psychiatry, particularly in situations of self and third party endangerment which are outlined and a rationale for an opening of the doors in acute psychiatric wards is provided. PMID:23538944
Sengul, Melike Ceyhan Balci; Kenar, Ayse Nur Inci; Hanci, Ezgi; Sendur, İbrahim; Sengul, Cem; Herken, Hasan
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
Shahid, Muhammad; Khan, Muhammad Zaman; Ejaz, Kiran; Nakeer, Rooham; Iftikhar, Sundus
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
Clemens, Elysia V.; Welfare, Laura E.; Williams, Amy M.
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…
Jaeger, Matthias; Briner, David; Kawohl, Wolfram; Seifritz, Erich; Baumgartner-Nietlisbach, Gabriela
Individuals with severe mental illness frequently have difficulties in obtaining and maintaining adequate accommodation. If they are not willing or able to adapt to requirements of traditional supported housing institutions they may live in sheltered and emergency accommodation. Adequate mental health services are rarely available in these facilities. The aim of the present study was to evaluate mental health, functional and social status of individuals living in community sheltered housing facilities. A cross-sectional survey of n=338 individuals in sheltered housing compared to a sample of patients at intake in acute inpatient psychiatry (n=619) concerning clinical and social variables was carried out in the catchment area of Zurich. Matched subsamples of individuals with schizophrenia (n=168) were compared concerning functioning and impairments on the Health of the Nation Outcome Scales (HoNOS). Individuals with schizophrenia in sheltered housing (25% of the residents) have significantly more problems concerning substance use, physical illness, psychopathological symptoms other than psychosis and depression, and relationships, daily activities and occupation than patients with schizophrenia at intake on an acute psychiatric ward. Community sheltered accommodation although conceptualized to prevent homelessness in the general population de facto serve as housing facilities for individuals with schizophrenia and other severe mental illness. PMID:26416587
Lewis, Geraint; Wright, Lorraine; Vaithianathan, Rhema
Virtual wards are a model for delivering multidisciplinary case management to people who are at high predicted risk of unplanned acute care hospitalization. First introduced in Croydon, England, in 2006, this concept has since been adopted and adapted by health care organizations in other parts of the United Kingdom and internationally. In this article, the authors review the model of virtual wards as originally described-with its twin pillars of (1) using a predictive model to identify people who are at high risk of future emergency hospitalization, and (2) offering these individuals a period of intensive, multidisciplinary preventive care at home using the systems, staffing, and daily routines of a hospital ward. The authors then describe how virtual wards have been modified and implemented in 6 sites in the United Kingdom, United States, and Canada where they are subject to formal evaluation. Like hospital wards, virtual wards vary in terms of patient selection, ward configuration, staff composition, and ward processes. Policy makers and researchers should be aware of these differences when considering the evaluation results of studies investigating the cost-effectiveness of virtual wards. PMID:22788975
Maciel, Cláudia; Kerr-Corrêa, Florence
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
Russell, Margot; Hogg, Maggie; Leach, Stuart; Penman, Mags; Friel, Susan
The seventh and final article in the series on Leading Better Care explores some of the challenges in clinical practice relating to the use of data and making information meaningful to senior charge nurses and ward sisters. It describes the collaborative approach taken by NHS Lanarkshire, which involved nursing staff, programme leads and the eHealth team in the development of a general ward nursing dashboard as a means of ensuring safe, effective person-centred care. The article also illustrates how this web-based data-reporting programme is used to support clinical practice. PMID:25492791
Zarea, Kourosh; Nikbakht-Nasrabadi, Alireza; Abbaszadeh, Abbas; Mohammadpour, Ali
Psychiatric nurses play an important role in the process of caring for mentally ill patients and are continually faced with the numerous challenges and complex issues related to this field. This study aimed to understand the perspectives of psychiatric nurses regarding the issues they face while providing care and examine the possible solutions for improvement of inpatient care in clinical settings. The study adopted a qualitative approach that utilized a content analysis of audio taped, semi-structured interviews that had been conducted with 24 nurses. Two main themes emerged from the data. The first, Challenges in Providing Care within Psychiatric Wards, had the following subthemes: Politics and Rules of Organization, Safety and Security Issues, Uncertainty about the Role, Lack of Trained Staff, and Sociocultural Issues. The second theme, Solutions for Improving Psychiatric Care, had the subthemes of Empowerment across four domains: Psychiatric Nurses, Mentally Ill Patients and their Families, The Psychiatric Mental Health System, and the Cultural Context. The results indicated that if nurses are expected to provide optimal nursing care within a psychiatric ward, then there is a need for a stable and responsible organizational structure, skilled psychiatric nurses, and community-based care along with an anti-stigma program. PMID:23017047
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,…
Bryant, Penelope A; Hopper, Sandy M
There is ever-increasing pressure on hospital resources in general and emergency departments (ED) in particular. At the same time, there is increasing recognition that traditional inpatient ward-based care is not necessary for the majority of children presenting to the ED with acute illness, and that there are patient, family and hospital benefits to pursuing other options. Here, we describe alternative pathways for children presenting to the ED, including short stay and observational medicine, hospital-in-the-home and non-admission enhanced care, in other words, additional management practices or pathways for children who are discharged from the ED. We discuss the principles, models and practical considerations involved in each of these. PMID:27062630
Burkholder, David; Hall, Stephanie F.; Burkholder, Jessica
This article investigated 71 counselor educators' perspectives and pedagogical practices related to "Ward v. Wilbanks" (2009) and the American Counseling Association (ACA) response to the case. The authors used qualitative content analysis to identify 6 themes from survey data: (a) views on gatekeeping and student training; (b)…
A case of scabies has been diagnosed in the Medical Ward where Sophie works, and the hospital is having to take appropriate measures. Scabies mites can spread quickly, and staff who are in contact with the infected patient risk catching the parasites and contaminating their own family in turn. One of the night nurses is probably infected. PMID:26365648
O'Nell, Robert M.
The University of Colorado's Ward Churchill is but the latest in a long line of professors whose volatile statements have created controversy for themselves and their universities. Specific personnel matters in the case have been meticulously addressed in Boulder, but several larger questions have been curiously neglected. One might well ask, for…
Chandler, Daniel Ross
Henry Ward Beecher was America's most prominent 19th century liberal preacher and a major spokesperson for New England Transcendentalism. His philosophy integrated four fundamental themes: the creation of a moral code based on the internalization of values and peer group pressures, the establishment of the reform ideal of the impartial nonpartisan…
Kahila, K; Kilkku, N; Kaltiala-Heino, R
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
Some of the problems of ward management are reviewed. Methods suggested for dealing with them are probably not the ideals that should ultimately be attained but minimum standards to serve as immediate objectives. They concern indications for and methods of isolation, control of infection from staff, environmental contamination, and a few technical procedures. A new type of dressing towel for wounds is described. Images PMID:16810967
Sweeney, Angela; Fahmy, Sarah; Nolan, Fiona; Morant, Nicola; Fox, Zoe; Lloyd-Evans, Brynmor; Osborn, David; Burgess, Emma; Gilburt, Helen; McCabe, Rosemarie; Slade, Mike; Johnson, Sonia
Background Poor service user experiences are often reported on mental health inpatient wards. Crisis houses are an alternative, but evidence is limited. This paper investigates therapeutic alliances in acute wards and crisis houses, exploring how far stronger therapeutic alliance may underlie greater client satisfaction in crisis houses. Methods and Findings Mixed methods were used. In the quantitative component, 108 crisis house and 247 acute ward service users responded to measures of satisfaction, therapeutic relationships, informal peer support, recovery and negative events experienced during the admission. Linear regressions were conducted to estimate the association between service setting and measures, and to model the factors associated with satisfaction. Qualitative interviews exploring therapeutic alliances were conducted with service users and staff in each setting and analysed thematically. Results We found that therapeutic alliances, service user satisfaction and informal peer support were greater in crisis houses than on acute wards, whilst self-rated recovery and numbers of negative events were lower. Adjusted multivariable analyses suggest that therapeutic relationships, informal peer support and negative experiences related to staff may be important factors in accounting for greater satisfaction in crisis houses. Qualitative results suggest factors that influence therapeutic alliances include service user perceptions of basic human qualities such as kindness and empathy in staff and, at service level, the extent of loss of liberty and autonomy. Conclusions and Implications We found that service users experience better therapeutic relationships and higher satisfaction in crisis houses compared to acute wards, although we cannot exclude the possibility that differences in service user characteristics contribute to this. This finding provides some support for the expansion of crisis house provision. Further research is needed to investigate why acute
Chaput, Yves; Beaulieu, Lucie; Paradis, Michel; Labonté, Edith
Introduction: Studies of aggressive behaviors in a nonforensic mental health setting have focused primarily on the inpatient ward and, on event prediction, using behavior-based clinical rating scales. Few studies have specifically targeted aggressive behaviors in the psychiatric emergency service or determined whether assessing the demographic and clinical characteristics of such patients might prove useful for their more rapid identification. Methods: We used a prospectively acquired database of over 20,900 visits to four services in the province of Quebec, Canada, over a two-year period from September 2002 onwards. A maximum of 72 variables could be acquired per visit. Visits with aggression (any verbally or physically intimidating behavior), both present and past, were tagged. Binary logistic regressions and cross-tabulations were used to determine whether the profile of a variable differed in visits with aggression from those without aggression. Results: About 7% of visits were marked by current aggression (verbal 49%, physical 12%, verbal and physical 39%). Including visits with a “past only” history of aggression increased this number to 20%. Variables associated with aggression were gender (male), marital status (single/separated), education (high school or less), employment (none), judicial history (any type), substance abuse (prior or active), medication compliance (poor), type of arrival to psychiatric emergency services (involuntary, police, judiciary, landlord), reason for referral (behavioral dyscontrol), diagnosis (less frequent in anxiety disorders), and outcome (more frequently placed under observation or admitted). Conclusion: Our results suggest that many state-independent variables are associated with aggressive behaviors in the psychiatric emergency service. Although their sum may not add up to a specific patient profile, they can nevertheless be useful in service planning, being easily integrated alongside state-dependent rating scales in a
Brand, M P; Suter, P; Gunn-Séchéhaye, A; Gardaz, J P; Gemperlé, M
Ten adult patients with psychiatric disorders in the intensive care ward were examined. The length of stay varied from one week to four months and mechanical ventilation was necessary for all patients. Their experience of intensive care and their psychosensorial problems were as follows: temperospatial disorientation, perturbation of the sense of posture, hallucinations which could go as far as oneiric delirium, anguish and symptoms of depression. No psychotic syndrome, literraly speaking, was observed objectively. In the monthes that followed the stay under intensive care many patients presented important psychosomatic disorders. Organic factors are responsible for these complications, though the environment of the intensive care could induce a marked disafferentation. An effort by the attending staff, aimed at orientating or "reafferenting" these patients, could reduce these problems. PMID:30349
Powers, Dennis W.
The May 23rd Eos “In Brief” could have been considerably more informative about Ward Valley and the work of the NAS panel in reviewing issues raised about the proposed site. The article should have included more comprehensive discussion by the scientific participants who reviewed the technical issues involved. In addition, the article raised two very different subjects—safety issues at Ward Valley and alleged bias of NAS panels—but did not separate the subjects well. Readers may not have distinguished between the Ward Valley panel and the NAS Board on Radioactive Waste Management in the question of bias. In addition, the nature of the reported-on attacks on scientific and personal integrity of the scientists may well discourage qualified but thinner-skinned geoscientists from public service on panels.
Soliman, Ash; Riyaz, Shahzad; Said, Elmhutady; Hale, Melissa; Mills, Andy; Kapur, Kapil
Models suggested for managing acute, non-elective, medical admissions include expanding geriatric services, extending the role of the acute physician and rejuvenating the role of the general physician. We investigated improving inpatient care by changing consultants' work patterns and placing a higher priority on the ward rounds. A focus group and a questionnaire were used to study the impact on several ward round parameters. All respondents reported an overall satisfaction: 93% rated the quality of care as good or excellent, 75% reported increased safe patient discharges and 68% observed improved teamwork. Length of stay reduced to 4 days from 5.3 days without an increase in readmission. The main themes showed improved quality of care, better assured patients and relatives, and better consultant job satisfaction, but also showed reduced junior doctors' independent decision-making and a slight reduction in specialty-related activity. The study concluded that placing a higher priority on ward rounds by altering consultants' work patterns has a positive impact on inpatient care. PMID:24298094
Liu, Wei; Manias, Elizabeth; Gerdtz, Marie
Physical environments of clinical settings play an important role in health communication processes. Effective medication management requires seamless communication among health professionals of different disciplines. This paper explores how physical environments affect communication processes for managing medications and patient safety in acute care hospital settings. Findings highlighted the impact of environmental interruptions on communication processes about medications. In response to frequent interruptions and limited space within working environments, nurses, doctors and pharmacists developed adaptive practices in the local clinical context. Communication difficulties were associated with the ward physical layout, the controlled drug key and the medication retrieving device. Health professionals should be provided with opportunities to discuss the effects of ward environments on medication communication processes and how this impacts medication safety. Hospital administrators and architects need to consider health professionals' views and experiences when designing hospital spaces. PMID:24486620
This article reports on the introduction of intentional rounding at University Hospitals Coventry and Warwickshire NHS Trust. The approach was piloted and implemented on the initiative of two nurses in wards that ranged from orthopaedic to general medical. Intentional rounding aims to put patients at the centre of care and consists of checking on their condition at hourly or two-hourly intervals, recording their nutritional status and skin integrity, and asking if they need pain relief or help with eating. The introduction of the approach follows concerns about failures in care highlighted by a number of recent high-profile reports. PMID:22690424
Jackson, S G; Yip-Chuck, D A; Clark, J B; Brodsky, M H
A series of Clostridium perfringens-related gastrointestinal outbreaks occurred over a period of several months among elderly, chronic care patients in a psychiatric hospital. Several serotypes of C. perfringens and many nontypeable isolates were found. The distribution of certain serotypes and the incidence of detection of enterotoxin in fecal extracts were related to wards on which patients were resident (six wards were involved). Several patients were reported to have chronic or recurring fecal incontinence or diarrhea or both. With a background of elevated spore counts of several serotypes and chronic diarrhea, only detection of enterotoxin could provide definitive evidence of C. perfringens etiology in gastoenteritis cases. PMID:2871043
Jones, Gareth H.; Lovett, Jonathan W.T.
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
Wood, Dennis Patrick; Koffman, Robert L; Arita, Anthony A
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
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
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Ayirolimeethal, Anithakumari; Ragesh, G.; Ramanujam, Jayanthi M.; George, Biju
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
de Saussure, Wassila Oulhaci; Andereggen, Elisabeth; Sarasin, François
When should a patient with abdominal pain be referred to the emergency ward? The following goals must be achieved upon managing patients with acute abdominal pain: 1) identify vital emergency situations; 2) detect surgical conditions that require emergency referral without further diagnostic procedures; 3) in "non surgical acute abdomen patients" perform appropriate diagnostic procedures, or in selected cases delay tests and reevaluate the patient after an observation period, after which a referral decision is made. Clues from the history and physical examination are critical to perform this evaluation. A good knowledge of the most frequent acute abdominal conditions, and identifying potential severity criteria allow an appropriate management and decision about emergency referral. PMID:20873434
Sunderji, Nadiya; de Bibiana, Jason Tan; Stergiopoulos, Vicky
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
2. STREETSCAPE SHOWING NORTH ENDS OF STANDARD AND COMBINATION WARDS ON RAMP NO. 4. ON LEFT IS BUILDING NO. 9952-B, FOLLOWED BY THE B (NORTH) SIDES OF BUILDING NOS. 9953-9958. - Madigan Hospital, Standard & Combination Wards, Bounded by Wilson & McKinley Avenues & Garfield & Lincoln Streets, Tacoma, Pierce County, WA
1. STREETSCAPE WITH THE SOUTH ENDS OF STANDARD WARDS ON RAMP NO. 4 ON WEST SIDE OF COMPLEX. CAMERA IS POINTED NORTHWEST. IN RIGHT FOREGROUND IN BUILDING NO. 9930-A, FOLLOWED BY THE A (SOUTH) SIDES OF BUILDING NOS. 9931-9937. - Madigan Hospital, Standard & Combination Wards, Bounded by Wilson & McKinley Avenues & Garfield & Lincoln Streets, Tacoma, Pierce County, WA
... child resides, is— (1) A foster child; (2) A ward of the State; or (3) In the custody of a public child welfare agency. (b) Exception. Ward of the State does not include a foster child who has a foster parent who meets the definition of a parent in § 300.30. (Authority: 20 U.S.C. 1401(36))...
Zeraati, Fatemeh; Homayounfar, Shahram; Esna-Ashari, Farzaneh; Khalili, Marzieh
Background: The door-to-needle-time (DNT) is considered a standard time for scheduling thrombolysis for acute ST-segment elevation of myocardial infarction and this time can be reduced by minimizing the delay in starting thrombolytic treatment once the patient has reached to the hospital. This study was carried out on a sample of Iranian patients with acute myocardial infarction to determine the DNT in those after changing schedule of thrombolysis during 8 years from emergency to coronary care unit (CCU). Methods: A descriptive cross-sectional study was carried out on all consecutive patients with a confirmed diagnosis of acute myocardial infarction admitted to the emergency ward of Ekbatan Hospital in Hamadan, Iran, within 2011 and had an indication of fibrinolytic therapy, which 47 patients were finally indicated to receive streptokinase in the part of CCU. Results: The mean time interval between arrival at the hospital and electrocardiogram (ECG) assessment was 6.30 min, taking ECG and patient's admission was 21.6 min and transferring the patient from admission to CCU ward was 31.9. The time between transferring the patients to CCU ward and fibrinolytic administration order and the time between its ordering and infusion was 31.2 min and 14.0 min respectively. In sum, the DNT was estimated 84.48 ± 53.00 min ranged 30-325 min that was significantly more than standard DNT (P <0.01). Furthermore, DNT mean in this study is significantly more than a study conducted 8 years ago in the same hospital (P <0.01). Conclusions: The DNT is higher than the standard level and higher than the estimated level in the past. This shows that DNT was longer after transferring to CCU. PMID:24829715
Tuerlings, Joep H A M; Pelger, E C M Noor; de Pont, Boudewijn J H B; van Waarde, Jeroen A
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
Maizel, S; Fainstein, V; Katzenelson, S K
Since 1990 we have been admitting mothers with postpartum psychiatric morbidity together with their babies to our open psychiatric ward. The aim of conjoint hospitalization is to maintain and develop the bond between mother and baby while treating the mother's psychiatric disorder. The presence of the infant in the hospital allows both a thorough evaluation of the mothers' maternal ability and to use the infant as a facilitator of the mothers' recovery by engaging maternal functions. It prevents the infants from being placed in a foster home for the duration of the mothers' hospitalization. Readily available in Britain and Australia, such conjoint hospitalization is controversial and rarely available elsewhere. In the past 5 years we hospitalized 10 women with 11 babies (1 woman was hospitalized twice, after different births). All women had received psychiatric treatment prior to childbirth, but this was the first psychiatric hospitalization for 2 of them. Diagnoses (DSM-IIIR) were chronic paranoid schizophrenia (4), affective disorder (4), schizo-affective schizophrenia (1) and borderline personality disorder (1). 8 were suffering from active psychotic symptoms on admission. They were treated pharmacologically, received individual and group psychotherapy, and participated in all ward activities. Families were engaged in marital, family and/or individual therapy according to need. All participated in cognitive-behavior treatment tailored to individual need to build and enrich the mother-infant bond. All improved significantly and were able to function independently on discharge, but in 1 case adoption was recommended. PMID:9885632
Tuvesson, Hanna; Eklund, Mona; Wann-Hansson, Christine
The present study aimed at investigating the relationship between environmental and individual factors and Stress of Conscience among nursing staff in psychiatric in-patient care. A questionnaire involving six different instruments measuring Stress of Conscience, the ward atmosphere, the psychosocial work environment, Perceived Stress, Moral Sensitivity, and Mastery was answered by 93 nursing staff at 12 psychiatric in-patient wards in Sweden. The findings showed that Sense of Moral Burden, Mastery, Control at Work and Angry and Aggressive Behavior were related to Stress of Conscience. We conclude that Mastery and Control at Work seemed to work as protective factors, while Sense of Moral Burden and perceptions of Angry and Aggressive Behavior made the nursing staff more vulnerable to Stress of Conscience. Future research should investigate whether measures to increase the level of perceived control and being part of decision making will decrease the level of Stress of Conscience among the staff. PMID:22457384
Bader, Shannon M; Evans, Sean E
Existing literature on aggression within psychiatric hospitals suggests that treating an aggressive patient's symptoms could be complemented by (a) milieu environments that mitigate violence and (b) hospital-wide policies and procedures that focus on creating a safe environment. Described as an ecological approach, examples of how this broader, situational approach can reduce inpatient violence in psychiatric settings are provided throughout. The authors identify potential barriers to focusing on wards and institutional rules as well as patient treatment. Last, details of how this ecological approach has been implemented at one state hospital in California are provided. PMID:25882371
Stotland, Nada L
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
Dike, Charles C; Nicholson, Elizabeth; Young, John L
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
Anderson, Eleanor A; Kim, Deborah R
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
Fereidooni Moghadam, Malek; Fallahi Khoshknab, Masoud; Pazargadi, Mehrnoosh
Background: The use of physical restraint as an intervention in the care of psychiatric patients dates back to the beginning of psychiatry. Although it is a challenging question, it is still one of the common procedures in psychiatry. Considering that very little research has been done in Iran in relation to physical restraint, this qualitative study aimed to investigate the experiences of nurses working in psychiatric wards regarding physical restraint. Methods: This qualitative study was done on 14 nurses working in the psychiatric hospitals of Ahvaz city, southern Iran, during 2011-2012. The participants were selected by purposive sampling. Semi-structured interviews were used for data collection, which were continued until data saturation and emergence of themes. Inductive content analysis was used to analyze the data. Results: Four categories emerged: (1) Restraint as a multi-purpose procedure, (2) Processing of physical restraint, (3) Restraint as a challenging subject and (4) The effects of restraint on the spectrum. Each category has several different sub-categories. Conclusion: The participants described using physical restraint as one of the main strategies to control psychiatric patients, and despite having negative consequences, it is extensively used. Given the risks and challenges of using physical restraint, nursing education should find alternative methods. PMID:25349842
Crabtree, Sara Ashencaen
An ethnographic study of female psychiatric patients was undertaken in East Malaysia. Findings indicate that these service users were subject to a number of sexist and oppressive practices that militate against their freedom of movement on the wards as well as their social interaction in the wider context of the hospital. Stereotypic notions of female sexuality and morality act as forms of moral containment and are interpreted in the hospital context as requiring heavy custodial care by the hospital authorities. PMID:15354623
Attri, Joginder Pal; Bala, Neeru; Chatrath, Veena
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
Increased security measures at high secure psychiatric hospitals can complicate hand hygiene. This audit assessed the availability of appropriate hand hygiene equipment and the practice of good hand hygiene at Broadmoor Hospital using the local hand hygiene policy as the standard for comparison. A data collection tool used to audit the hand hygiene equipment on 23 wards in the hospital showed that there were significant deficits in the supply of hand hygiene equipment on the wards. In addition, a staff survey was conducted using a questionnaire designed to assess awareness, training and hand decontamination practice among nursing staff. This survey identified a need to increase awareness of the hand hygiene policy and the appropriate timing of hand decontamination procedures. As a result of the audit, appropriate equipment was ordered and the duties of infection prevention link nurses on each ward were made more explicit; namely, to check and order equipment for hand hygiene as necessary, to conduct regular reminder sessions of the hand decontamination procedure and to raise awareness of hand hygiene policy. Posters were also placed on wards in patient areas to increase awareness of hand hygiene among patients, and alcohol gel dispensers were introduced into nursing stations. Similar audits may prove beneficial at other psychiatric hospitals. PMID:20304525
El-Mallakh, Rif S; Roberts, R Jeannie; El-Mallakh, Peggy L; Findlay, Lillian Jan; Reynolds, Kristen K
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
Solomon, S; McCartney, J R; Saravay, S M; Katz, E
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
Hadi, Fatemeh; Khosravi, Termeh; Shariat, Seyed Vahid; Jalali Nadoushan, Amir Hossein
Background: Considering the negative consequences of using physical restraints, we conducted this study to identify patients who are more frequently restrained in a psychiatric emergency ward as an initial step to limit the use of restraint to the minimum possible. Methods: This was a retrospective case control study conducted in Iran Psychiatric Hospital in Tehran, Iran. We reviewed the files of 607 patients who were admitted during a one year period using convenience sampling; of them, 186 were in the restrained group and 421 in the unrestrained group. Results: Surprisingly, no significant difference was found between the restrained and unrestrained groups in demographic characteristics. The patients who were referred because of violence were diagnosed as having methamphetamine induced psychotic disorder or bipolar I disorder in manic 1episode and had a higher odds of being restrained (OR=2.51, OR=1.61, and OR=1.57 respectively). Being restrained was also associated with a longer duration of hospitalization and duration of staying in the emergency ward. Moreover, patients in their first admission were more frequently restrained. Conclusion: Medical and nursing staff should consider special measures for the patients who are at a higher risk for being restrained. More frequent visits and education for both patients and staff may be effective in reducing the number of physical restraints for these groups of patients. PMID:26913259
Hallas, Jesper; Gram, Lars F.; Grodum, Ellen; Damsbo, Niels; Brøsen, Kim; Haghfelt, Torben; Harvald, Bent; Beck-Nielsen, Jørgen; Worm, Jørgen; Birger Jensen, Kurt; Davidsen, Otto; Frandsen, Niels E.; Hagen, Claus; Andersen, Morten; Frølund, Flemming; Kromann-Andersen, Hans; Schou, Jens
1 In total 1999 consecutive admissions to six medical wards were subjected to a prospective high-intensity drug event monitoring scheme to assess the extent and pattern of admissions caused by adverse drug reactions (ADRs) or dose related therapeutic failures (TF), in a population-based design. The wards were sub-specialised in general medicine, geriatrics, endocrinology, cardiology, respiratory medicine and gastroenterology. 2 Considering definite, probable and possible drug events, the prevalence of drug related hospital admissions was 11.4% of which 8.4% were caused by ADRs and 3.0% by TFs. There were large inter-department differences. 3 The six classes of drugs most frequently involved in admissions caused by ADRs were anti-rheumatics and analgesics (27%), cardiovascular drugs (23%), psychotropic drugs (14%), anti-diabetics (12%), antibiotics (7%), and corticosteroids (5%). Non-compliance accounted for 66% of the TFs with diuretics and anti-asthmatics most frequently involved. 4 The pattern of drugs involved in ADRs was compared with the regional drug sales statistics. Drugs with a particularly high rate of ADR related admissions per unit dispensed were nitrofurantoin and insulin (617 and 182 admissions per 1,000,000 defined daily doses), while low rates were seen for diuretics and benzodiazepines (10 and 7 admissions per 1,000,000 defined daily doses). Confidence intervals were wide. 5 Patients who had their therapy prescribed by a hospital doctor had a slightly higher prevalence of drug events than those who were treated by a general practitioner (12.6% vs 11.8%). The reverse applied for drug events assessed as avoidable (3.3% vs 4.6%). Although these differences were not statistically significant, it may suggest general practitioners as the appropriate target for interventive measures. 6 Only one ADR was reported to The Danish Committee on Adverse Drug Reactions, indicating a severe under-reporting and a potential for gross selectivity. The data collection
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Minen, Mia Tova; Begasse De Dhaem, Olivia; Kroon Van Diest, Ashley; Powers, Scott; Schwedt, Todd J; Lipton, Richard; Silbersweig, David
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
Sebergsen, K; Norberg, A; Talseth, A-G
Accessible summary Early intervention to prevent and reduce new episodes of psychosis involves patients, relatives and mental health personnel recognizing the early signs of psychosis. Twelve participants with psychotic illnesses narrated how they experienced becoming psychotic before they were admitted to acute psychiatric wards. The results of this study demonstrate that participants and their close others who sensed, understood and articulated experienced changes as signs of psychosis established a dialogue with mental health personnel and initiated treatment and care. Participants who did not perceive the experienced changes as signs of psychosis articulated the experienced changes as an awareness of a poor health condition and illness. These participants, who had no other people to advocate for them, appeared to experience poor communication and coercion during intervention. Abstract To assist in improving early interventions for psychosis, this study explored how adult people narrated their experience of becoming psychotic, and how contact with mental health personnel was established. Narrative interviews were conducted with 12 participants with psychotic illnesses recruited from acute psychiatric wards. The interviews were content analysed. Participants described being in a process of transition to psychosis as follows: experiencing changes as well-known signs of psychosis, experiencing sudden unexpected changes as signs of psychosis and experiencing unidentified changes as signs of illness. Our results show that participants and their close others who knew the signs of psychosis established a dialogue with mental health personnel and were better equipped to prevent and mitigate the psychosis. Our results demonstrate that participants who did not perceive the signs of psychosis and did not have other people to advocate for them were at risk for delayed treatment, poor communication and coercive interventions. Furthermore, participants who did not know the
Samuel, Edith; Williams, Robert B; Ferrell, Richard B
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
The Ward identity in gauge theory constrains the behavior of the amplitudes. We discuss the Ward identity for amplitudes with a pair of shifted lines with complex momenta. This will induce a recursion relation identical to Britto-Cachazo-Feng-Witten recursion relations at the finite poles of the complexified amplitudes. Furthermore, according to the Ward identity, it is also possible to transform the boundary term into a simple form, which can be obtained by a new recursion relation. For the amplitude with one off-shell line in pure Yang-Mills theory, we find this technique is effective for obtaining the amplitude even when there are boundary contributions.
Westphal, James R.
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…
Lewis-Fernández, Roberto; Aggarwal, Neil Krishan
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
Mackrill, J; Jennings, P; Cain, R
Sound is often considered as a negative aspect of an environment that needs mitigating, particularly in hospitals. It is worthwhile however, to consider how subjective responses to hospital sounds can be made more positive. The authors identified natural sound, steady state sound and written sound source information as having the potential to do this. Listening evaluations were conducted with 24 participants who rated their emotional (Relaxation) and cognitive (Interest and Understanding) response to a variety of hospital ward soundscape clips across these three interventions. A repeated measures ANOVA revealed that the 'Relaxation' response was significantly affected (n(2) = 0.05, p = 0.001) by the interventions with natural sound producing a 10.1% more positive response. Most interestingly, written sound source information produced a 4.7% positive change in response. The authors conclude that exploring different ways to improve the sounds of a hospital offers subjective benefits that move beyond sound level reduction. This is an area for future work to focus upon in an effort to achieve more positively experienced hospital soundscapes and environments. PMID:24768090
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…
Suicide mortality of suicide attempt patients discharged from emergency room, nonsuicidal psychiatric patients discharged from emergency room, admitted suicide attempt patients, and admitted nonsuicidal psychiatric patients.
Choi, Jae W; Park, Subin; Yi, Ki K; Hong, Jin P
The suicide mortality rate and risk factors for suicide completion of patients who presented to an emergency room (ER) for suicide attempt and were discharged without psychiatric admission, patients who presented to an ER for psychiatric problems other than suicide attempt and were discharged without psychiatric admission, psychiatric inpatients admitted for suicide attempt, and psychiatric inpatients admitted for other reasons were examined. The records of 3,897 patients who were treated at a general hospital in Seoul, Korea, from July 2003 to December 2006 were reviewed. Forty-three of the 3,897 subjects died by suicide during the 2.5-year observation period. Compared to the general Korean population, the suicide mortality rate was 82-fold higher for suicide attempt patients, admitted; 54-fold higher for suicide attempt patients, discharged; 21-fold higher for nonsuicidal patients, admitted; and 11-fold higher for nonsuicidal patients, discharged. In all four groups, diagnosis of a depressive disorder and suicide attempt at presentation were each significant independent risk factors for suicide completion. These results highlight the need for suicide prevention strategies for depressed patients who present to the ER or are admitted to a psychiatric ward after a suicide attempt. PMID:22380459
1. VIEW OF DETENTION WARD AREA, LOOKING NORTHWEST FROM Y STREET - Fort McCoy, Building No. T-1065, Northeast of Intersection of South Ninth Avenue & South "Y" Street, Block 10, Sparta, Monroe County, WI
Los Angeles County Poor Farm, Patient Wards 201, 202, 203, 204, 205, 206, 207, 208 & 209 - Type A Plan, 7601 Imperial Highway; bounded by Esperanza Street, Hawthorn Avenue, Laurel Street, and Descanso Street, Downey, Los Angeles County, CA
Los Angeles County Poor Farm, Patient Ward Nos. 210 & 211 - Type B Plan, 7601 Imperial Highway; bounded by Esperanza Street, Laurel Street, Flores Street, and Descanso Street, Downey, Los Angeles County, CA
Elevation of north facades of #156-158 (triple wards) - National Home for Disabled Volunteer Soldiers, Pacific Branch, Mental Health Buildings, 11301 Wilshire Boulevard, West Los Angeles, Los Angeles County, CA
Interior view of typical ward on second floor, south wing; camera facing northwest. - Mare Island Naval Shipyard, Hospital Headquarters, Johnson Lane, west side at intersection of Johnson Lane & Cossey Street, Vallejo, Solano County, CA
Tanner, Laurel N.; Tanner, Daniel
A review is presented of the legacy of Lester Frank Ward, widely recognized as the architect of environmentalism in American pedagogy and the creator of some of the most fundamental ideas about American curriculum. (CB)
Tye, Laura; Urmson, Stephanie; Maloney, Lindsey
Introducing a ward housekeeping service may give nursing staff more time to focus on essential care. This small-scale evaluation found the role freed up healthcare assistant time and improved staff morale. PMID:22479768
Khademi, Gholamreza; Roudi, Masoumeh; Shah Farhat, Ahmad; Shahabian, Masoud
Introduction: The improvement of technology has increased noise levels in hospital Wards to higher than international standard levels (35-45 dB). Higher noise levels than the maximum level result in patient’s instability and dissatisfaction. Moreover, it will have serious negative effects on the staff’s health and the quality of their services. The purpose of this survey is to analyze the level of noise in intensive care units and emergency wards of the Imam Reza Teaching Hospital, Mashhad. Procedure: This research was carried out in November 2009 during morning shifts between 7:30 to 12:00. Noise levels were measured 10 times at 30-minute intervals in the nursing stations of 10 wards of the emergency, the intensive care units, and the Nephrology and Kidney Transplant Departments of Imam Reza University Hospital, Mashhad. The noise level in the nursing stations was tested for both the maximum level (Lmax) and the equalizing level (Leq). The research was based on the comparison of equalizing levels (Leq) because maximum levels were unstable. Results: In our survey the average level (Leq) in all wards was much higher than the standard level. The maximum level (Lmax) in most wards was 85-86 dB and just in one measurement in the Internal ICU reached 94 dB. The average level of Leq in all wards was 60.2 dB. In emergency units, it was 62.2 dB, but it was not time related. The highest average level (Leq) was measured at 11:30 AM and the peak was measured in the Nephrology nursing station. Conclusion: The average levels of noise in intensive care units and also emergency wards were more than the standard levels and as it is known these wards have vital roles in treatment procedures, so more attention is needed in this area. PMID:24303374
Tsuji, Keiko; Matsumoto, Maki; Takai, Kiyako; Kodama, Hiromi; Hagiwara, Tomoko; Iwata, Naomi
Environmental design should be required at medical facilities for conducting medical practice safely and for making hospitalization comfortable. Many medical nursing students cannot imagine medical facilities, especially hospital wards, when they study medical environments in a basic nursing lecture. As a result, they cannot connect well with patient assistance. We employed a computer assisted designing software, "3D My Home Designer" (Mega Soft Company) that runs on Windows 8, and considered the usefulness of it for lectures on environmental design showing how to design a hospital ward for patients' optimal hospital stay. We drew a medical facility in 2-D first, transformed it into 3D images, and then created movies of a virtual hospital ward in which a patient walked around. These movies consisted of 3 kinds: a) hospital room with changeable wall color, b) different allocations of hospital room and nurse station, and c) a blurred ward which corresponded to how a patient with poor eyesight (cataract) would see a ward. We prepared as controls: a') still images of a hospital room, b') still images of ward, and c') a documentation on how a ward is seen by a patient with a cataract. We gave a questionnaire to students and nurses about these movies and still images (controls). In a) and b), there were no differences between the movies and still images in both students and nurses. In c), both students and nurses had a viewpoint from the patient with poor eyesight. From these results, we consider that the students, who have fewer experiences in a hospital, may understand the environments well by movies and the application of a virtual movie ward to nursing education may be useful in a lecture, depending on the readiness of the students. PMID:26073505
It has been suggested that current care for diabetes inpatients remains inadequate and that greater attention is required for high quality management. In this project the aspect of hypoglycaemia was studied in a busy medical receiving ward at the Glasgow Royal Infirmary. A large proportion of inpatients have diabetes and episodes of hypoglycaemia experienced by this population can delay discharge and indeed be detrimental to health. Thus it is important from both an organisational and patient perspective to manage this population well. In this project BM machine data was analysed to identify patients who were hypoglycaemic. These patients were then tracked down to study the subsequent management and compared this against recommended guidance. Following this an intervention was made to promote identification, management, documentation, and prevention of hypoglycaemia. This was deliberately a simple intervention involving discussions with staff and provision of basic documented guidance next to every BM machine. In the first phase 17 patients were identified and in a second and third phase 16 patients each time were further identified. Patients in the study were both type 1 and type 2 diabetics. Initial results in phase I were compared to results in phase II and III respectively. This intervention produced significant improvements in management with correct monitoring of low BMs (i.e. upon identification of low BM repeat within 1 hour) improving from 47% to 100% (for Phase II and III). Also, recording of preventative measures of hypoglycaemia improved from 35% to 88% and 94% with an improvement from 24% to 69% and 75% in recording of treatment given if needed. In conclusion, the study successfully demonstrated that simple measures can significantly improve the quality care of inpatient diabetic patients in relation to hypoglycaemia management. PMID:26734389
Hashemian, Seyed Mohammad Reza; Farzanegan, Behrooz; Fathi, Mohammad; Ardehali, Seyed Hossein; Vahedian-Azimi, Amir; Asghari-Jafarabadi, Mohammad; Hajiesmaeili, Mohammadreza
Background: Stress has been recognized as a significant psychosocial and physiologic component in educational and practical processes. Objectives: The purpose of present study was to survey stress among Iranian nurses in critical wards. Patients and Methods: In this cross-sectional study, 3643 anonymous questionnaires were disseminated among nurses in different hospitals in Tehran, Iran, by utilizing multistage random sampling. The questionnaire consisted of two sections: demographic characteristics and a 22-item list on a five-point Likert scale. The association of variables with stress was evaluated using hierarchical logistic regression. Results: A total of 3043 completed questionnaires were completed and returned (response rate, 83.53%). Age (> 33 years, 1571 (51.63%); < 33 years old, 1472 (48.37%)), marital status (single, 188 (6.18%); married, 2685 (88.24%); and widow, 170 (5.59%)), working shift (morning, 605 (19.88%); evening, 631 (20.74%); night, 603 (19.82%); and rotation, 1204 (39.57%)), and the years of experience of nurses (1 - 5 years, 413 (13.57%); 6 - 10 years, 589 (19.36%); 11 - 15 years, 832 (27.34%); 16 - 20 years, 758 (24.91%); and 21-25 years, 451 (14.82%)) had significant association with the level of stress (P < 0.05 for all parameters). However, sex (male, 937 (30.79%); and female, 2106 (69.21%)), education (associate, 444 (14.59%); baccalaureate, 2250 (73.94%); and master, 349 (11.47%)), and body mass index (> 24.6 kg/m2, 2514 (49.75%); and < 24.6 kg/m2, 1529 (50.25%)) showed no significant association with the level of stress (P > 0.05 for all parameters). Conclusions: Considering the personal and background characteristics of personnel and understanding their association with stress and stressful situations encompasses the ability to persevere and adapt to contextual stressors. PMID:26380798
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
Lewis-Fernández, Roberto; Aggarwal, Neil Krishan
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
Meyer, I; Cournos, F; Empfield, M; Agosin, B; Floyd, P
An HIV prevention program was piloted on an acute inpatient admission ward. Patients who volunteered to participate had significantly higher rates of histories of substance use than non-participants, suggesting that patients participated based on rational concerns about past HIV risk behavior. The program consisted of 75 minute sessions once a week for seven weeks and was co-led by an HIV counselor and the ward's social worker. Each session focused on a specific topic and included a short presentation of informational material, viewing of an educational videotape, a discussion, and role play and other educational games. In spite of a wide range in functioning among the participants, discussion was lively and participation was good. The pilot program demonstrates that chronic mentally ill patients can engage in, and benefit from, risk reduction programs and that frank and explicit discussion of sexual issues is well tolerated. Recommendations for improvement in the program are discussed. PMID:1488461
Lanthén, Klas; Rask, Mikael; Sunnqvist, Charlotta
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
Elkhatib, Rania; Idowu, Modupe; Brown, Gregory S.; Jaber, Yasmeen M.; Reid, Matthew B.; Person, Cheryl
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
Hörberg, Ulrica; Sjögren, Reet; Dahlberg, Karin
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
Almeida, Jaime; da Silva, Joaquim Alves; Xavier, Miguel; Gusmão, Ricardo
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
Rowley, Emma; Wright, Nicola; Waring, Justin; Gregoriou, Kyri; Chopra, Arun
Introduction Strategies to reduce hospital admissions for mental health service users have received vast amounts of attention, yet the transfer of care from hospital to the community has been ignored. The discharge process is complex, messy, disjointed and inefficient, relying on cross-agency and organisational working. Focusing on one acute mental health admission ward, we will investigate whether the discharge process for people with severe mental health problems can be enhanced through the creation, implementation and utilisation of a knowledge sharing proforma that is used on their admission to the ward. Methods and analysis The project uses qualitative interviews to understand the complex processes associated with being admitted and discharged from inpatient mental health wards. Practitioners will be asked to identify and map the relevant stakeholders involved in admission and discharge, and discuss any problems with the process. The study team will work with clinicians to develop a knowledge collection proforma, which will be piloted for 2 months. Qualitative interviews will be carried out to collect reflections on the experiences of using the tool, with data used for further refinement of the intervention. Baseline and repeat quantitative measures will be taken to illustrate any changes to length of stay and readmission rates achieved as a result of the study. Ethics and dissemination A key issue is that participants are able to comment frankly on something that is a core part of their work, without fear or reprise. It is equally important that all participants are offered the opportunity to develop and coproduce the knowledge collection proforma, in order that the intervention produced is fit for purpose and usable in the real world, away from a research environment. The study has received ethical approval from Nottingham University Business School ethics committee, and has all appropriate National Health Service research governance clearances. PMID
Jones, Joanne; Carroll, Andrea
The ageing British population is placing increased demands on the delivery of care in mainstream health-care institutions. While people are living longer, a significant percentage is also living with one or more long-term conditions. These issues, alongside continuing financial austerity measures, require a radical improvement in the care of patients away from hospitals. The Wyre Forest Clinical Commissioning Group introduced a virtual ward model for two main purposes: to save on spiralling costs of hospital admissions, and, secondly, to ensure the preferred wishes of most patients to be cared for and even die at home were achieved. This commentary describes how the virtual ward model was implemented and the impact of preventing unplanned emergency admissions to hospitals. The setting up of enhanced care services and virtual wards in one county is discussed, aiming to highlight success points and potential pitfalls to avoid. The results from the implementation of the virtual ward model show a significant reduction in emergency and avoidable patient admissions to hospital. The success of virtual wards is dependent on integrated working between different health-care disciplines. PMID:25039341
Mason, Michael J; Aplasca, Alexis; Morales-Theodore, Rosa; Zaharakis, Nikola; Linker, Julie
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
Smith, R. M.; Rae, A.
The patient is identified as being of prime importance for comfort standards in hospital ward areas, other ward users being expected to adjust their dress to suit the conditions necessary for patients comfort. A study to identify the optimum steady state conditions for patients comfort is then described. Although this study raises some doubts as to the applicability of the standard thermal comfort assessment techniques to ward areas, it is felt that its results give a good indication of the steady-state conditions preferred by the patients. These were an air temperature of between 21-5 degrees and 22 degrees C and a relative humidity of between 30% and 70%, where the air velocity was less than 0-1 m/s and the mean radiant temperature was close to air temperature. PMID:264497
The preconceived 'foaming' and 'violent' seizure stereotypes are misrepresentations, particularly by non-specialist health professionals. Thus the vast semiology (signs and symptoms) of seizures and their subtle signs too easily go unrecognised by the untrained eye. Nevertheless, a significant proportion of adult patients admitted to the ward for treatment of their current illness will have a pre-existing seizure disorder (epilepsy). Furthermore, such hospitalised patients are more likely to suffer a seizure within the ward environment as triggering factors are unavoidably present. Thus, it is essential that nurses are prepared to encounter seizures, irrespective of the reason for admission. This article discusses the clinical semiology of the various seizure types in association with the underpinning neuropathophysiology, as well as the potential seizure triggers. It thereby enhances nurses' awareness and observations of seizure activity in patients in the ward environment. PMID:26500124
Scaife, Clair; October, Margaret; Kellett, Valerie
Taking charge of a clinical shift on a ward is daunting for newly qualified staff nurses. This article describes the co-ordinators competency pathway, written to guide and assess band 5 ward nurses, and a co-ordinators development day, which is a simulation-based training day developed by a team of senior nurses to prepare band 5 nurses to become competent children's ward co-ordinators. Each of two groups - of either experienced or less experienced band 5s - starts with the training day as a base for either 12 or 18 months of in-work training that follow. A new job description matching the trust's workforce reorganisation enabled this development of the band 5 nurse's role. A service evaluation has found staff are more competent and confident as a result of this initiative. PMID:25004046
Voineskos, G.; Denault, S.
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
The purpose of clinical training is to develop doctors capable of delivering professional, personal, effective, high quality, safe clinical care with Intelligent Kindness. The processes supporting training must promote development towards excellence. In 2004 a formative assessment process for use on medical post take ward rounds was introduced based on a model of a Driving Instructor and Learner Driver. This process has been evaluated in comparison with the Case based Discussion (CbD) and mini-Cex by 140 of 369 trainees, using online surveys. Ten trainees were interviewed in depth. The majority of trainees reported that this process had helped them more in their development as doctors than the CbD or mini-CEX. Trainees were able to describe positive effects in areas such as diagnosis, prescribing and confidence in their work. In the NHS the assessments are meant to be "trainee driven", however all but one of the trainees stated that they preferred the routine provision of an assessment to having to ask for an assessment. This evaluation of a truly formative assessment process shows that the trainees benefit in their progression towards clinical excellence. Effective formative feedback can be provided on an Acute Medical Unit even within the constraints of busy post take ward rounds. Within a team of Consultants one should be allowed time to develop an extended Clinical Supervisor role. PMID:24364051
Background Frequent reporting of cases of hysterical conversion reaction (HCR) among hospitalized female medical patients in Bangladesh’s public hospital system led us to explore the prevalence of “HCR” diagnoses within hospitals and the manner in which physicians identify, manage, and perceive patients whom they diagnose with HCR. Methods We reviewed admission records from women’s general medicine wards in two public hospitals to determine how often and at what point during hospitalization patients received diagnoses of HCR. We also interviewed 13 physicians about their practices and perceptions related to HCR. Results Of 2520 women admitted to the selected wards in 2008, 6% received diagnoses of HCR. HCR patients had wide-ranging symptoms including respiratory distress, headaches, chest pain, convulsions, and abdominal complaints. Most doctors diagnosed HCR in patients who had any medically-unexplained physical symptom. According to physician reports, women admitted to medical wards for HCR received brief diagnostic evaluations and initial treatment with short-acting tranquilizers or placebo agents. Some were referred to outpatient psychiatric treatment. Physicians reported that repeated admissions for HCR were common. Physicians noted various social factors associated with HCR, and they described failures of the current system to meet psychosocial needs of HCR patients. Conclusions In these hospital settings, physicians assign HCR diagnoses frequently and based on vague criteria. We recommend providing education to increase general physicians’ awareness, skill, and comfort level when encountering somatization and other common psychiatric issues. Given limited diagnostic capacity for all patients, we raise concern that when HCR is used as a "wastebasket" diagnosis for unexplained symptoms, patients with treatable medical conditions may go unrecognized. We also advocate introducing non-physician hospital personnel to address psychosocial needs of HCR
Kallweit, Ulf; Werth, Esther; Seiz, Angela; Sefidan, Sandra; Dahmen, Norbert; Manconi, Mauro; Ehlert, Ulrike; Bassetti, Claudio L A
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
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…
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
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,…
Singh, Delar K.
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…
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
Chaplin, Rob; Crawshaw, Jacob; Hood, Chloe
The aim of this audit was to assess the effect of the Quality Mark programme on the quality of acute care received by older patients by comparing the experiences of staff and older adults before and after the programme. Data from 31 wards in 12 acute hospitals were collected over two stages. Patients and staff completed questionnaires on the perceived quality of care on the ward. Patients rated improved experiences of nutrition, staff availability and dignity. Staff received an increase in training and reported better access to support, increased time and skill to deliver care and improved morale, leadership and teamwork. Problems remained with ward comfort and mealtimes. Overall, results indicated an improvement in ratings of care quality in most domains during Quality Mark data collection. Further audits need to explore ways of improving ward comfort and mealtime experience. PMID:25727634
Luigjes, Judy; de Kwaasteniet, Bart P; de Koning, Pelle P; Oudijn, Marloes S; van den Munckhof, Pepijn; Schuurman, P Richard; Denys, Damiaan
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
Trethowan, W. H.
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
Goldberg, R J; Daly, J; Golinger, R C
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
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
Southern Regional Education Board, Atlanta, GA.
Designed primarily for use by ward personnel in residential facilities for the mentally retarded, the manual presents an overview of recreational services. Four papers introduce the importance of recreation and consider approaches for its provision: "Why Recreation?" (W. Lawler); "The Role of the Attendant in Providing Recreation for the Retarded"…
14. Photocopy of ca. 1891 rendering of Receiving Ward, built at west end 1892-94. Designed by George W. Hewitt and his brother, William D. Hewitt of Philadelphia. - Hospital of Protestant Episcopal Church in Philadelphia, Front Street & Lehigh Avenue, Philadelphia, Philadelphia County, PA
Zuelke, Dennis C.
Replies to James G. Ward's objections to the author's recent "Journal of Education Finance" article, which concluded that comprehensive collective bargaining had no significant effect on teachers' salaries or fringe benefits in Wisconsin school districts during 1979-80. Calls for alternative strategies to improve teachers' economic condition. (MLH)
Hayden, Ellen T.; Benson, Robert T.
This curriculum guide consists of materials for use in teaching a course in job skills for hospital ward clerks. Included in the front matter of the guide are an introduction, guidelines for using the guide, and a course outline. The second section contains a job description, seven categories of job duties and tasks, a final examination, sample…
Westcott, Eliza; Broadhurst, Alicia; Crossley, Steven; Lee, Lloyd; Phan, Xuyen; Scharli, Rainer; Xu, Yan
A floor-washing robot has been acquired to assist physicists with decontamination of radioiodine therapy ward rooms after discharge of the patient at Sir Charles Gairdner Hospital. The effectiveness of the robot in decontaminating the ward has been evaluated. A controlled experiment was performed by deliberately contaminating a polyvinyl chloride flooring offcut with 131I followed by automated decontamination with the robot. The extent of fixed and removable contamination was assessed before and after decontamination by two methods: (1) direct Geiger-Mueller counting and (2) beta-counting wipe tests. Surface contamination was also assessed in situ on the ward by Geiger-Mueller counting and wipe testing. Contamination maps confirmed that contamination was removed rather than spread around by the robot. Wipe testing revealed that the robot was successful in clearing approximately 60-80% of removable contamination. The robotic floor-washing device was considered suitable to provide effective automated decontamination of the radioiodine ward. In addition, the robot affords other benefits: the time spent by the physicists decontaminating the room is greatly reduced offering financial and occupational safety and health benefits. The robot has also found utility in other decontamination applications in the healthcare environment. PMID:22249471
20. View of south side of East Ward Street east of South McDonald Avenue, facing southeast. - Gaskin Avenue Neighborhood, Bounded by Dart Street to east, CSX Railroad to south, Pearl & Madison Avenues to west, & Wilson & Gordon Streets to north, Douglas, Coffee County, GA
19. View of southeast corner of East Ward Street and South McDonald Avenue, facing southeast. - Gaskin Avenue Neighborhood, Bounded by Dart Street to east, CSX Railroad to south, Pearl & Madison Avenues to west, & Wilson & Gordon Streets to north, Douglas, Coffee County, GA
14. View of southwest corner of East Ward Street and South McDonald Avenue, facing southwest. - Gaskin Avenue Neighborhood, Bounded by Dart Street to east, CSX Railroad to south, Pearl & Madison Avenues to west, & Wilson & Gordon Streets to north, Douglas, Coffee County, GA
2. View of north side of East Ward Street east of North Coweta Avenue, facing northeast. - Gaskin Avenue Neighborhood, Bounded by Dart Street to east, CSX Railroad to south, Pearl & Madison Avenues to west, & Wilson & Gordon Streets to north, Douglas, Coffee County, GA
17. View of north side of East Ward Street east of North McDonald Avenue, facing northwest. - Gaskin Avenue Neighborhood, Bounded by Dart Street to east, CSX Railroad to south, Pearl & Madison Avenues to west, & Wilson & Gordon Streets to north, Douglas, Coffee County, GA
6. Views of southeast corner of East Ward Street and South Coweta Avenue, facing southeast. - Gaskin Avenue Neighborhood, Bounded by Dart Street to east, CSX Railroad to south, Pearl & Madison Avenues to west, & Wilson & Gordon Streets to north, Douglas, Coffee County, GA
21. View of south side of East Ward Street midblock between South McDonald Avenue and Fales Avenue, facing southeast. - Gaskin Avenue Neighborhood, Bounded by Dart Street to east, CSX Railroad to south, Pearl & Madison Avenues to west, & Wilson & Gordon Streets to north, Douglas, Coffee County, GA
16. View of northeast corner of East Ward Street and North McDonald Avenue, facing northeast. - Gaskin Avenue Neighborhood, Bounded by Dart Street to east, CSX Railroad to south, Pearl & Madison Avenues to west, & Wilson & Gordon Streets to north, Douglas, Coffee County, GA
13. View of south side of East Ward Street east of Sibett Avenue, facing southwest. - Gaskin Avenue Neighborhood, Bounded by Dart Street to east, CSX Railroad to south, Pearl & Madison Avenues to west, & Wilson & Gordon Streets to north, Douglas, Coffee County, GA
11. View of north side of East Ward Street midblock between Dewey AVenue and North McDonald Avenue, facing northeast. - Gaskin Avenue Neighborhood, Bounded by Dart Street to east, CSX Railroad to south, Pearl & Madison Avenues to west, & Wilson & Gordon Streets to north, Douglas, Coffee County, GA
3. View of north side of East Ward Street midblock between North Coweta Avenue and Dewey Avenue. - Gaskin Avenue Neighborhood, Bounded by Dart Street to east, CSX Railroad to south, Pearl & Madison Avenues to west, & Wilson & Gordon Streets to north, Douglas, Coffee County, GA
12. View of south side of East Ward Street west of Sibett Avenue, facing southwest. - Gaskin Avenue Neighborhood, Bounded by Dart Street to east, CSX Railroad to south, Pearl & Madison Avenues to west, & Wilson & Gordon Streets to north, Douglas, Coffee County, GA
10. View of north side of East Ward Street midblock between Dewey Avenue and North McDonald Avenue, facing northeast. - Gaskin Avenue Neighborhood, Bounded by Dart Street to east, CSX Railroad to south, Pearl & Madison Avenues to west, & Wilson & Gordon Streets to north, Douglas, Coffee County, GA
15. View of north side of East Ward Street at the intersection with North McDonald Avenue, facing northeast. - Gaskin Avenue Neighborhood, Bounded by Dart Street to east, CSX Railroad to south, Pearl & Madison Avenues to west, & Wilson & Gordon Streets to north, Douglas, Coffee County, GA
8. View of south side of East Ward Street midblock between South Coweta Avenue and Sibett Avenue, facing southwest. - Gaskin Avenue Neighborhood, Bounded by Dart Street to east, CSX Railroad to south, Pearl & Madison Avenues to west, & Wilson & Gordon Streets to north, Douglas, Coffee County, GA
1. View of north side of East Ward Street west of North Coweta Avenue, facing northwest. - Gaskin Avenue Neighborhood, Bounded by Dart Street to east, CSX Railroad to south, Pearl & Madison Avenues to west, & Wilson & Gordon Streets to north, Douglas, Coffee County, GA
7. View of south side of East Ward Street east of South Coweta Avenue, facing southwest. - Gaskin Avenue Neighborhood, Bounded by Dart Street to east, CSX Railroad to south, Pearl & Madison Avenues to west, & Wilson & Gordon Streets to north, Douglas, Coffee County, GA
4. View of north side of East Ward Street west of Dewey Avenue, facing northeast. - Gaskin Avenue Neighborhood, Bounded by Dart Street to east, CSX Railroad to south, Pearl & Madison Avenues to west, & Wilson & Gordon Streets to north, Douglas, Coffee County, GA
18. View of north side of East Ward Street at the intersection with North Dart Street, facing northwest. - Gaskin Avenue Neighborhood, Bounded by Dart Street to east, CSX Railroad to south, Pearl & Madison Avenues to west, & Wilson & Gordon Streets to north, Douglas, Coffee County, GA
5. View of northwest corner of East Ward Street and Dewey Avenue, facing northwest. - Gaskin Avenue Neighborhood, Bounded by Dart Street to east, CSX Railroad to south, Pearl & Madison Avenues to west, & Wilson & Gordon Streets to north, Douglas, Coffee County, GA
20. West Elevation and Section, Ward 'K', Letterman General Hospital, Presidio of San Francisco, Cal. Sheet No. 2. May 1917. BUILDING 1049. - Presidio of San Francisco, Letterman General Hospital, Building No. 12, Letterman Hospital Complex, Edie Road, San Francisco, San Francisco County, CA
19. First and Second Floors. Ward 'K', Letterman General Hospital, Presidio of San Francisco, Cal. Sheet No. 1. May 1917. BUILDING 1049. - Presidio of San Francisco, Letterman General Hospital, Building No. 12, Letterman Hospital Complex, Edie Road, San Francisco, San Francisco County, CA
Lehnbom, Elin C; Adams, Kristian; Day, Richard O; Westbrook, Johanna I; Baysari, Melissa T
Much clinical information is computerised and doctors' use of mobile devices such as iPad tablets to access this information is expanding rapidly. This study investigated the use of iPads during ward rounds and their usefulness in providing access to information during ward rounds. Ten teams of doctors at a large teaching hospital were given iPads for ten weeks and were observed on ward rounds for 77.3 hours as they interacted with 525 patients. Use of iPads and other information technology devices to access clinical information was recorded. The majority of clinical information was accessed using iPads (56.2%), followed by computers-on-wheels (35.8%), stationary PCs (7.9%) and smartphones (0.1%). Despite having read-only access on iPads, doctors were generally happy using iPads on ward rounds. These findings provide evidence of the value of iPads as a tool to access information at the point of care. PMID:25087529
17. New York Connecting Railroad: Little Hell Gate Bridge. Wards Island, New York Co., NY. Sec. 4207, MP 8.02. - Northeast Railroad Corridor, Amtrak Route between New Jersey/New York & New York/Connecticut State Lines, New York County, NY
Sophia, R. Grace; Veliappan, A.
The purpose of the present study is to explore how parents are encouraging towards health care of their wards. A "Survey Method" was used in the present study. A standardized "Agarwal Parental Encouragement Scale (APES)" was used to collect information from the students. The sample consists of thousand and ninety five higher…
Grandahl, Mia Gall; Nielsen, Svend Erik; Koerner, Ejnar Alex; Schultz, Helga Holm; Arnfred, Sidse Marie
Background Delirium is a frequent psychiatric complication to cancer, but rarely recognized by oncologists. Aims 1. To estimate the prevalence of delirium among inpatients admitted at an oncological cancer ward 2. To investigate whether simple clinical factors predict delirium 3. To examine the value of cognitive testing in the assessment of delirium. Methods On five different days, we interviewed and assessed patients admitted to a Danish cancer ward. The World Health Organization International Classification of Diseases Version 10, WHO ICD-10 Diagnostic System and the Confusion Assessment Method (CAM) were used for diagnostic categorization. Clinical information was gathered from medical records and all patients were tested with Mini Cognitive Test, The Clock Drawing Test, and the Digit Span Test. Results 81 cancer patients were assessed and 33% were diagnosed with delirium. All delirious participants were CAM positive. Poor performance on the cognitive tests was associated with delirium. Medical records describing CNS metastases, benzodiazepine or morphine treatment were associated with delirium. Conclusions Delirium is prevalent among cancer inpatients. The Mini Cognitive Test, The Clock Drawing Test, and the Digit Span Test can be used as screening tools for delirium among inpatients with cancer, but even in synergy, they lack specificity. Combining cognitive testing and attention to nurses' records might improve detection, yet further studies are needed to create a more detailed patient profile for the detection of delirium. PMID:26882016
Tremmery, S; Danckaerts, M; Bruckers, L; Molenberghs, G; De Hert, M; Wampers, M; De Varé, J; de Decker, A
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
Molin, Jenny; Graneheim, Ulla H; Lindgren, Britt-Marie
Everyday life consists of daily activities that are taken for granted. It forms the foundation for human efforts and contains elements of both comfort and boredom. Because everyday life escapes no one, life in a psychiatric ward will become ordinary while staying there. This study aims to explore everyday life in psychiatric inpatient care based on patients' experiences. We individually interviewed 16 participants with experiences of psychiatric inpatient care and analysed the data in accordance with the methods of grounded theory. Data collection and analysis continued in parallel in accordance with the method. Our results showed that everyday life is linked to the core category quality of interactions influences everyday life, and three constructed categories-staff makes the difference, looking for shelter in a stigmatizing environment, and facing a confusing care content-were related to the core category. Our results highlight the importance of ordinary relationships between staff and patients in psychiatric inpatient care. These results can be used to develop nursing interventions to improve psychiatric inpatient care and might also be used as a basis for reflective dialogues among staff. PMID:26806313
Molin, Jenny; Graneheim, Ulla H.; Lindgren, Britt-Marie
Everyday life consists of daily activities that are taken for granted. It forms the foundation for human efforts and contains elements of both comfort and boredom. Because everyday life escapes no one, life in a psychiatric ward will become ordinary while staying there. This study aims to explore everyday life in psychiatric inpatient care based on patients’ experiences. We individually interviewed 16 participants with experiences of psychiatric inpatient care and analysed the data in accordance with the methods of grounded theory. Data collection and analysis continued in parallel in accordance with the method. Our results showed that everyday life is linked to the core category quality of interactions influences everyday life, and three constructed categories—staff makes the difference, looking for shelter in a stigmatizing environment, and facing a confusing care content—were related to the core category. Our results highlight the importance of ordinary relationships between staff and patients in psychiatric inpatient care. These results can be used to develop nursing interventions to improve psychiatric inpatient care and might also be used as a basis for reflective dialogues among staff. PMID:26806313
Helle, Siri; Gjestad, Rolf; Johnsen, Erik; Kroken, Rune Andreas; Jørgensen, Hugo A; Løberg, Else-Marie
Illicit drug use may influence cognition in non-affective psychosis. Previous studies have shown better cognition in psychosis with illicit drug use as compared to psychosis only. Possibly, illicit drug using patients have more transient drug-related cognitive deficits. Thus, the aim of the present study was to examine cognitive change the first weeks after admission to a psychiatric emergency ward, expecting more cognitive improvement at follow-up in the illicit drug group as compared to psychosis only. Patients with acute non-affective psychosis with (26%) and without illicit drug use were examined at baseline (n=123) and follow-up (n=67), with alternative forms of the Repeatable Battery for the Assessment of Neuropsychological Status. Latent Growth Curve models, controlling for cognition at baseline and age differences between the groups, were used to analyze cognitive change. The illicit drug using patients showed the largest improvement in cognition, especially among the youngest patients. Younger patients with non-affective psychosis and illicit drug use showed more cognitive improvement the first weeks after acute psychosis as compared to psychosis only. This suggests that the illicit drug users constitute a sub-group with less stable cognitive deficits and less cognitive vulnerability. PMID:25240944
Rose, D; Evans, J; Laker, C; Wykes, T
Background. Acute psychiatric provision in the UK today as well as globally has many critics including service users and nurses. Method. Four focus groups, each meeting twice, were held separately for service users and nurses. The analysis was not purely inductive but driven by concerns with the social position of marginalised groups - both patients and staff. Results. The main themes were nurse/patient interaction and coercion. Service users and nurses conceptualised these differently. Service users found nurses inaccessible and uncaring, whereas nurses also felt powerless because their working life was dominated by administration. Nurses saw coercive situations as a reasonable response to factors 'internal' to the patient whereas for service users they were driven to extreme behaviour by the environment of the ward and coercive interventions were unnecessary and heavy handed. Conclusion. This study sheds new light on living and working in acute mental health settings today by comparing the perceptions of service users and nurses and deploying service user and nurse researchers. The intention is to promote better practice by providing a window on the perceptions of both groups. PMID:24330951
Hubbard, Grace B
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
Ellingsen, Gunnar; Munkvold, Glenn
Purpose The paper contributes to the conceptualisation of “integrated care” in heterogeneous work practices. A dynamic perspective is developed, emphasising how integrated care is malleable, open, and achieved in practice. Furthermore, we explore the role of nursing plans in integrated care practices, underscoring the inherent difficulties of building one common infrastructural system for integrated care. Methods Empirically, we studied the implementation of an electronic nursing plan in a psychiatric ward at the University Hospital of North Norway. We conducted 80 hours of participant observation and 15 interviews. Results While the nursing plan was successful as a formal tool among the nurses, it was of limited use in practice where integrated care was carried out. In some instances, the use of the nursing plan even undermined integrated care. Conclusion Integrated care is not a constant entity, but is much more situated and temporal in character. A new infrastructural system for integrated care should not be envisioned as replacing most of the existing information sources, but rather seen as an extension to the heterogeneous ensemble of existing ones. PMID:17627295
Jones, Stephanie G; Benca, Ruth M
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
Coscas, Sarah; Benyamina, Amine; Reynaud, Michel; Karila, Laurent
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
Krasnoshteĭn, A E; Barannikov, V G; Shchekotov, V V; Lebedeva, T M; Bitinskaia, L N; Khasanova, R B; Surovtseva, M V; Mezentseva, E V; Isaevich, A G; Lysenko, D I
Ambient air in ground wards made to contain natural potassium-sodium salt is close in characteristics to the atmosphere of underground wards but has a number of specificities: daily fluctuations of concentrations of light aeroions and aerosol particles, elevated concentration of light aeroions concentration, low radiation background, minimal bacterial contamination. The stay in ground wards brings great benefit for patients with bronchial asthma. Ground speleo-climatic wards are perspective in nonpharmacological treatment of patients with allergic respiratory diseases. PMID:10429568
... AGENCY Ward Transformer Superfund Site; Raleigh, Wake County, NC; Notice of Settlement AGENCY... Agency has entered into a settlement at the Ward Transformer Superfund Site located in Raleigh, Wake... EPA Region 4 contact Ms. Paula V. Painter. Submit your comments by Site name Ward...
... AGENCY Ward Transformer Superfund Site Raleigh, Wake County, NC; Notice of Settlements AGENCY... Ward Transformer Superfund Site located in Raleigh, Wake County, North Carolina for publication. DATES... your comments, identified by Docket ID No. EPA-RO4- SFUND-2010-1053 or Site name Ward...
There are over 70,000 residents in Ward 8, the poorest area of Washington, DC and along with Ward 7, it's most geographically remote. Approximately 36% of the Ward 8 population consists of children and youth, 18 years or younger. Children in the District of Columbia are at greater risk for poorer health and life outcomes than children in other…
Hasley, Peggy B.; Arnold, Robert M.
No previous studies have described how faculty give summative evaluations to learners on the medical wards. The aim of this study was to describe summative evaluations on the medical wards. Participants were students, house staff and faculty at the University of Pittsburgh. Ward rotation evaluative sessions were tape recorded. Feedback was…
Berg, John E; Grimeland, Jorid
Hospitals are labor intensive facilities based on highly skilled employees. A merger of hospitals is an effort to increase and rationalize this production. Decisions behind a merger are made at the top leadership level. How this might be done is demonstrated by examples from a 36 bed acute psychiatric facility. The aim of the study was to calculate the hidden costs of fragmented destruction of parts of a total hospital supply to patients after a merger. Fragmented destruction is the deliberate stopping of activities deemed not part of the core activities of the hospital without due consideration of the impact on core activities. The proposed changes to operational expenses at a single acute psychiatric hospital were materials for the study. The changes included activities as a reduction in local laboratory service, cleaning services, closure of physiotherapy unit, closing of cultural activities and reduced productivity. The selected activities are calculated as giving an imputed gain of € 630,000 as indicated by the leadership. The not calculated costs of reducing or removing the selected activities are estimated at € 1,955,640. The cost of staff disappointment after a merger is difficult to assess, but is probably higher than assumed in the present calculations. Imputed cost containment is not attained. The calculations indicate that implemented changes may increase cost, contrary to the belief of the leadership at both the hospital level and further up in the hospital trust. Arguments in favor of a merger have to be scrutinized thoroughly for optimistic neglect of uncalculated costs of mergers. Future hospital mergers and selected fragmentation of productive tasks at ward or hospital levels should include calculations of unavoidable costs as shown in the present paper. PMID:25478133
Kivimäki, Mika; Vahtera, Jussi; Kawachi, Ichiro; Ferrie, Jane E; Oksanen, Tuula; Joensuu, Matti; Pentti, Jaana; Salo, Paula; Elovainio, Marko; Virtanen, Marianna
Recent reviews show that self-reported psychosocial factors related to work, such as job demands and job control, are associated with employee mental health, but it is not known whether this association is attributable to reporting bias. The authors examined this question using objectively measured hospital ward overcrowding as an instrument. The extent of overcrowding provided a strong instrument for self-reported job demands but not for job control, and it was used to examine unbiased associations between self-reported job demands and sickness absence with a psychiatric diagnosis among 2,784 female nurses working in somatic illness wards in Finland. During the 12-month follow-up period (2004-2005), 102 nurses had an absence with a psychiatric diagnosis, 33 with a diagnosis of depressive disorder. Both greater extent of overcrowding and higher self-reported job demands were associated with increased risk of psychiatric absence. The latter association was stronger but less precisely estimated in an instrumental-variables analysis which took into account only the variation in self-reported job demands that was explained by overcrowding. Repeating these analyses with absence due to depressive disorders as the outcome led to similar results. Findings from this instrumental-variables analysis support the status of high self-reported job demands as a risk factor for absence with a psychiatric diagnosis. PMID:20534822
Olden, K W; Johnson, M P
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
Wilson, Michael P; Nordstrom, Kimberly; Shah, Asim A; Vilke, Gary M
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
Ben-Tovim, David I.
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.
Grover, Sandeep; Somaiya, Mansi; Kumar, Santhosh; Avasthi, Ajit
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
Grover, Sandeep; Somaiya, Mansi; Kumar, Santhosh; Avasthi, Ajit
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
Fraidakis, M J
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
Avery, Steven G.; Schwab, Burkhard U. W.
Recently, a number of new Ward identities for large gauge transformations and large diffeomorphisms have been discovered. Some of the identities are reinterpretations of previously known statements, while some appear to be genuinely new. We use Noether's second theorem with the path integral as a powerful way of generating these kinds of Ward identities. We reintroduce Noether's second theorem and discuss how to work with the physical remnant of gauge symmetry in gauge fixed systems. We illustrate our mechanism in Maxwell theory, Yang-Mills theory, p-form field theory, and Einstein-Hilbert gravity. We comment on multiple connections between Noether's second theorem and known results in the recent literature. Our approach suggests a novel point of view with important physical consequences.
Capper, D.M.; Leibbrandt, G.
We have calculated the pole part of the one-loop graviton self-energy in the noncovariant axial gauge n/sub ..mu../phi/sub munu/ = 0, n/sup 2/not =0, where phi/sub munu/ is the physical graviton field and n/sub ..mu../ is an arbitrary but constant vector. It is shown that the self-energy is, unexpectedly, both nontransverse and n/sub ..mu../ dependent, even though it satisfies the correct gravitational Ward identity. This Ward identity is found to contain a term corresponding to a ''pincer'' Feynman diagram which is directly responsible for the nontransversality of the graviton self-energy. Ghost particles do not contribute to the graviton amplitude. All axial-gauge integrals are consistently evaluated in the context of dimensional regularization and by applying the principal-value prescription.
Capper, D. M.; Leibbrandt, George
We have calculated the pole part of the one-loop graviton self-energy in the noncovariant axial gauge nμφμν=0, n2≠0, where φμν is the physical gravition field and nμ is an arbitrary but constant vector. It is shown that the self-energy is, unexpectedly, both nontransverse and nμ dependent, even though it satisfies the correct gravitational Ward identity. This Ward identity is found to contain a term corresponding to a "pincer" Feynman diagram which is directly responsible for the nontransversality of the graviton self-energy. Ghost particles do not contribute to the graviton amplitude. All aixal-gauge integrals are consistently evaluated in the context of dimensional regularization and by applying the principal-value prescription.
Hoyos, Carlos; Fernández, David Rodríguez
We derive relations between viscosities and momentum conductivity in 2 + 1 dimensions by finding a generalization of holographic Ward identities for the energy-momentum tensor. The generalization is novel in the sense that it goes beyond the usual identities obtained from holographic renormalization. Our results are consistent with previous field theory analysis. The main tools we use are a constant `probability current' in the gravity dual, that we are able to define for any system of linear ODEs, and parity symmetry.
Bolten, Margarete I
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
Haghani, Fariba; Arabshahi, Seyed Kamran Soltani; Bigdeli, Shoaleh; Alavi, Mousa; Omid, Athar
Background: Medical students spend most of their time in hospital wards and it is necessary to study clinical educational opportunities. This study was aimed to explore faculty members’ experience on Ward Round Teaching content. Methods and Materials: This qualitative study was conducted by purposive sampling with the maximum variation of major clinical departments faculty members in Isfahan University of Medical Sciences (n = 9). Data gathering was based on deep and semi-structured interviews. Data gathering continued till data saturation. Data was analyzed through the Collaizzi method and validated. Strategies to ensure trustworthiness of data (credibility, dependability, conformability, transferability) were employed (Guba and Lincoln). Results: Basic codes extracted from the analyzed data were categorized into two main themes and related subthemes, including (1) tangible teachings (analytic intelligence, technical intelligence, legal duties) and (2) implied teachings (professionalism, professional discipline, professional difficulties). Conclusion: Ward round teaching is a valuable opportunity for learners to learn not only patient care aspects but also ethical values. By appropriate planning, opportunities can be used to teach capabilities that are expected of general practitioners. PMID:24627858
Thunes, Sissel; Sekse, Ragnhild Johanne Tveit
Considerable research has been made in order to find what promotes students' learning in general, but few studies have included midwifery students and their learning in clinical practice. The purpose of this study was to get a better understanding of the midwifery students' first encounter with the maternity ward and of what was essential to them in the learning environment. A qualitative study, based on in-depth interviews with six students during their first clinical practice at a maternity ward, was conducted. The findings show that the students needed to feel their presence desired and to be included in the activities in the ward. Learning needed to be based on the students' expectations, understanding and previous experiences. The most important factor influencing the students' well-being and learning was their relationships with their mentor. In conclusion, learning in a clinical setting required more than just motivated students. Engaged mentors, who linked the students' previous experiences and expectations to the clinical practice, were crucial to learning outcomes. Mutual engagement, shared understanding and common goals were imperative for the students' experiences of a good learning environment. PMID:25701290
Morra, D.; Lo, V.; Quan, S.; Wu, R.
Summary Objective To describe the uses of institutional and personal smartphones on General Internal Medicine wards and highlight potential consequences from their use. Methods A mixed methods study consisting of both quantitative and qualitative research methods was conducted in General Internal Medicine wards across four academic teaching hospitals in Toronto, Ontario. Participants included medical students, residents, attending physicians and allied health professionals. Data collection consisted of work shadowing observations, semi-structured interviews and surveys. Results Personal smartphones were used for both clinical communication and non-work-related activities. Clinicians used their personal devices to communicate with their medical teams and with other medical specialties and healthcare professionals. Participants understood the risks associated with communicating confidential health information via their personal smartphones, but appear to favor efficiency over privacy issues. From survey responses, 9 of 23 residents (39%) reported using their personal cell phones to email or text patient information that may have contained patient identifiers. Although some residents were observed using their personal smartphones for non-work-related activities, personal use was infrequent and most residents did not engage in this activity. Conclusion Clinicians are using personal smartphones for work-related purposes on the wards. With the increasing popularity of smartphone devices, it is anticipated that an increasing number of clinicians will use their personal smartphones for clinical work. This trend poses risks to the secure transfer of confidential personal health information and may lead to increased distractions for clinicians. PMID:25298819
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
van Loon, Kim; van Zaane, Bas; Bosch, Els J.; Kalkman, Cor J.; Peelen, Linda M.
Background Failure to recognize acute deterioration in hospitalized patients may contribute to cardiopulmonary arrest, unscheduled intensive care unit admission and increased mortality. Purpose In this systematic review we aimed to determine whether continuous non-invasive respiratory monitoring improves early diagnosis of patient deterioration and reduces critical incidents on hospital wards. Data Sources Studies were retrieved from Medline, Embase, CINAHL, and the Cochrane library, searched from 1970 till October 25, 2014. Study Selection Electronic databases were searched using keywords and corresponding synonyms ‘ward’, ‘continuous’, ‘monitoring’ and ‘respiration’. Pediatric, fetal and animal studies were excluded. Data Extraction Since no validated tool is currently available for diagnostic or intervention studies with continuous monitoring, methodological quality was assessed with a modified tool based on modified STARD, CONSORT, and TREND statements. Data Synthesis Six intervention and five diagnostic studies were included, evaluating the use of eight different devices for continuous respiratory monitoring. Quantitative data synthesis was not possible because intervention, study design and outcomes differed considerably between studies. Outcomes estimates for the intervention studies ranged from RR 0.14 (0.03, 0.64) for cardiopulmonary resuscitation to RR 1.00 (0.41, 2.35) for unplanned ICU admission after introduction of continuous respiratory monitoring, Limitations The methodological quality of most studies was moderate, e.g. ‘before-after’ designs, incomplete reporting of primary outcomes, and incomplete clinical implementation of the monitoring system. Conclusions Based on the findings of this systematic review, implementation of routine continuous non-invasive respiratory monitoring on general hospital wards cannot yet be advocated as results are inconclusive, and methodological quality of the studies needs improvement. Future
Rankin, Eric; France, Cheryl; El-Missiry, Ahmed; John, Collin
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
Wantz, Richard A; Firmin, Michael W; Stolzfus, Melissa J; Ray, Brigitte N; Holmes, Hannah J; Geib, Ellen F
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
Schellack, N; Martins, V; Botha, N; Meyer, J C
Poor management of pharmaceuticals could lead to wastage of financial resources and poor services in the public sector. The main aim of the study was to investigate the quality of pharmaceutical services at ward level in a teaching hospital. The design of the study was descriptive. Three data collection instruments were designed and pilot-tested prior to the actual data collection. Two structured questionnaires were used to interview the sister-in-charge of each ward and the stock and drug controller at the pharmacy. A checklist for the management of pharmaceuticals was completed for each ward. Descriptive statistics were used to describe and summarise the data. Sisters-in-charge of 30 wards and the stock and drug controller at the pharmacy participated in the study. The relationship with the pharmacy was perceived to be average by 54% (n = 30) of the sisters-in-charge of the wards. Communication with the pharmacy was mainly by telephone and 57% of the sisters-in-charge mentioned that they experienced difficulties in conveying messages to the pharmacy. Ten of the wards received regular ward visits by a pharmacist. Expiry dates were checked by all wards but at different intervals. The majority of the wards (90%) used patient cards, which refer to prescription charts, for stock control and ordering from the pharmacy. Fridge temperatures were checked and charted on a daily basis by 30% of the wards. Written standard operating procedures (SOPs) were used by the pharmacy for issuing ward stock. Although 83% of the wards indicated that they used SOPs, evidence of written SOPs was not available. The results indicated that the management of pharmaceutical services at ward level could be improved. Implementation of appropriate communication systems will enhance cooperation between the pharmacy and the wards. A uniform ward stock control system, either by computer or stock cards, should be introduced. Regular ward visits by a pharmacist to oversee ward stock management are
Kalarchian, Melissa A; Marcus, Marsha D
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
Hidasi, Zoltan; Salacz, Pal; Csibri, Eva
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
Henderson, M; Harvey, S B; Overland, S; Mykletun, A; Hotopf, M
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
Beit-Hallahmi, B; Argyle, M
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
Rocco, Pier Luigi; Orbitello, Barbara; Ciano, Rossana P; Angarano, Alberto; Balestrieri, Matteo
BACKGROUND Suicidal behaviour represents a social and health-related issue of prime importance in both the general and psychiatric population. People with mental illness are at great risk of suicide, but indirect evidence suggests that the treatment of psychiatric disorders may prevent suicide. The aim of our study was to compare the risk of suicide in the population of psychiatric patients with that of the general population in Friuli Venezia-Giulia (FVG). METHOD We analyzed the suicide rates, based on the official statistical database, relating to the resident population in FVG during the years 1998-1999. The sucide rates (per 100 000 subjects) were standardised by sex and age. The characteristics of suicidal behaviour in subjects who had been in contact with (Community Mental Health Centres) CMHC (n=65) were compared with that of suicidal subjects not in contact (n=237). RESULTS There was an increase in the suicide phenomenon in the elderly population in FVG over the tested period. The rates were three times higher in males than in females. The rates of patients in contact with CMHC in 1998 and in 1999 were, respectively, 14 and 20 times higher than that of the general population. Most suicidal schizophrenics and 37% of the depressed patients have been previously hospitalised. CONCLUSION The population of north-eastern Italy is at high risk of suicide compared to other regions. The mortality ratio of psychiatric subjects who commit suicide in our sample is elevated. Since Italian community-oriented services rely less on hospitalisation than in other countries, the fact that about 50% of suicidal psychiatric patients have been previously admitted in a psychiatric ward may indicate that previous hospitalisation is a hierarchic factor related to suicide. PMID:24941205
Rostworowska, Maria; Opoczyńska, Małgorzata
Basing on the example of one patient and her family, the system family consultation--as a way towards therapeutic dialogue--is presented. The patient was hospitalised due to schizophrenia. In the given example, the psychiatrist was an observer of the consultation conducted by the psychologist. A system therapy consultation allowed a "multiple-picture" to be obtained: the family members and the patient presented their own understanding of the situation. This new multi-perspective description--showing the patient's symptoms functionality caused diagnostic uncertainty in the psychiatrist--how far is the diagnosis of schizophrenia a justifiable one. According to the authors, the systemic consultation, giving the possibility to empathize with existential, psychological and family problems of the patient, leads to a dialogue with his/her family and it plays one of the most important roles in the therapeutic and diagnostic process. PMID:18567401
Krystal, John H.; State, Matthew W.
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
Kendler, Kenneth S
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
Cardoso Zoppe, Eva Helena C.; Schoueri, Patricia; Castro, Monica; Neto, Francisco Lotufo
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…
Parrott, Fiona R
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
Wampers, Martien; De Lepeleire, Jan; Correll, Christophe U.
Introduction When psychiatric patients express a wish for euthanasia, this should first and foremost be interpreted as a cry for help. Due to their close day-to-day relationship, psychiatric nurses may play an important and central role in responding to such requests. However, little is known about nurses’ attitudes towards euthanasia motivated by unbearable mental suffering. Objectives The aim of this study was to provide insight into the attitudes and actions taken by psychiatric nurses when confronted with a patient’s euthanasia request based on unbearable mental suffering (UMS). Method A questionnaire was sent to 11 psychiatric hospitals in the Flemish part of Belgium. Results The overall response rate was 70% (N = 627). Psychiatric nurses were frequently confronted with a request for euthanasia, either directly (N = 329, 53%) or through a colleague (N = 427, 69%). A majority (N = 536, 84%) did not object to euthanasia in a psychiatrically ill population with UMS. Confounding factors were the psychiatric diagnosis and the type of ward where the nurses were working. Most participants acknowledged a lack of knowledge and skills to adequately address the euthanasia request (N = 434, 71%). Nearly unanimously (N = 618, 99%), study participants indicated that dealing with euthanasia requests and other end-of-life issues should be part of the formal training of nurses. Conclusion The results highlight the need for ethically sound and comprehensive provision of care. Psychiatric nurses play an important role in dealing with the complex issue of requests for euthanasia. There is also a need for education, training and clear guidelines on the level of health care organizations. PMID:26700007
Norfleet, M A; Burnell, G M
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
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Devine, J; Cooke, R P; Wright, E P
A survey of two acute district general hospitals (A and B) was undertaken to investigate the extent of methicillin-resistant Staphylococcus aureus (MRSA) contamination of ward-based computer terminals. Of 25 terminals examined, MRSA was identified in six (24%). Environmental contamination was of a low level. Five of the MRSA positive terminals were from hospital A which had a significantly higher rate of MRSA transmission compared to hospital B (1.02 vs. 0.49 new inpatient MRSA cases per 100 hospital admissions for 1999). MRSA containment and handwashing policies were similar at both hospitals, though only hospital B actively audited handwashing compliance and had a 44% higher rate of paper towel usage per hospital bed. Ward-based computer terminals pose a low risk of MRSA cross-infection. This risk can be further reduced if all staff wash their hands before and after patient contact. PMID:11358473
With the The NHS Plan (Department of Health, 2000) the government made it clear there was a need to reintroduce the role of matron to establish a clear responsibility for standards in the ward setting. The role of modern matron is now considered to be a fundamental part of clinical governance, ensuring the quality of the care provided is of the highest standard. Staff at South Essex Partnership NHS Trust instituted an audit to provide an accurate picture of the impact of modern matrons. PMID:15552487
Laskaratos, Faidon-Marios; Wallace, Deirdre; Gkotsi, Despoina; Burns, Aine; Epstein, Owen
The ward round (WR) is a complex task and medical teachers are often faced with the challenge of finding a balance between service provision and clinical development of learners. The educational value of WRs is an under-researched area. This short communication aims to evaluate the educational role of WRs for junior trainees and provides insight into current practices. It also identifies obstacles to effective teaching/training in this setting and provides suggestions for improving the quality of WR teaching. PMID:25907002
We use the compactified twistor correspondence for the (2 + 1) -dimensional integrable chiral model to prove a conjecture of Ward. In particular, we construct the correspondence space of a compactified twistor fibration and use it to prove that the second Chern numbers of the holomorphic vector bundles, corresponding to the uniton solutions of the integrable chiral model, equal the third homotopy classes of the restricted extended solutions of the unitons. Therefore we deduce that the total energy of a time-dependent uniton is proportional to the second Chern number.
de Lima, Ana Paula Cardoso Rodrigues; Dias, Sebastião Alves
By considering a general Abelian chiral gauge theory, we investigate the behavior of anomalous Ward-Takahashi (WT) identities concerning their prediction for the usual relationship between the vertex and two-point fermion functions. Using gauge anomaly vanishing results, we show that the usual (in the nonanomalous case) WT identity connecting the vertex and two-point fermion 1PI functions is modified for Abelian chiral gauge theories. The modification, however, implies a relation between fermion and charge renormalization constants that can be important in a future study of renormalization of such theories.
Costa, L. C.; Ferraz, A.; Mastropietro, Vieri
Coupled fermionic chains are usually described by an effective model written in terms of bonding and anti-bonding fermionic fields with linear dispersion in the vicinities of the respective Fermi points. We derive for the first time exact Ward Identities (WI) for this model, proving the existence of chiral anomalies which verify the Adler-Bardeen non-renormalization property. Such WI are expected to play a crucial role in the understanding of the thermodynamic properties of the system. Our results are non-perturbative and are obtained analyzing Grassmann functional integrals by means of constructive quantum field theory methods.
Laskaratos, Faidon-Marios; Wallace, Deirdre; Gkotsi, Despoina; Burns, Aine; Epstein, Owen
The ward round (WR) is a complex task and medical teachers are often faced with the challenge of finding a balance between service provision and clinical development of learners. The educational value of WRs is an under-researched area. This short communication aims to evaluate the educational role of WRs for junior trainees and provides insight into current practices. It also identifies obstacles to effective teaching/training in this setting and provides suggestions for improving the quality of WR teaching. PMID:25907002
Blanchard, E B; Hickling, E J; Taylor, A E; Loos, W
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
Thomas, Joan; Lackey, Nancy
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
Cohen, David; Porter, Sally
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
Wong, Lai Fun; Lim, Eunice Ya Ping; Ang, Sophia Bee Leng; Mujumdar, Sandhya; Ho, Jasmine Tze Yin; Mordiffi, Siti Zubaidah; Ang, Emily Neo Kim
Background Nurses play an important role in detecting patients with clinical deterioration. However, the problem of nurses failing to trigger deteriorating ward patients still persists despite the implementation of a patient safety initiative, the Rapid Response System. A Web-based simulation was developed to enhance nurses’ role in recognizing and responding to deteriorating patients. While studies have evaluated the effectiveness of the Web-based simulation on nurses’ clinical performance in a simulated environment, no study has examined its impact on nurses’ actual practice in the clinical setting. Objective The objective of this study was to evaluate the impact of Web-based simulation on nurses' recognition of and response to deteriorating patients in clinical settings. The outcomes were measured across all levels of Kirkpatrick’s 4-level evaluation model with clinical outcome on triggering rates of deteriorating patients as the primary outcome measure. Methods A before-and-after study was conducted on two general wards at an acute care tertiary hospital over a 14-month period. All nurses from the two study wards who undertook the Web-based simulation as part of their continuing nursing education were invited to complete questionnaires at various time points to measure their motivational reaction, knowledge, and perceived transfer of learning. Clinical records on cases triggered by ward nurses from the two study wards were evaluated for frequency and types of triggers over a period of 6 months pre- and 6 months postintervention. Results The number of deteriorating patients triggered by ward nurses in a medical general ward increased significantly (P<.001) from pre- (84/937, 8.96%) to postintervention (91/624, 14.58%). The nurses reported positively on the transfer of learning (mean 3.89, SD 0.49) from the Web-based simulation to clinical practice. A significant increase (P<.001) on knowledge posttest score from pretest score was also reported. The
Barloon, Linda Funk; Hilliard, Wanda
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
Seritan, Andreea L.; Ortigas, Melina; Seritan, Stefan; Bourgeois, James A.; Hagerman, Randi J.
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
Sarkar, Jaydip; Murthy, Pratima; Singh, Swaran P
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
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…
Wolf, Abraham W.; And Others
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,…
Ward, M; Cowman, S
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
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
Zivin, Kara; Ganoczy, Dara; Pfeiffer, Paul N.; Miller, Erin M.; Valenstein, Marcia
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
Segraves, R T
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
Ghanizadeh, Ahmad; Mohammadi, Mohammad Reza; Moini, Rozita
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…
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
Driesen, Babiche E. J. M.; Merten, Hanneke; Ludikhuize, Jeroen; van der Spoel, Johannes I.; Kramer, Mark H. H.; Nanayakkara, Prabath W. B.
Background An unplanned ICU admission of an inpatient is a serious adverse event (SAE). So far, no in depth-study has been performed to systematically analyse the root causes of unplanned ICU-admissions. The primary aim of this study was to identify the healthcare worker-, organisational-, technical,- disease- and patient- related causes that contribute to acute unplanned ICU admissions from general wards using a Root-Cause Analysis Tool called PRISMA-medical. Although a Track and Trigger System (MEWS) was introduced in our hospital a few years ago, it was implemented without a clear protocol. Therefore, the secondary aim was to assess the adherence to a Track and Trigger system to identify deterioration on general hospital wards in patients eventually transferred to the ICU. Methods Retrospective observational study in 49 consecutive adult patients acutely admitted to the Intensive Care Unit from a general nursing ward. 1. PRISMA-analysis on root causes of unplanned ICU admissions 2. Assessment of protocol adherence to the early warning score system. Results Out of 49 cases, 156 root causes were identified. The most frequent root causes were healthcare worker related (46%), which were mainly failures in monitoring the patient. They were followed by disease-related (45%), patient-related causes (7, 5%), and organisational root causes (3%). In only 40% of the patients vital parameters were monitored as was instructed by the doctor. 477 vital parameter sets were found in the 48 hours before ICU admission, in only 1% a correct MEWS was explicitly documented in the record. Conclusions This in-depth analysis demonstrates that almost half of the unplanned ICU admissions from the general ward had healthcare worker related root causes, mostly due to monitoring failures in clinically deteriorating patients. In order to reduce unplanned ICU admissions, improving the monitoring of patients is therefore warranted. PMID:27537689
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…
Schwarzbold, Marcelo; Diaz, Alexandre; Martins, Evandro Tostes; Rufino, Armanda; Amante, Lúcia Nazareth; Thais, Maria Emília; Quevedo, João; Hohl, Alexandre; Linhares, Marcelo Neves; Walz, Roger
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
Matson, J L; Zeiss, A M; Zeiss, R A; Bowman, W
Twelve chronic psychiatric patients were treated with either social skills training or contingent attention to improve behavioural assets or deficits noted on the ward by independently trained raters blind to experimental conditions. Treatment was applied across groups using a multiple-baseline format. Inspection of the data revealed that clinically significant improvements in socially appropriate assets and deficits observed on the ward resulted with social skills training but no substantiative change accrued due to the contingent attention. The behaviours selected for treatment were those which staff were most willing to reinforce. This variable may account, in part at least, for the generalization of treatment effects to the natural environment with persons who received social skills training. PMID:7357230
Little-Upah, Pat; Carson, Chris; Williamson, Robert; Williams, Tom; Cimino, Michael; Mehta, Neena; Buehrle, Jeff; Kisiel, Steve
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
Spaulding, W D; Fleming, S K; Reed, D; Sullivan, M; Storzbach, D; Lam, M
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
: Editor's note: From its first issue in 1900 through to the present day, AJN has unparalleled archives detailing nurses' work and lives over more than a century. These articles not only chronicle nursing's growth as a profession within the context of the events of the day, but they also reveal prevailing societal attitudes about women, health care, and human rights. Today's nursing school curricula rarely include nursing's history, but it's a history worth knowing. To this end, From the AJN Archives highlights articles selected to fit today's topics and times.This month's article, from the June 1926 issue, offers ideas "by which we hope to make ward experiences of more value to the student." Author Mina A. McKay originally presented this material at a meeting of the Massachusetts State League of Nursing Education. She calls for more comprehensive morning and evening reports ("not just a mere reading of… orders"), the use of student experience records, ward clinics ("the type of bedside talk which supplements class room lectures"), and case reports presented by the students themselves. Efforts to improve clinical nursing education are ongoing, and in "'Flipping' the Classroom" in this month's AJN, Diane M. Billings describes a relatively new way of translating clinical concepts into practice. PMID:27560341
Durrell, P. R.; Young, W.; Pirko, R.; Shanks, S. L.; Neiheisel, J.; Dean, M. E.; Kotel, R.; Schaefer, S.; Morlan, R.; Wilson, A.; Feldmeier, J. J.
We report on recent progress and future public outreach plans in light of a significant upgrade of the Ward Beecher Planetarium at Youngstown State University. Over a period of 40 years, the facility has been a first-rate 150 seat planetarium and introductory astronomy classroom, and in its history has seen over 50 000 undergraduate students and over 750 000 visits from people in the surrounding area and beyond. Through a recent generous donation from the Ward Beecher Foundation, we have added the SciDome full-dome visualization system, and soon will be replacing our Spitz A3P planetarium star projector. These upgrades, in addition to new digital video projectors and a complete overhaul of our roof-top observatory, are being done in order to further enhance both the education of YSU students and our ability to continue numerous public outreach programs, including full-dome digital planetarium shows, public observing, shows for both elementary and high school students, and home-schooling programs.
Lurkittikul, N.; Kittithreerapronchai, O.
The aging population and the introduction of Thailand universal healthcare have increased inpatients and outpatients to public hospitals, particularly to a hospital that provides special and comprehensive health services. Many inpatient wards have experienced large influx of inpatients as the hospitals have to admit all patients regardless their conditions. These overcrowding wards cause stress to medical staffs, block access between medical departments, hospital-acquired infections, and ineffective uses of resources. One way to manage such inundated inpatient is to select some patients whose conditions require less clinical attention or whose lengths of stay are predictable and short and, then, place them at an observation ward. This intermediate ward increases turnover of beds and reduces unnecessary paperwork as patients are considered to be outpatients. In this article, we studied inpatient data of a tertiary care hospital in which an observation ward was considered to alleviate the overcrowding problem at Internal Medicine Department. The analysis of data showed that the hospital can balance inpatient flow by managing a group of patients who is admitted because of treatments ordered by its special clinics. Having explored several alternatives, we suggested patient selection criteria and proposed a layout at an observation ward. The hospital should increase medical beds in a new building ward because the current observation ward can handle 27.3% of total short stay patients, while the observation ward is projected to handle 80% of total short stay patients.
Kivimäki, M; Voutilainen, P; Koskinen, P
This study investigated work motivation and job satisfaction at hospital wards with high and low levels of job enrichment. Primary nursing was assumed to represent a highly enriched job, whereas functional nursing represented a job with a low level of enrichment. Five surgical wards were divided into these two categories based on the structured interviews with head nurses. Work motivation and job satisfaction among ward personnel were assessed by a questionnaire. The ward personnel occupying highly enriched jobs reported significantly higher work motivation and satisfaction with the management than the personnel occupying jobs with a low level of enrichment. PMID:7735655
The international congress called "Birth Quality-Life Quality" has been a key scientific event in Poland resulting in great changes in perinatal care. Improvements in the quality of care at maternity wards were not limited to purely medical issues. Attention became increasingly focused on psycho-social problems of women after parturition. Emphasis is now directed to support by the doctors and nurses and efforts to acquaint young mothers with the benefits of natural feeding, as well as to prepare them for taking good care of their child. Social support is seen as an important tool in the improvement of care over the mother and child. The present study has classified social support according to J. House as informational, emotional, instrumental and worthing. Informational support consists of methods to cope with specific problems that require delivery of information and teaching of new skills. Emotional support focuses on demonstrating care, winning trust and showing empathy. Instrumental support is reflected by delivery of goods or services to persons in need. Finally, worthing support aims at promoting self-esteem. The aim of this study was (1) to analyze the determinants of informational, emotional, instrumental and worthing support and to compare the needs for different types of support among primiparas and multiparas at an obstetrics ward with the rooming-in system; (2) to study correlations between availability and demand for social support; (3) to determine the expectations of patients as to sources of informational, emotional, instrumental and worthing support and as to methods and means used during delivery of informational support. The study was done in a group of 200 women giving birth at the Department of Obstetrics and Perinatology, Pomeranian Medical University in Szczecin. A special questionnaire was developed to determine the needs for support. A modified Social Support Score was also used. It was found that the demand for all determinants of
Sambhi, R; Lepping, P
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
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
Prasad, Venkat L.
Deliberate injection of mercury, especially subcutaneous injection, is rare but is seen in psychiatric patients, individuals who attempt suicide, those who are accidentally injected, and boxers who wish to build muscle bulk. Metallic mercury plays a major role in ethnic folk medicine. Neurologic and renal complications can result from high systemic levels of mercury, and subcutaneous injection usually results in sterile abscesses. Urgent surgical evacuation and close monitoring for neurologic and renal functions as well as chelation (if toxicity is indicated) are key aspects of treatment. Education of the adverse effects and dangers of mercury is important, especially in pregnant women and children. As increased immigration changes demographic patterns, proper disposal of mercury and preventing its sale and use should become urgent societal priorities. Psychiatric consultation should be obtained whenever appropriate. PMID:15345347
Godfrey, P S; Toone, B K; Carney, M W; Flynn, T G; Bottiglieri, T; Laundy, M; Chanarin, I; Reynolds, E H
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
"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
Hellier, Cyril; Tully, Vicki; Forrest, Sandra; Jaggard, Pamela; MacRae, Morag; Habicht, Dirk; Greene, Alexandra; Collins, Karen
The priority to ensure patient safety and use resources effectively, demands attention and innovation. Video enhanced reflective practice (VERP) provides training based upon analysis of film clips of one's professional practice to develop practical insight into the processes of communication, so that effective changes can be made to ongoing behaviour and practice. In this case the focus was on multi-disciplinary communication within daily board rounds on an acute medicine and care of the elderly ward. Baseline assessment and post intervention testing of perceptions of change by both full and core team were undertaken to establish the impact of VERP training. In addition pre and post focus group discussion and film analysis supplemented evaluation. The findings support the view that after VERP training of a core team, board rounds were seen as consistently easier to participate in, providing improved focus, were more efficient in goal setting and resulting in better care for patients as well as improved pathways to discharge. This suggests benefits to the communication “culture” of a multidisciplinary team resulting in increased benefits for the wider team. It is concluded that the use of tailored VERP training for personal, professional and team development is relevant, feasible, and worthy of further testing and investigation. PMID:26734342
Doherty, Tanya; Kroon, Max; Rhoda, Natasha; Sanders, David
South Africa (SA) has emerged from the Millennium Development Goal era with a mixture of success and failure. The successful national scale-up of prevention of mother-to-child transmission of HIV services with increasingly efficacious antiretroviral regimens has reduced the mother-to-child transmission rate dramatically; however, over the same period there appears to have been no progress in coverage of high-impact interventions for pneumonia and diarrhoea, which are now leading causes of under-5 mortality. SA embarked on a strategy to re-engineer the primary healthcare system in 2011, which included the creation of ward-based outreach teams consisting of community health workers (CHWs). In this article we argue that the proposed ratio of CHWs to population is too low for public health impact and that the role and scope of CHWs should be extended beyond giving of health information to include assessment and treatment of childhood illnesses (particularly diarrhoea and suspected pneumonia). Evidence and experience amply demonstrate that CHWs in sufficient density can have a rapid and positive impact on neonatal and young child mortality, especially when they are allowed to treat common acute conditions. SA's mediocre performance in child survival could be dramatically improved if there were more CHWs who were allowed to do more. PMID:27384356
Kalra, G.; Desousa, A.
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
Anand, R.; Trivedi, J.K.; Gupta, S.C.
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
Hashimoto, R; Ohi, K; Yamamori, H; Yasuda, Y; Fujimoto, M; Umeda-Yano, S; Watanabe, Y; Fukunaga, M; Takeda, M
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
Hashimoto, R; Ohi, K; Yamamori, H; Yasuda, Y; Fujimoto, M; Umeda-Yano, S; Watanabe, Y; Fukunaga, M; Takeda, M
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
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
Kang, Eunchai; Wen, Zhexing; Song, Hongjun; Christian, Kimberly M; Ming, Guo-Li
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
Kendler, Kenneth S
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
Graham, Noni A; Frost-Pineda, Kimberly; Gold, Mark S
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
Yen, Yung-Chieh; Huang, Chih-Kuan; Tai, Chi-Ming
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
Brunner, Marcus; Abramowicz, Henrik; Niebert, Norbert; Correia, Luis M.
In this paper, we describe several approaches to address the challenges of the network of the future. Our main hypothesis is that the Future Internet must be designed for the environment of applications and transport media of the 21st century, vastly different from the initial Internet's life space. One major requirement is the inherent support for mobile and wireless usage. A Future Internet should allow for the fast creation of diverse network designs and paradigms and must also support their co-existence at run-time. We detail the technical and business scenarios that lead the development in the EU FP7 4WARD project towards a framework for the Future Internet.
Just under half of all six-week-old babies in the U.K. are breastfed, and just under a quarter are still being breastfed at six months old so it is likely that children's nurses will frequently encounter breastfed babies on children's wards. Support for breastfeeding has traditionally been left to midwives but Department of Health guidance requires that all relevant staff have training in this practice. Children's nurses need to understand the principles and practice of breastfeeding support including correct positioning and attachment, prevention and management of breastfeeding problems, mothers' needs and safe use of breast pumps. Breastfeeding should be part of the curriculum for children's nursing courses, including practical sessions to observe breastfeeding support in the clinical setting. Children's nurses should be aware that literature and learning resources written for midwives might be appropriate for them to access to increase their understanding in this important area of practice. PMID:17326552
Manninen, Katri; Henriksson, Elisabet Welin; Scheja, Max; Silen, Charlotte
Purpose: This study aims to explore and understand first year nursing students' experiences of learning at a clinical education ward. Design/methodology/approach: The setting is a clinical education ward for nursing students at a department of infectious diseases. A qualitative study was carried out exploring students' encounters with patients,…
National Inst. of Law Enforcement and Criminal Justice (Dept. of Justice/LEAA), Washington, DC.
The Ward Grievance Procedure of the California Youth Authority is one of 17 programs that earned the National Institute's "Exemplary" label. This brochure provides the requisite practical information for those who wish to test or consider testing the ward grievance procedure. The program was developed as a way of dealing with the questions raised…
Bate, J. G.
Current trends in ward flooring materials and cleaning methods are considered from the point of view of the hospital bacteriologist. Methods employed in an investigation into the bacteriological safety of a number of floor-cleaning machines are described, and some considerations governing the choice of vacuum cleaners for ward use are discussed. Images PMID:13687726
Library Journal, 2004
This article details the work of Vonda Ward--a middle-school teacher turned librarian. When Vonda Ward was a middle-school teacher, she could not get her students to share her excitement about history because they could not read its stories. That is when she realized how much subject mastery depended on the basics. Broward County Library's leaders…
Bui, Quan M; Simpson, Scott; Nordstrom, Kimberly
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
Bui, Quan M.; Simpson, Scott; Nordstrom, Kimberly
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
Shiraishi, Nariaki; Mizutani, Chiemi; Menjho, Masafumi; Deguchi, Akira; Takase, Koujirou; Hamaguchi, Hitoshi; Kawamura, Youichi; Suzuki, Shigeyuki; Sugimura, Kimiya
We investigated changes in the Activities of Daily Living (ADL) of stroke patients in a convalescent rehabilitation ward and a general ward using a Functional Independent Measure (FIM). The subjects were 109 patients hospitalized for rehabilitation purposes at the Oyamada Memorial Spa Hospital. The change in FIM at the time of hospitalization and that at 1 week later was investigated in 81 patients in the convalescent rehabilitation group (CRG) and 28 patients in the control group (CG). In addition, the CRG was investigated again after one month. Intensive rehabilitation service based on ADL and worksheets was introduced in the CRG. On the other hand, these were not introduced in the CG. The total score of FIM increased significantly (p<0.01) in the first week after hospitalization in both groups. The FIM-gain after one week in the CRG was high. With regard to each item, a significant improvement was observed in patients' motor skills while eating, grooming, bathing, dressing the upper body, dressing the lower body, toilet, bladder management, transfer bed/chair, toilet and tub, and walking/wheelchair (11/13). Multiple regressions were used to assess the relationships between FIM-gain (one week, one month), age, rehabilitation intensity and other predictive variables. Better rehabilitation outcomes were observed in patients with lower level of dementia and high rehabilitation intensity. It was thought that planned rehabilitation based on ADL was effective in the CRG, and it was suggested that the CRG's system is effective in the rehabilitation of stroke patients. PMID:15651383
Ridenour, Marilyn; Lanza, Marilyn; Hendricks, Scott; Hartley, Dan; Rierdan, Jill; Zeiss, Robert; Amandus, Harlan
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
Crossley, Nicolas A.; Scott, Jessica; Ellison-Wright, Ian; Mechelli, Andrea
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
Martiny, Klaus; Refsgaard, Else; Lund, Vibeke; Lunde, Marianne; Sørensen, Lene; Thougaard, Britta; Lindberg, Lone; Bech, Per
Background This paper reports day-to-day data for from a one-week intervention phase, part of a 9-weeks randomised parallel study with patient having major depression (data from weekly visits have been reported). Wake therapy (sleep deprivation) has an established antidepressant effect with onset of action within hours. Deterioration on the following night’s sleep is, however, common, and we used daily light therapy and sleep time stabilisation as a preventive measure. In particular, we evaluated the day-to-day acute effect of and tolerance to sleep deprivation and examined predictors of response. Methods Patients were assessed at psychiatric inpatient wards. In the wake group (n = 36), patients did three wake therapies in combination with light therapy each morning together with sleep time stabilisation. In the exercise group (n = 38), patients did daily exercise. Hamilton subscale scores were primary outcome (not blinded), secondary outcome was self-assessment data from the Preskorn scale and sleep. Results Patients in the wake therapy group had an immediate, large, stable, and statistically significant better antidepressant effect than patients in the exercise group with response rates at day5 of 75.0%/25.1% and remission rates of 58.6%/6.0%, respectively. The response and remission rates were diminished at day8 with response rates of 41.9%/10.1% and remission rates of 19.4%/4.7%, respectively. Patients and ward personnel found the method applicable with few side effects. Positive diurnal variation (mood better in the evening) predicted a larger response to wake therapy. In the wake group napping on days after intervention predicted greater deterioration on day8. Conclusions The intervention induced an acute antidepressant response without relapse between wake nights but with a diminishing effect after intervention. Development is still needed to secure maintenance of response. Avoiding napping in the days after wake therapy is important. Trial
Kurkjian, Natalie; Tucker, Phebe
A 24-year-old Caucasian female, DD, was admitted to the medical service at an academic hospital with symptoms of weakness in bilateral lower extremities, falls, headaches, and altered mental status. Psychiatry was consulted to evaluate for psychiatric causes of her symptoms. This case presented a diagnostic challenge as the patient's identified symptoms changed almost daily, depending on what practitioner or medical service she encountered. In this study, we discuss the differential diagnoses, tests and treatments the patient received, with a review of literature helping differentiate between diagnostic parameters. PMID:27027143
Vitaliani, Roberta; Mason, Warren; Ances, Beau; Zwerdling, Theodore; Jiang, Zhilong; Dalmau, Josep
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
Lee, Yoo Jin; Kim, Eun Soo; Park, Kyung Sik; Cho, Kwang Bum; Jang, Byoung Kuk; Chung, Woo Jin; Hwang, Jae Seok
Although adequate bowel preparation is a prerequisite for colonoscopy, preparation among inpatients is often suboptimal. This study aimed to evaluate the impact of ward nurse education on the quality of bowel preparation of inpatients.A prospective, double-blinded, non-randomized, controlled study was performed. Expert endoscopists provided enhanced education to nurses who belonged to an "educated ward" followed by training that was repeated every week for 1 month. The primary outcome was the quality of the bowel preparation, which was based on the Ottawa Bowel Preparation Scale (OBPS). Patient compliance and their subjective feelings and the factors affecting inadequate bowel preparation were also analyzed.One hundred three inpatients in the educated ward and 102 patients in the control ward were enrolled. Baseline data were comparable between the 2 wards. The mean values of the total OBPS scores were 4.42 ± 2.23 and 6.15 ± 2.38 in the educated and control wards, respectively (P < 0.001). The rate of poor preparation (OBPS ≥ 6) in the educated ward was significantly lower than that in the control ward (31.1% vs 58.8%, P < 0.001). Compliance with preparation and diet instructions in the educated ward was superior to that in the control ward (P<0.001). Control patients were more likely to be anxious before colonoscopy (P < 0.001), whereas patients in the educated ward showed higher level of satisfaction (P = 0.001) and better sleep quality (P < 0.001). A lack of ward nurse education (OR 2.365, P = 0.025), constipation (OR 6.517, P < 0.001), and insufficient water ingestion (OR 2.044, P = 0.042) were independently associated with inadequate bowel preparation among inpatients.Ward nurse education effectively improved the quality of bowel preparation, and relevant colonoscopic outcomes among inpatients. Additional efforts are needed to control constipation and to encourage additional water ingestion in inpatients for
Nishio, Ayako; Sumi, Takuro; Yamada, Masato; Kuwahata, Yuko
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
Wolfersdorf, M; Bahnmüller, J; Bretschneider, S; Brisch, U H; Freeman, G; Heuft, H; Heuft, G; Hrubesch, C; Jontza, T; Keller, F
New therapeutic concepts are usually developed and realised step by step. Over the past years changes occurred mainly in two ways. There is a trend to reduce the size of the psychiatric hospital as such and/or to section off certain areas by introducing specialised units. From the experience with the so called "Affective Disorder Units" or "Mood Clinics" developed the concept of a Depression Unit, first introduced in Europe for research purposes at the Psychiatric University Hospital in Basle in 1968. In Germany the first Depression Unit was established at the PLK Weissenau in 1976. Similar units followed over the years at the PLK Reichenau, Weinsberg, the BKH Günzburg, the Landesklinik Nordschwarzwald Hirsau/Calw and the Rheinische Landesklinik Bedburg-Hau, other hospitals are planning them. Existing units are described in terms of their structural organisation, staffing situation and the service they provide. The concept of the Depression Unit according to criteria laid down agreed upon in the literature is summed up, and emotional atmosphere, structural organisation, activation, and individual therapeutic measures, discussed. Advantages are mentioned such as better understanding of patients, allowing them to let go and be cared for, aimed regression, the effects of being taken along, improved communication, and a way of dealing with suicidal thoughts and depressive behavior that reduces anxiety. Disadvantages such as the danger of spoiling patients or inducing a sense of resignation both in patients and staff are discussed. PMID:3043523
Mazefsky, Carla A.; Oswald, Donald P.; Day, Taylor N.; Eack, Shaun M.; Minshew, Nancy J.; Lainhart, Janet E.
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…
Xie, Hui; Kang, Jian
The patients in the Intensive Care Units are often exposed to excessive levels of noise and activities. They can suffer from sleep disturbance, especially at night, but they are often too ill to cope with the poor environment. This article investigates the acoustic environment of typical intensive care wards in the UK, based on long period nocturnal measurements, and examines the differences between singlebed and multibed wards, using statistical analysis. It has been shown that the acoustic environment differs significantly every night. There are also significant differences between the noise levels in the singlebed and multibed wards, where acoustic ceilings are present. Despite the similar background noises in both ward types, more intrusive noises tend to originate from the multibed wards, while more extreme sounds are likely to occur in the single wards. The sound levels in the measured wards for each night are in excess of the World Health Organization's (WHO) guide levels by at least 20 dBA, dominantly at the middle frequencies. Although the sound level at night varies less than that in the daytime, the nocturnal acoustic environment is not dependant on any specific time, thus neither the noisiest nor quietest period can be determined. It is expected that the statistical analysis of the collected data will provide essential information for the development of relevant guidelines and noise reduction strategies. PMID:23117538
Cameron-Buccheri, R; Ogier, M E
The nurse manager/ward sister role is becoming endangered as many of these nurses are being asked to take fiscal and personnel responsibility for multiple units/programmes and supervise more non-registered nursing staff. Loss of this important nurse manager/ward sister role could severely decrease nursing's voice in the development and implementation of policies that affect nurses and the care they deliver. The authors review 20 years of literature from both the USA and the UK regarding supportive supervision and the role of the nurse manager/ward sister. Nurse managers/ward sisters were found to be key individuals within the entire health-care organization. Nurse managers/ward sisters can empower the nurses they supervise to initiate changes that will improve patient care. Nurse managers/ward sisters can also improve the working conditions and thus increase the job satisfaction and retention of those they supervise. Strategies for being more supportive of these overworked and endangered nurse managers/ward sisters are suggested. PMID:8055167
Nikendei, C.; Huhn, D.; Pittius, G.; Trost, Y.; Bugaj, T. J.; Koechel, A.; Schultz, J.-H.
Introduction: Ward rounds are an essential activity for interprofessional teams in hospital settings and represent complex tasks requiring not only medical knowledge but also communication skills, clinical technical skills, patient management skills and team-work skills. The present study aimed to analyse final year students’, nurses’ as well as physiotherapists’ views on a simulation-based interprofessional ward round training. Methods: In two successive passes a total number of 29 final year students, nursing students and physiotherapy students (16 in the first run, 13 in the second) volunteered to participate in two standardized patient ward round scenarios: (1) patient with myocardial infarction, and (2) patient with poorly controlled diabetes. Views on the interprofessional ward round training were assessed using focus groups. Results: Focus group based feedback contained two main categories (A) ward round training benefits and (B) difficulties. Positive aspects enfolded course preparation, setting of the training, the involvement of the participants during training and the positive learning atmosphere. Difficulties were seen in the flawed atmosphere and realization of ward rounds in the daily clinical setting with respect to inter-professional aspects, and course benefit for the different professional groups. Conclusion: The presented inter-professional ward round training represents a well received and valuable model of interprofessional learning. Further research should assess its effectiveness, processes of interprofessional interplay and transfer into clinical practice. PMID:27280125
Waldinger, Marcel D
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
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
Rudnick, Abraham; Eastwood, Diane
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
Peña, Catherine J; Bagot, Rosemary C; Labonté, Benoit; Nestler, Eric J
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
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
Hadjipavlou, George; Hernandez, Carlos A Sierra; Ogrodniczuk, John S
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
Peña, Catherine J; Bagot, Rosemary C; Labonté, Benoit; Nestler, Eric J
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
Lee, Yoo Jin; Kim, Eun Soo; Park, Kyung Sik; Cho, Kwang Bum; Jang, Byoung Kuk; Chung, Woo Jin; Hwang, Jae Seok
Abstract Although adequate bowel preparation is a prerequisite for colonoscopy, preparation among inpatients is often suboptimal. This study aimed to evaluate the impact of ward nurse education on the quality of bowel preparation of inpatients. A prospective, double-blinded, non-randomized, controlled study was performed. Expert endoscopists provided enhanced education to nurses who belonged to an “educated ward” followed by training that was repeated every week for 1 month. The primary outcome was the quality of the bowel preparation, which was based on the Ottawa Bowel Preparation Scale (OBPS). Patient compliance and their subjective feelings and the factors affecting inadequate bowel preparation were also analyzed. One hundred three inpatients in the educated ward and 102 patients in the control ward were enrolled. Baseline data were comparable between the 2 wards. The mean values of the total OBPS scores were 4.42 ± 2.23 and 6.15 ± 2.38 in the educated and control wards, respectively (P < 0.001). The rate of poor preparation (OBPS ≥ 6) in the educated ward was significantly lower than that in the control ward (31.1% vs 58.8%, P < 0.001). Compliance with preparation and diet instructions in the educated ward was superior to that in the control ward (P<0.001). Control patients were more likely to be anxious before colonoscopy (P < 0.001), whereas patients in the educated ward showed higher level of satisfaction (P = 0.001) and better sleep quality (P < 0.001). A lack of ward nurse education (OR 2.365, P = 0.025), constipation (OR 6.517, P < 0.001), and insufficient water ingestion (OR 2.044, P = 0.042) were independently associated with inadequate bowel preparation among inpatients. Ward nurse education effectively improved the quality of bowel preparation, and relevant colonoscopic outcomes among inpatients. Additional efforts are needed to control constipation and to encourage additional water ingestion in
Thompson, A; Jacob, K; Fulton, J; McGavin, C
The post-take ward round is a critical time for reviewing the initial history, examination and results, and the stage at which further treatment and investigations will be determined. However documentation of this ward round is often inadequate, so the benefits of decision making are lost. The documentation of 95 ward rounds was assessed for key items of information before and after the introduction of a proforma sheet. The introduction of the proforma led to a significant improvement in the documentation of a diagnosis, management plan, prophylaxis for deep vein thrombosis, and resuscitation status (p<0.05), which will have a significant impact on patient care. PMID:15537856
Neubauer, Katharina M.; Höll, Bernhard; Aberer, Felix; Donsa, Klaus; Augustin, Thomas; Schaupp, Lukas; Spat, Stephan; Beck, Peter; Fruhwald, Friedrich M.; Schnedl, Christian; Rosenkranz, Alexander R.; Lumenta, David B.; Kamolz, Lars-Peter; Plank, Johannes; Pieber, Thomas R.
Abstract Background: This study investigated the efficacy, safety, and usability of standardized glycemic management by a computerized decision support system for non-critically ill hospitalized patients with type 2 diabetes on four different wards. Materials and Methods: In this open, noncontrolled intervention study, glycemic management of 99 patients with type 2 diabetes (62% acute admissions; 41 females; age, 67±11 years; hemoglobin A1c, 65±21 mmol/mol; body mass index, 30.4±6.5 kg/m2) on clinical wards (Cardiology, Endocrinology, Nephrology, Plastic Surgery) of a tertiary-care hospital was guided by GlucoTab® (Joanneum Research GmbH [Graz, Austria] and Medical University of Graz [Graz, Austria]), a mobile decision support system providing automated workflow support and suggestions for insulin dosing to nurses and physicians. Results: Adherence to insulin dosing suggestions was high (96.5% bolus, 96.7% basal). The primary outcome measure, percentage of blood glucose (BG) measurements in the range of 70–140 mg/dL, occurred in 50.2±22.2% of all measurements. The overall mean BG level was 154±35 mg/dL. BG measurements in the ranges of 60–70 mg/dL, 40–60 mg/dL, and <40 mg/dL occurred in 1.4%, 0.5%, and 0.0% of all measurements, respectively. A regression analysis showed that acute admission to the Cardiology Ward (+30 mg/dL) and preexisting home insulin therapy (+26 mg/dL) had the strongest impact on mean BG. Acute admission to other wards had minor effects (+4 mg/dL). Ninety-one percent of the healthcare professionals felt confident with GlucoTab, and 89% believed in its practicality and 80% in its ability to prevent medication errors. Conclusions: An efficacious, safe, and user-accepted implementation of GlucoTab was demonstrated. However, for optimized personalized patient care, further algorithm modifications are required. PMID:26355756
Yeo, Jing Ming
International efforts have mandated guidelines on antibiotic use and prescribing, therefore the focus is now on encouraging positive behavioral changes in antibiotic prescribing practice. Documentation of indication and intended duration of antibiotic use in drug charts is an evidence-based method of reducing inappropriate antibiotic prescribing. It is also a standard detailed in our local antimicrobial guidelines. We collected baseline data on compliance with documentation of indication and duration in drug charts in a respiratory ward which revealed compliance rates of 24% and 39% respectively. We introduced interventions to improve accessibility to the guideline and to increase awareness by distributing antibiotic guardian pocket cards with a three-point checklist and strategically-placed mini-posters. We also aim to increase team motivation by obtaining their feedback in multidisciplinary team meetings and by introducing certificates for their involvement in the quality improvement process. The results of the second cycle post-intervention showed an increase in compliance rates for documentation of indication and duration of 97% and 69% respectively. After a further awareness and discussion session at the multidisciplinary team meeting with the local antimicrobial management team audit nurses, a third cycle showed compliance rates of 94% and 71% for indication and duration respectively. This project has highlighted the importance of improving accessibility and of encouraging interventions that would bring about a change in personal value and subsequently in behavior and individual practice. PMID:26893898
Walton, Karen; Williams, Peter; Tapsell, Linda; Hoyle, Matthew; Shen, Zhi Wei; Gladman, Lauren; Nurka, Martin
Malnutrition is common in long-stay elderly hospitalized patients and their dietary intakes are often poor, despite the provision of adequate quantities of food to meet patient needs. The aim of this study was to identify environmental factors that were associated with achieving adequate food consumption in a hospital context. This study observed the daily routines of 30 elderly patients over 2days in rehabilitation wards in three Australian hospitals. All activities associated with mealtimes were recorded, from the commencement of breakfast to the conclusion of supper at the end of the day. Four key themes emerged: the eating location; assistance given at meals; negative and positive interruptions. The time taken to eat meals averaged 22min, ranging from 3 to 55min. Food intakes appeared to be better when meals were consumed communally in a dining room. There were many occasions when patients needed more assistance to eat than was available. The most common factors negatively affecting meal consumption were medication rounds, inappropriate placement of trays, packaging being hard to open, and patient showering. The presence of visitors, dietitians and nutrition assistants appeared to improve dietary intakes. Trials of protected mealtimes in Australian hospitals are certainly important and timely. PMID:23523667
Using the Batalin-Vilkovisky formalism, we study the Ward identities and the equations of gauge dependence in potentially anomalous general gauge theories, renormalizable or not. A crucial new term, absent in manifestly nonanomalous theories, is responsible for interesting effects. We prove that gauge invariance always implies gauge independence, which in turn ensures perturbative unitarity. Precisely, we consider potentially anomalous theories that are actually free of gauge anomalies thanks to the Adler-Bardeen theorem. We show that when we make a canonical transformation on the tree-level action, it is always possible to re-renormalize the divergences and re-fine-tune the finite local counterterms, so that the renormalized Γ functional of the transformed theory is also free of gauge anomalies, and is related to the renormalized Γ functional of the starting theory by a canonical transformation. An unexpected consequence of our results is that the beta functions of the couplings may depend on the gauge-fixing parameters, although the physical quantities remain gauge independent. We discuss nontrivial checks of high-order calculations based on gauge independence and determine how powerful they are.
De Regge, M; Monsieurs, K G; Vandewoude, K; Calle, P A
Automated external defibrillators (AEDs) have shown to improve survival after cardiopulmonary arrest (CPA) in many, but not all clinical settings. A recent study reported that the use of AEDs in-hospital did not improve survival. The current retrospective study reports the results of an in-hospital AED programme in a university hospital, and focuses on the quality of AED use. At Ghent University Hospital 30 AEDs were placed in non-monitored hospital wards and outpatient clinics treating patients with non-cardiac problems. Nurses were trained to use these devices. From November 2006 until March 2011, the AEDs were used in 23 of 39 CPA cases, in only one patient the presenting heart rhythm was ventricular fibrillation and this patient survived. Pulseless electrical activity was present in 14 patients (four survived) and asystole in eight patients (one survived). AEDs were attached to eight patients without CPA, and in 16 patients with CPA AED was not used. The quality of AED use was often suboptimal as illustrated by external artifacts during the first rhythm analysis by the AED in 30% (7/23) and more than 20 seconds delay before restart of chest compressions after the AED rhythm analysis in 50% (9/18). The literature data, supported by our results, indicate that in-hospital AED programmes are unlikely to improve survival after CPA. Moreover, their use is often suboptimal. Therefore, if AEDs are introduced in a hospital, initial training, frequent retraining and close follow-up are essential. PMID:23019797
Wagoro, M C A; Othieno, C J; Musandu, J; Karani, A
To explore structure and process factors which influence patients' perception of quality inpatient psychiatric nursing care at Mathari hospital. This was a cross-sectional study of 236 inpatients selected by stratified random sampling. Competence to give consent was determined by a minimum score of 24 on Mini Mental State Examination. Patients were interviewed using a semi-structured questionnaire. Differences in proportions of variables were determined by calculating confidence interval and summary chi-squared statistics. P-values of < or =0.05 were considered significant. Majority of patients (87%) were aged 20-49 years with 43% having stayed in the ward for over a month. Structure factors related to patients' perception of care included physical environment, being happy with the way the ward looked was significantly related to satisfaction with care (chi(2) = 5.506, P = 0002). Process factors significantly related to patients' satisfaction with care included nurses providing patients with information on prescribed medicines (chi(2) = 10.50, P = 00012). Satisfaction with care was positively related to ability to recommend someone for admission in the same ward (chi(2) = 20.2, P = 00001). Structure and process factors identified as influencing patients' perception of care were physical environment and nurses' qualities that fit within the characteristics of Peplau's Interpersonal Relations Theory. PMID:18307654
DeBar, Lynn L; Lynch, Frances L; Boles, Myde
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
Rabenschlag, Franziska; Hoffmann, Sven; Kozel, Bernd; Sprenger, Rosmarie
In the interdisciplinary treatment process nurses play an important role, assessing suicide risk. To cope with this responsibility, the use of assessment instruments is recommended. Although a lot of instruments exist to assess the risk of suicide, nurses do not use them consistently. This cross-sectional study seeks to answer the following questions: How do nurses assess the suicidality of patients of psychiatric hospitals in the German speaking part of Switzerland? Do they use assessment instruments and if so, which ones? Ward nurses in every psychiatric hospital (n = 32) were asked about the state of the nursing practice in assessing the suicide risk by means of an electronic questionnaire. The following results emerged: Nurses use instruments to assess suicide risk on about half of the wards (n = 119, 50.63%). 13% of the mentioned instruments are research-based. Nurses mostly assess suicide endangerment in the case of a presumed danger, less often at admission and least often during the discharge process. As suicidality is assessed mostly when nurses assume a danger in this study, and due to the fact that suicides most frequently occur shortly prior to or during the discharge process, an expansion of or the introduction of the assessment is recommended before the discharge process. PMID:23876661
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…
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…
Ghosh, Sreyoshi; Behere, Rishikesh V; Sharma, PSVN; Sreejayan, K
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
Luo, John S.; Ton, Hendry
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…
Fazzito, Mirella Martins; Jordy, Sérgio Semeraro; Tilbery, Charles Peter
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
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…
Talbott, John A.; Sacks, Michael
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…
Carter, Gregory L.; Safranko, Ivan; Lewin, Terry J.; Whyte, Ian M.; Bryant, Jennifer L.
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:…
Ramtekkar, Ujjwal; Ivanenko, Anna
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
Sarin, Alok; Murthy, Pratima; Chatterjee, Sudipto
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
Kerr, David C. R.; Washburn, Jason J.; Feingold, Alan; Kramer, Anne C.; Ivey, Asha Z.; King, Cheryl A.
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…
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
Ramchandani, Paul; Psychogiou, Lamprini
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
de Schutter, Marja A M; Kramer, Hein J M Th; Franken, Ernest J F; Lodewijkx, Hein F M; Kleinepier, Tom
Current approaches in Dutch mental health care institutions towards inpatients' aggression have focused predominantly on environmental factors, such as training the staff in aggression management. However, personality traits might be an important factor in patients' aggression - as shown by incidents in the wards. This study explores the influence of dysfunctional impulsivity and alexithymia on psychiatric patients' aggressive behavior, through self-reports and through involvement in aggressive incidents. Personality traits influencing patients' aggression emphasize the importance of a more direct approach to their aggression. Clinical patients at Dutch mental health care institution Emergis (n=84) filled out questionnaires about their aggressiveness (using Buss and Perry's Aggression Questionnaire Short Form), dysfunctional impulsivity and alexithymia. Multiple regression analyses indicated that dysfunctional impulsivity positively related to self-reported aggressive behavior. The relationship, however, could not be confirmed for inpatients' aggression as reported by the staff on the wards. Unexpectedly affective alexithymia negatively related to hostility. Gender differences in self-reported aggression were found. Female patients showed higher levels of hostility. Regression analyses indicated that the male gender positively related to physical aggression. Findings emphasize the importance of a new approach in Dutch mental health care, in which patients may engage in aggression-regulation training programs. PMID:27387554
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Tovar, Diego; Cornejo, Eduardo; Xanthopoulos, Petros; Guarracino, Mario R; Pardalos, Panos M
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
Erdman, Harold P.; Jefferson, James W.; Greist, John H.; Olson, Warren; Klein, Marjorie H.; Salinger, Robert
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.
Imbert, D; Daubech, M J; Tignol, J; Bourgeois, M
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
Background The organization of nursing services could be important to the quality of patient care and staff satisfaction. However, there is no universally accepted nomenclature for this organization. The objective of the current study was to classify general hospital wards based on data describing organizational practice reported by the ward nurse managers, and then to compare this classification with the name used in the wards to identify the organizational model (self-identification). Methods In a cross-sectional postal survey, 93 ward nurse managers in Norwegian hospitals responded to questions about nursing organization in their wards, and what they called their organizational models. K-means cluster analysis was used to classify the wards according to the pattern of activities attributed to the different nursing roles and discriminant analysis was used to interpret the solutions. Cross-tabulation was used to validate the solutions and to compare the classification obtained from the cluster analysis with that obtained by self-identification. The bootstrapping technique was used to assess the generalizability of the cluster solution. Results The cluster analyses produced two alternative solutions using two and three clusters, respectively. The three-cluster solution was considered to be the best representation of the organizational models: 32 team leader-dominated wards, 23 primary nurse-dominated wards and 38 wards with a hybrid or mixed organization. There was moderate correspondence between the three-cluster solution and the models obtained by self-identification. Cross-tabulation supported the empirical classification as being representative for variations in nursing service organization. Ninety-four per cent of the bootstrap replications showed the same pattern as the cluster solution in the study sample. Conclusions A meaningful classification of wards was achieved through an empirical cluster solution; this was, however, only moderately consistent with
Appelbaum, Paul S
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
Abreu, José Luís Pio Da Costa; Reis, José Pedro Gaspar Dos; Figueiredo, Américo Manuel Da Costa
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
Krautter, Markus; Andreesen, Sven; Köhl-Hackert, Nadja; Hoffmann, Katja; Herzog, Wolfgang; Nikendei, Christoph
Background Peer-assisted learning (PAL) has become a well-accepted teaching method within medical education. However, descriptions of on-ward PAL programs are rare. A focus group analysis of a newly established PAL program on an internal medicine ward was conducted to provide insights into PAL teaching from a student perspective. Purpose To provide insights into students’ experiences regarding their on-ward training with and without accompanying PAL tutors. Methods A total of N=168 medical students in their sixth semester participated in the investigation (intervention group: N=88; control group: N=80). The intervention group took part in the PAL program, while the control group received standard on-ward training. There were seven focus groups with N=43 participants (intervention group: four focus groups, N=28 participants; control group: three focus groups, N=15 participants). The discussions were analyzed using content analysis. Results The intervention group emphasized the role of the tutors as competent and well-trained teachers, most beneficial in supervising clinical skills. Tutors motivate students, help them to integrate into the ward team, and provide a non-fear-based working relationship whereby students’ anxiety regarding working on ward decreases. The control group had to rely on autodidactic learning strategies when neither supervising physicians nor final-year students were available. Conclusion On-ward PAL programs represent a particularly valuable tool for students’ support in training clinical competencies on ward. The tutor–student working alliance acts through its flat hierarchy. Nevertheless, tutors cannot represent an adequate substitute for experienced physicians. PMID:25278789
Calderon, Alvin S.; Blackmore, C. Craig; Williams, Barbara L.; Chawla, Kavita P.; Nelson-Peterson, Dana L.; Ingraham, Michael D.; Smith, Donna L.; Kaplan, Gary S.
Background Traditional “batched” bedside clinical care rounds, where rounds for all patients precede clinical tasks, may delay clinical care and reduce resident work efficiency. Innovation Using Lean concepts, we developed a novel “Rounding-in-Flow” approach, with the patient care team completing all tasks for a single patient before initiating any tasks for the next patient. Outcome measures included timely patient discharge and intern work hours. Methods We performed a retrospective cohort study with historic and contemporaneous control groups, with time series adjustment for underlying temporal trends at a single medical center. Primary outcomes were timely patient discharge orders and resident duty hours. Participants were 17 376 consecutive hospital inpatients between January 1, 2011, and June 30, 2012, and medical ward rounding teams of interns, residents, and attending hospitalists. Results Timely discharge orders, defined as written by 9:00 am, improved from 8.6% to 26.6% (OR, 1.55; 95% CI 1.17–2.06; P = .003). Time of actual patient discharge was unchanged. Resident duty hour violations, defined as less than 10 hours between clinical duties, decreased from 2.96 to 0.98 per intern per rotation (difference, 1.98; 95% CI 1.09–2.87; P < .001). Average daily intern work hours decreased from 12.3 to 11.9 hours (difference, 0.4 hours; 95% CI 0.16–0.69; P = .002). Conclusions Compared with batched rounding, Lean Rounding-in-Flow using “1-piece flow” principles was associated with more discharge orders written before 9:00 am and fewer violations in the 10-hour break rule, with minimal changes to intern total work hours and actual patient discharge time. PMID:26140131
Background Home-based renal replacement therapy (RRT) [peritoneal dialysis (PD) and home hemodialysis (HHD)] offers independent quality of life and clinical advantages compared to conventional in-center hemodialysis. However, follow-up may be less complete for home dialysis patients following a change in care settings such as post hospitalization. We aim to implement a Home Dialysis Virtual Ward (HDVW) strategy, which is targeted to minimize gaps of care. Methods/design The HDVW Pilot Study will enroll consecutive PD and HHD patients who fulfilled any one of our inclusion criteria: 1. following discharge from hospital, 2. after interventional procedure(s), 3. prescription of anti-microbial agents, or 4. following completion of home dialysis training. Clinician-led telephone interviews are performed weekly for 2 weeks until VW discharge. Case-mix (modified Charlson Comorbidity Index), symptoms (the modified Edmonton Symptom Assessment Scale) and patient satisfaction are assessed serially. The number of VW interventions relating to eight pre-specified domains will be measured. Adverse events such as re-hospitalization and health-services utilization will be ascertained through telephone follow-up after discharge from the VW at 2, 4, 12 weeks. The VW re-hospitalization rate will be compared with a contemporary cohort (matched for age, gender, renal replacement therapy and co-morbidities). Our protocol has been approved by research ethics board (UHN: 12-5397-AE). Written informed consent for participation in the study will be obtained from participants. Discussion This report serves as a blueprint for the design and implementation of a novel health service delivery model for home dialysis patients. The major goal of the HDVW initiative is to provide appropriate and effective supports to medically complex patients in a targeted window of vulnerability. Trial registration (NCT01912001). PMID:24528505
Jesmin, Akhter; Rahman, Khan Muhammad Zillur; Muntasir, Maruf Mohammad
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
Richman, J; Mercer, D
This case study elaborates the aftermath of the Blom-Cooper Inquiry (1992), which forced the special hospital, Ashworth, into a radical 'culture change'. To this end, two groups of external consultants--a management consultancy and a professional task force--were introduced into the hospital. Newly established ward managers were to spearhead the organizational change by bringing social and clinical order to the wards over which the higher management had lost control. Few studies have mapped out the interaction between segments of an organization and expert outsiders. In this study, the interaction of the ward manager to the newly appointed external management consultancy and task force was analysed. It was clear that ward managers rated poorly the efforts of the management consultancy and task force--it was considered that they were not giving value for money. The task force rated slightly more favourably than the management consultancy. The fact that the management consultancy did not have ward credibility in this closed forensic setting was attributed to low prestige. The management consultancy also failed to fulfill the organizational ambitions of ward managers, who wished to be central to the hospital's major decision-making process. PMID:11507808
Jensen, Lisa; Clough, Rebecca
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
Zurowski, Mateusz; McDonald, William M; Fox, Susan; Marsh, Laura
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
HUME, P B; RUDIN, E
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
Zschokke, J; Freeberg, M R; Errickson, E
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
Bostrom, Andrea C
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
Mayou, R; Hawton, K
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
Ewalds-Kvist, Beatrice; Algotsson, Martina; Bergström, Annelie; Lützén, Kim
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
Aydemir, O; Ozmen, E; Küey, L; Kültür, S; Yeşil, M; Postaci, N; Bayata, S
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
Hägele, Claudia; Friedel, Eva; Schlagenhauf, Florian; Sterzer, Philipp; Beck, Anne; Bermpohl, Felix; Stoy, Meline; Held-Poschardt, Dada; Wittmann, André; Ströhle, Andreas; Heinz, Andreas
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
Kovács, M; Juranovics, J
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
... 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 ...
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 ...
Dieckhöfer, K; Riemer, M
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
Mouton, Johannes P.; Njuguna, Christine; Kramer, Nicole; Stewart, Annemie; Mehta, Ushma; Blockman, Marc; Fortuin-De Smidt, Melony; De Waal, Reneé; Parrish, Andy G.; Wilson, Douglas P.K.; Igumbor, Ehimario U.; Aynalem, Getahun; Dheda, Mukesh; Maartens, Gary; Cohen, Karen
Abstract Limited data exist on the burden of serious adverse drug reactions (ADRs) in sub-Saharan Africa, which has high HIV and tuberculosis prevalence. We determined the proportion of adult admissions attributable to ADRs at 4 hospitals in South Africa. We characterized drugs implicated in, risk factors for, and the preventability of ADR-related admissions. We prospectively followed patients admitted to 4 hospitals’ medical wards over sequential 30-day periods in 2013 and identified suspected ADRs with the aid of a trigger tool. A multidisciplinary team performed causality, preventability, and severity assessment using published criteria. We categorized an admission as ADR-related if the ADR was the primary reason for admission. There were 1951 admissions involving 1904 patients: median age was 50 years (interquartile range 34–65), 1057 of 1904 (56%) were female, 559 of 1904 (29%) were HIV-infected, and 183 of 1904 (10%) were on antituberculosis therapy (ATT). There were 164 of 1951 (8.4%) ADR-related admissions. After adjustment for age and ATT, ADR-related admission was independently associated (P ≤ 0.02) with female sex (adjusted odds ratio [aOR] 1.51, 95% confidence interval [95% CI] 1.06–2.14), increasing drug count (aOR 1.14 per additional drug, 95% CI 1.09–1.20), increasing comorbidity score (aOR 1.23 per additional point, 95% CI 1.07–1.41), and use of antiretroviral therapy (ART) if HIV-infected (aOR 1.92 compared with HIV-negative/unknown, 95% CI 1.17–3.14). The most common ADRs were renal impairment, hypoglycemia, liver injury, and hemorrhage. Tenofovir disoproxil fumarate, insulin, rifampicin, and warfarin were most commonly implicated, respectively, in these 4 ADRs. ART, ATT, and/or co-trimoxazole were implicated in 56 of 164 (34%) ADR-related admissions. Seventy-three of 164 (45%) ADRs were assessed as preventable. In our survey, approximately 1 in 12 admissions was because of an ADR. The range of ADRs and implicated drugs reflect
Fijnheer, R; van de Ven, P J; Erkelens, D W
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
Pedley, Ryan; Whitehouse, Anna; Hammond, Sarah
The Productive Ward series has effectively helped to standardise the storage of equipment in hospital ward treatment rooms; however, in our organisation equipment for venepunture and cannulation had been excluded. This resulted in clinicians having to navigate several unfamiliar environments while on-call and hence waste valuable time searching for basic equipment. We aimed to make it easier to locate and identify the basic equipment used for cannulation, venepuncture, and arterial blood gas sampling and more efficient to collect. We examined the initial layout of equipment on four surgical wards in a large teaching hospital. The time taken for junior doctors, nurses, health care assistants, and physician assistants to gather equipment on these wards was recorded along with a process map of steps involved. Our intervention was to relocate the equipment into adjacent storage and make it easily identifiable by the use of a 'red dot'. Following these changes we repeated the measurements. There was an overall reduction in the mean time taken to gather the equipment required to insert a venous cannula on an unfamiliar ward from 2 min 41 s pre-intervention (range 52 s to 6 mins 58 s, n = 23) to 26 s post-intervention (range 8 s to 1 min 20 s, n = 51). Additionally, the number of steps involved in the process was reduced from 16 to five. All of the 32 junior doctors surveyed felt that faster identification improved patient safety. A significant reduction in the time wasted by clinicians searching for venepuncture equipment on surgical wards has been achieved by simplifying the storage, layout, and identification of this kit. The accumulated benefit includes increased productivity, familiarity, and safety, which is paramount when attending unwell patients on unfamiliar wards. PMID:26734247
Baxter, Ruth; Taylor, Natalie; Kellar, Ian; Lawton, Rebecca
Introduction Positive deviance is an asset-based approach to improvement which has recently been adopted to improve quality and safety within healthcare. The approach assumes that solutions to problems already exist within communities. Certain groups or individuals identify these solutions and succeed despite having the same resources as others. Within healthcare, positive deviance has previously been applied at individual or organisational levels to improve specific clinical outcomes or processes of care. This study explores whether the positive deviance approach can be applied to multidisciplinary ward teams to address the broad issue of patient safety among elderly patients. Methods and analysis Preliminary work analysed National Health Service (NHS) Safety Thermometer data from 34 elderly medical wards to identify 5 ‘positively deviant’ and 5 matched ‘comparison’ wards. Researchers are blinded to ward status. This protocol describes a multimethod, observational study which will (1) assess the concurrent validity of identifying positively deviant elderly medical wards using NHS Safety Thermometer data and (2) generate hypotheses about how positively deviant wards succeed. Patient and staff perceptions of safety will be assessed on each ward using validated surveys. Correlation and ranking analyses will explore whether this survey data aligns with the routinely collected NHS Safety Thermometer data. Staff focus groups and researcher fieldwork diaries will be completed and qualitative thematic content analysis will be used to generate hypotheses about the strategies, behaviours, team cultures and dynamics that facilitate the delivery of safe patient care. The acceptability and sustainability of strategies identified will also be explored. Ethics and dissemination The South East Scotland Research Ethics Committee 01 approved this study (reference: 14/SS/1085) and NHS Permissions were granted from all trusts. Findings will be published in peer
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…
... 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...
... 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...
Winner, Joel G.; Goebert, Deborah; Matsu, Courtenay; Mrazek, David A.
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…
Jellinek, Michael S.; Henderson, Schuyler W.
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.
Lewis, K.E.; Lubetsky, M.J.; Wenger, S.L.; Steele, M.W.
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.
Camacho, H S; Cottrell, P A
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
Grunze, Heinz C R
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
Lawlor, Caroline; Cole, Laura; Howard, Louise M.
Background: Much recent debate on excess rates of compulsory detention and coercive routes to care has focused on young black men; evidence is less clear regarding ethnic variations among women and factors that may mediate these. Aim: To explore ethnic variations in compulsory detentions of women, and to explore the potential role of immediate pathways to admission and clinician-rated reasons for admission as mediators of these differences. Method: All women admitted to an acute psychiatric inpatient ward or a women’s crisis house in four London boroughs during a 12-week period were included. Data were collected regarding their pathways to care, clinician-rated reasons for admission, hospital stays, and social and clinical characteristics. Results: Two hundred and eighty seven (287) women from white British, white other, black Caribbean, black African and black other groups were included. Adjusting for social and clinical characteristics, all groups of black patients and white other patients were significantly more likely to have been compulsorily admitted than white British patients; white British patients were more likely than other groups to be admitted to a crisis house and more likely than all the black groups to be admitted because of perceived suicide risk. Immediate pathways to care differed: white other, black African and black other groups were less likely to have referred themselves in a crisis and more likely to have been in contact with the police. When adjustment was made for differences in pathways to care, the ethnic differences in compulsory admission were considerably reduced. Discussion: There are marked ethnic inequities not only between white British and black women, but also between white British and white other women in experiences of acute admission. Differences between groups in help-seeking behaviours in a crisis may contribute to explaining differences in rates of compulsory admission. PMID:21059630
Sheikhmoonesi, Fatemeh; Khademloo, Mohammad; Pazhuheshgar, Samaneh
Aim: Self- discharged patients are at high risk for readmission and ultimately higher cost for care. We intended to find the proportion of patients who leave hospital against medical advice and explore some of their characteristics. Methods: This prospective study of discharge against medical advice was conducted in psychiatric wards of Zare hospital in Iran, 2011. A psychologist recorded some information on a checklist based on the documented information about the patient who wanted to leave against medical advice. The psychologist interviewed these patients and recorded the reasons for discharge against medical advice. Descriptive statistics were calculated for the variables. Results: The rate of premature discharge was 34.4%. Compared to patients with regular discharges, patients with premature discharge were significantly more likely to be male, self-employed, to have co morbid substance abuse and first admission and positive family history of psychiatric disorder. Disappearance of symptoms was the most frequent reason for premature discharge. Conclusion: The 34.4% rate of premature discharge observed in our study is higher than rate reported in other studies. One possible explanation is our teaching hospital serves a low-income urban area and most patients had low socioeconomic status. Further studies are needed to compare teaching and non-teaching hospital about the rate of premature discharge and the reasons of patients who want to leave against medical advice. PMID:24762365
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
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
Amstadter, Ananda B.; Myers, John M.; Kendler, Kenneth S.
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
Patkar, Shobha V.
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
Rosecan, A S; Goldberg, R L; Wise, T N
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
Talih, Farid; Fattal, Omar; Malone, Donald
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
Booth, Brenda M; Blow, Frederic C; Loveland Cook, Cynthia A
OBJECTIVE To measure the persistence of impaired health-related quality of life (HRQL) and psychological distress associated with co-occurring psychiatric and substance use disorders in a longitudinal sample of medically hospitalized male veterans. DESIGN A random sample followed observationally for 1 year after study enrollment. SETTING Inpatient medical and surgical wards at three university-affiliated Department of Veterans Affairs Medical Centers. PATIENTS/PARTICIPANTS A random sample of 1,007 admissions to medical and surgical inpatient services, excluding women and admissions for psychiatric reasons. A subset of participants (n = 736) was designated for longitudinal follow-up assessments at 3 and 12 months after study enrollment. This subset was selected to include all possible participants with study-administered psychiatric diagnoses (52%) frequency-matched by date of study enrollment to approximately equivalent numbers of participants without psychiatric diagnoses (48%). MEASUREMENTS AND MAIN RESULTS All participants were administered a computerized structured psychiatric diagnostic interview for 13 psychiatric (include substance use) disorders and received longitudinal assessments at 3 and 12 months on a multidimensional measure of HRQL, the SF-36, and a measure of psychological distress, the Symptom Checklist, 90-item version. On average, HRQL declined and psychological distress increased over time (P < .05). Psychiatric disorders were associated with significantly greater impairments in functioning and increased distress on all measures (P < .001) except physical functioning (P < .05). These results were replicated in the patients (n = 130) who received inpatient or outpatient mental health or substance abuse services. CONCLUSIONS General medical physicians need to evaluate the mental health status of their hospitalized and seriously ill patients. Effective mental health interventions can be initiated posthospitalization, either immediately in primary
Hörberg, Ulrica; Dahlberg, Karin
The aim of this article is to shed light on contemporary forensic psychiatric care through a philosophical examination of the empirical results from two lifeworld phenomenological studies from the perspective of patients and carers, by using the French philosopher Michel Foucault's historical–philosophical work. Both empirical studies were conducted in a forensic psychiatric setting. The essential results of the two empirical studies were reexamined in a phenomenological meaning analysis to form a new general structure in accordance with the methodological principles of Reflective Lifeworld Research. This general structure shows how the caring on the forensic psychiatric wards appears to be contradictory, in that it is characterized by an unreflective (non-)caring attitude and contributes to an inconsistent and insecure existence. The caring appears to have a corrective approach and thus lacks a clear caring structure, a basic caring approach that patients in forensic psychiatric services have a great need of. To gain a greater understanding of forensic psychiatric caring, the new empirical results were further examined in the light of Foucault's historical–philosophical work. The philosophical examination is presented in terms of the three meaning constituents: Caring as correction and discipline, The existence of power, and Structures and culture in care. The philosophical examination illustrates new meaning nuances of the corrective and disciplinary nature of forensic psychiatric care, its power, and how this is materialized in caring, and what this does to the patients. The examination reveals embedded difficulties in forensic psychiatric care and highlights a need to revisit the aim of such care. PMID:26319100
Hörberg, Ulrica; Dahlberg, Karin
The aim of this article is to shed light on contemporary forensic psychiatric care through a philosophical examination of the empirical results from two lifeworld phenomenological studies from the perspective of patients and carers, by using the French philosopher Michel Foucault's historical-philosophical work. Both empirical studies were conducted in a forensic psychiatric setting. The essential results of the two empirical studies were reexamined in a phenomenological meaning analysis to form a new general structure in accordance with the methodological principles of Reflective Lifeworld Research. This general structure shows how the caring on the forensic psychiatric wards appears to be contradictory, in that it is characterized by an unreflective (non-)caring attitude and contributes to an inconsistent and insecure existence. The caring appears to have a corrective approach and thus lacks a clear caring structure, a basic caring approach that patients in forensic psychiatric services have a great need of. To gain a greater understanding of forensic psychiatric caring, the new empirical results were further examined in the light of Foucault's historical-philosophical work. The philosophical examination is presented in terms of the three meaning constituents: Caring as correction and discipline, The existence of power, and Structures and culture in care. The philosophical examination illustrates new meaning nuances of the corrective and disciplinary nature of forensic psychiatric care, its power, and how this is materialized in caring, and what this does to the patients. The examination reveals embedded difficulties in forensic psychiatric care and highlights a need to revisit the aim of such care. PMID:26319100
Rong, Jiin-Ru; Shiau, Shu-Jen; Su, Shu-Fang
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
Bhatia, Manjeet Singh; Gupta, Ravi
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
Cao, Miao; Wang, Zhijiang; He, Yong
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
Cao, Miao; Wang, Zhijiang; He, Yong
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
Brumm, V L; Bilder, D; Waisbren, S E
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
Durham, Thomas W.
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…
Fagin, L; Brown, D; Bartlett, H; Leary, J; Carson, J
The Claybury community psychiatric nurse (CPN) stress study collected data on stress levels in 250 CPNs and 323 ward-based psychiatric nurses (WBPN) in the North East Thames region. Four out of 10 CPNs were found to be experiencing high levels of psychological distress on GHQ scores. Whilst both CPNs and WBPNs scored highly on scores of occupational burnout, especially on emotional exhaustion scores, WBPNs scored worse on emotional detachment from their patients and were achieving less personal fulfilment from their work. Both groups of nurses were more satisfied with direct patient clinical work than with their employment conditions, particularly their working environments and, for CPNs, their relationships with their managers. The different patterns of coping skills are explored and discussed for both groups of nurses, especially the use of social support, time management and organization of tasks. The study concludes that whilst major changes are occurring in the psychiatric arena for both groups of nurses, stress is reaping its toll on mental health nurses, in terms of higher absence rates, lower self-esteem and personal unfulfilment. This could not only affect the quality of patient care but also future career prospects for nurses. The study invites serious consideration of introducing stress-reducing measures in the work-place as well as further research into specific stressors for different groups of nurses. PMID:7593957
Gebicke-Haerter, Peter J.
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
Doerr-Zegers, O; Hartmann, L; Lira, E; Weinstein, E
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
Verma, Rohit; Mina, Shaily; Deshpande, Smita N.
Background: There is a dearth of specialized mental health services for Indian paramilitary service personnel. Those requiring psychiatric evaluation are referred to government psychiatric services often with minimal information. Hence, major diagnostic and decision making relies on the psychiatrist's clinical evaluation and judgment. The aim of the present study was to quantitatively evaluate the paramilitary referrals to psychiatric services at a tertiary care referral center. Materials and Methods: A retrospective chart analysis of all consecutive referrals by various Indian paramilitary services to a tertiary care hospital (2008-2010) was carried out. Results: Among the sample of 18 referrals, all were males (mean age: 37 years ± standard deviation (SD) =7.79). Various reasons for referral included: Evaluation of fitness for duty (83.3%), fitness to handle firearms (16.7%), and for disability certification (5.6%). There were no informants at all in 22.2%, and family members were available in only 11.1%. Hence, most referrals were admitted to the psychiatry ward for observation for various lengths of time. The mean duration of assessment (outpatient and inpatient) was 17.89 days (SD = 20.74) and final reported diagnoses were schizophrenia, depression, and bipolar disorder in 16.7, 11.1, and 11.1%, respectively. There was concurrent history of alcohol and nicotine dependence (40%). A large group (40%) was diagnosed not to suffer from a major mental illness, while a firm and final diagnosis could not be arrived at in 16.7% subjects. Only one subject was given the fitness to handle firearms, fitness for duty was refused in three (16.7%) subjects, and one subject was referred to neurology after being diagnosed as a case of seizure disorder. Conclusion: There is an urgent need for intensive training both to paramilitary physicians as well as to general hospital psychiatrists regarding proper assessment of paramilitary personnel, as there are frequent chances of the
McManama O'Brien, Kimberly H.
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
Bhaumik, S.; Tyrer, F. C.; McGrother, C.; Ganghadaran, S. K.
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…
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.
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
De las Cuevas, Carlos; Sanz, Emilio J.
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
Jensen, Tomas Ostergaard; Stelzer-Braid, Sacha; Willenborg, Christiana; Cheung, Carol; Andresen, David; Rawlinson, William; Clezy, Kate
We describe an outbreak of respiratory syncytial virus (RSV) infection on a hematology ward without allogeneic stem cell transplant patients. Twelve patients and one staff member infected with RSV were identified from the laboratory database. Five patients had lower respiratory tract infection, seven had upper respiratory tract infection, one was asymptomatic, and there were two (15.4%) deaths. Most patients had overlapping periods of potential infectiousness on the ward. Sequencing was possible on eight specimens and five of these had identical sequences. Results were consistent with transmission occurring both on the ward and by introduction of RSV from the community. J. Med. Virol. 88:1827-1831, 2016. © 2016 Wiley Periodicals, Inc. PMID:26990584
Curtis, Kate; Wiseman, Taneal; Kennedy, Belinda; Kourouche, Sarah; Goldsmith, Helen
The majority of trauma nursing education is focused on the emergency phases of care. We describe the development and evaluation of a trauma eLearning module for the ward environment. The module was developed using adult learning principles and implemented in 2 surgical wards. There were 3 phases of evaluation: (1) self-efficacy of nurses; (2) relevance and usability of the module and; (3) application of knowledge learnt. The majority indicated they had applied new knowledge, particularly when performing a physical assessment (85.7%), communicating (91.4%), and identifying risk of serious illness (90.4%). Self-efficacy relating to confidence in caring for patients, communication, and escalating clinical deterioration improved (p = .023). An eLearning trauma patient assessment module for ward nursing staff improves nursing knowledge and self-efficacy. PMID:26745537
du Souich, Christèle; Austin, Jehannine C; Friedlander, Robin; Boerkoel, Cornelius F
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
Cerimele, Joseph M; Halperin, Abigail C; Saxon, Andrew J
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
Taheri, Leila; Jahromi, Marzieh Kargar; Hojat, Mohsen
Introduction and Aims: Patient satisfaction is the most important indicator of high-quality health care and is used for the assessment and planning of health care. Also, Job satisfaction is an important factor on prediction and perception of organizational manner. The aim of this study is to identify and compare patient and staff satisfaction in general versus special wards. Material and Method: In order to identify the various indicators of satisfaction and dissatisfaction, a descriptive study (cross sectional) was done to assess patients’ satisfaction with in-patient care at Jahrom University of Medical Science hospitals. The sample size was 600 patients that selected by sequential random sampling technique and are close to their discharge from the hospital. Patients were asked to indicate the scale point which best reflected their level of satisfaction with the treatment or service. Also we assess the staff satisfaction (sample size was 408 staffs) in general ward using a researcher made questionnaire. It should be noted that the participants were anonymous and there was no obligation to participation. We tried to set a secure and comfortable environment for filling out the questionnaire. Results: Among 600 patients, 239 (n = 38.67%) were men and 368 (61.33%) were female. Number of nurses was 408, of which 135 (33.08%) were men and 273 (66.92%) female. There was a significant correlation between working experience and professional factors of personnel. The mean total patient satisfaction in general and special wards is (2.75 ± .35, 3.03 ± .53) respectively. Differences of patient satisfaction in domains such respect, care and confidence in general wards versus special ward were statistically significant, but there was no difference in expect time of patients in these wards. Differences Between the mean patient and staff satisfaction in the general wards versus special wards were statistically significant using independent t-tests (p = .018, p = .029
Hewart, Carol; Fethney, Loveday
There is much research concerning the psychological and physical effects of sleep deprivation on patients in healthcare systems, yet interrupted sleep on hospital wards at night remains a problem. Staff at Plymouth Hospitals NHS Trust, Devon, wanted to identify the factors that prevent patients from sleeping well at night. Two audits were carried out, between April and August 2015, to assess noise and light levels on wards at night, and to engage nurses in ways of reducing these. A number of recommendations were made based on the audit findings, many of which have been put into practice. PMID:26938911
Ng, Peter K L; Lin, Chia-Wei; Naruse, Tohru
The Western Pacific epialtid genus Sargassocarcinus Ward, 1936, is revised. The genus had been regarded as monotypic but is here shown to contain three species: S. sublimis (Rathbun, 1916), S. cristatus (Balss, 1924), and S. foliatus Ward, 1936 (type species). The many unusual characters possessed by Sargassocarcinus are figured and discussed; and diagnostic features of the three species are clarified. The taxonomy of the three species and aspects of their ecology are discussed. Sargassocarcinus species are found free-living on coral rubble habitats and not associated with macrophytic algae. PMID:27615976
Aung, Tin Htun; Judith Beck, Adèle; Siese, Thomas; Berrisford, Richard
Potentially inappropriate prescribing in healthcare of the elderly (HCE) is associated with avoidable adverse drug events (ADEs).1,2 A recent set of prescribing criteria has been designed and validated, called “Screening Tool of Older Persons' Prescriptions” (STOPP), to rationalise prescribing in hospitalised patients on HCE wards.1,3 The aim of this quality improvement project was to identify how many potentially inappropriate medications (PIMs) were prescribed on these wards, and remove them. This was executed by implementing a ward round checklist, which incorporated STOPP criteria, for the twice weekly, consultant led ward rounds. This quality improvement project was carried out over four months. In a pilot study, we identified eight inappropriate medical prescriptions among 148 medications (5.4% ) prescribed on one ward. After applying a checklist for a structured ward round, we reviewed the medications prescribed on that ward, and found 10 PIMs out of 192 (5.2% ). Utilising the increasingly recognised “plan, do, study, act” (PDSA) cycle,4 we implemented departmental teaching and meetings with other members of the multidisciplinary team, which raised awareness of PIMs among junior doctors, as well as involving our pharmacists in drug chart screening. During this process we continued with a further six cycles on a bi-weekly basis, and saw a gradual decrease in PIM to 1.5%. In conclusion, a structured ward round, facilitated by a checklist that included review of drug charts based on STOPP criteria, demonstrated a considerable reduction of PIMs. It would be interesting to apply this quality improvement project to non-HCE wards, including general surgical wards or adult psychiatry wards, as a means of not only reducing the effects of ADEs, but also the expenditure associated with unnecessary drug prescriptions, and the costs associated with additional care arising from associated ADEs. PMID:27096089
Hesdorffer, Dale C
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
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
Jokiranta, Elina; Brown, Alan S.; Heinimaa, Markus; Cheslack-Postava, Keely; Partanen, Auli; Sourander, Andre
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
Glaser, W F
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
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
... Psychiatric Residential Treatment Facilities Providing Inpatient Psychiatric Services for Individuals Under Age 21 § 483.354 General requirements for psychiatric residential treatment facilities. A...
... Psychiatric Residential Treatment Facilities Providing Inpatient Psychiatric Services for Individuals Under Age 21 § 483.354 General requirements for psychiatric residential treatment facilities. A...
... Psychiatric Residential Treatment Facilities Providing Inpatient Psychiatric Services for Individuals Under Age 21 § 483.354 General requirements for psychiatric residential treatment facilities. A...
Ural, Dilek; Çavuşoğlu, Yüksel; Eren, Mehmet; Karaüzüm, Kurtuluş; Temizhan, Ahmet; Yılmaz, Mehmet Birhan; Zoghi, Mehdi; Ramassubu, Kumudha; Bozkurt, Biykem
Acute heart failure (AHF) is a life threatening clinical syndrome with a progressively increasing incidence in general population. Turkey is a country with a high cardiovascular mortality and recent national statistics show that the population structure has turned to an 'aged' population.As a consequence, AHF has become one of the main reasons of admission to cardiology clinics. This consensus report summarizes clinical and prognostic classification of AHF, its worldwide and national epidemiology, diagnostic work-up, principles of approach in emergency department,intensive care unit and ward, treatment in different clinical scenarios and approach in special conditions and how to plan hospital discharge. PMID:26574757
Shulman, K I
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
Novac, Andrei; McEwan, Stephanie; Bota, Robert G
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
Dean, C; Roberts, M M; French, K; Robinson, S
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
McEwan, Stephanie; Bota, Robert G.
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
Madhusoodanan, Subramoniam; Ting, Mark Bryan; Farah, Tara; Ugur, Umran
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
Raza, Muhammad Ummear; Tufan, Turan; Wang, Yan; Hill, Christopher; Zhu, Meng-Yang
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
Cleary, Michelle; Hunt, Glenn E; Horsfall, Jan
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
Pandurangi, Anand K.
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
Salinsky, Martin; Evrard, Collette; Storzbach, Daniel; Pugh, Mary Jo
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
Moffic, H Steven; Saeed, Sy Atezaz; Silver, Stuart; Koh, Steve
As with all professional ethical principles, those in psychiatry have to evolve over time and societal changes. The current ethical challenges for psychiatric administration and leadership, especially regarding for-profit managed care, need updated solutions. One solution resides in the development by the American Association of Psychiatric Administrators (AAPA) of the first set of ethical principles designed specifically for psychiatric administrators. These principles build on prior Psychological Theories of leadership, such as those of Freud, Kernberg, and Kohut. Supplementing these theories are the actual real life models of psychiatrist leadership as depicted in the memoirs of various psychiatrists. Appreciating these principles, theories, and models may help emerging leaders to better recognize the importance of ethical challenges. A conclusion is that psychiatrists should have the potential to assume more successful leadership positions once again. In such positions, making the skills and well-being of all in the organization seems now to be the foremost ethical priority. PMID:26024739
Dvir, Yael; Ford, Julian D.; Hill, Michael; Frazier, Jean A.
Affect dysregulation, defined as the impaired ability to regulate and/or tolerate negative emotional states, and has been associated with interpersonal trauma and post-traumatic stress. Affect regulation difficulties also play a role in many other psychiatric conditions, including anxiety disorders and mood disorders, specifically major depression in youth and bipolar disorder throughout the life span. Exposure to traumatic events and interpersonal trauma in childhood is associated with a wide range of psychosocial, developmental, and medical impairments in children, adolescents and adults, with emotional dysregulation being a core feature that may help to account for this heightened risk. In order to understand how the developmental effects of childhood maltreatment contribute to emotional dysregulation and psychiatric sequelae, we review emotional regulation and its developmental neurobiology, and examine the research evidence of associations between childhood traumatization, emotional dysregulation, and psychiatric co-morbidities in children, adolescents and adults. PMID:24704784
Dvir, Yael; Ford, Julian D; Hill, Michael; Frazier, Jean A
Affect dysregulation, defined as the impaired ability to regulate or tolerate negative emotional states, has been associated with interpersonal trauma and posttraumatic stress. Affect-regulation difficulties play a role in many psychiatric conditions, including anxiety and mood disorders, and especially major depression in youth and bipolar disorder throughout the life span. Exposure to traumatic events and interpersonal trauma in childhood is associated with wide-ranging psychosocial, developmental, and medical impairments in children, adolescents, and adults, with emotional dysregulation being a core feature that may help to account for this heightened risk. In order to understand how the developmental effects of childhood maltreatment contribute to emotional dysregulation and psychiatric sequelae, we review emotional regulation and its developmental neurobiology, and examine the research evidence of associations between childhood trauma, emotional dysregulation, and psychiatric comorbidities in children, adolescents, and adults. PMID:24704784
Gilchrist, A C; Hannaford, P C; Frank, P; Kay, C R
Between October 1976 and July 1979, 1509 general practitioners throughout the UK recruited 13,261 women with an unplanned pregnancy to a prospective study comparing the subsequent psychiatric morbidity rate in the women who underwent an induced abortion with that of the women with other pregnancy outcomes. There was no significant difference in the rates of total psychiatric disorder between women who underwent pregnancy termination and those who underwent childbirth. For example, among women who had no previous illness, the standardized rate of any psychiatric illness was 63.5/1000 woman-years for women who underwent abortion compared to 60.8-63.1/1000 woman-years for other women. In fact, the relative risk (RR) for every group was 1. Women with no history of psychosis faced a lower risk of psychosis after abortion than women with an unplanned pregnancy but who did not seek abortion (4.9/1000 woman-years vs. 11.8/1000 woman-years; RR = 0.4). On the other hand, the rates of psychosis requiring hospital admission for the two groups were similar. In women with no earlier history of psychiatric illness, deliberate self-harm (DSH) occurred significantly more often in women who underwent induced abortion (RR = 1.7) or who were refused an abortion (RR = 2.9). Drug overdoses comprised 89% of DSH cases. DSH was associated with a past history of DSH. It had an inverse trend with age. Women with no history of psychiatric illness had a significant increased risk of subsequent DSH whether they underwent abortion (RR = 1.7) or were refused abortion (RR= 2.9). These findings indicate that psychiatric morbidity after induced abortion is similar to that after childbirth. PMID:7582677