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Sample records for psychiatric day hospital

  1. A Controlled Comparison of Psychiatric Day Treatment and Inpatient Hospitalization

    ERIC Educational Resources Information Center

    Washburn, Stephen; And Others

    1976-01-01

    Seriously ill female psychiatric patients (N=59) were randomly assigned to an inpatient or day service. Data indicate the day treatment is, on the whole, superior to inpatient treatment in subjective distress, community functioning, family burden, total hospital cost, and days of attachment to the hospital program. (Author)

  2. [Eating disorders and psychiatric day hospital treatment].

    PubMed

    Mekui, C A; Weber, K

    2015-02-11

    Eating disorders are complex pathologies characterised by the entanglement between physical and mental aspects and by their high impact on health. Studies on care models showed the need for other therapeutic modalities due to the complexity of treatments, the risk of recurrence after hospitalisation, as well as to the cost and duration of hospital stays. Day hospitals specific to these disorders have been created, albeit with very few studies. Even though the available studies tend to find good therapeutic efficacy, they are disparate, describing care centres that are rather different in their structure and theoretical approach, and factors of therapeutic efficacy are not always well described.

  3. Day hospital versus admission for acute psychiatric disorders

    PubMed Central

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

    2014-01-01

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 We approached trialists to identify unpublished studies.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

  4. Treatment concepts of day hospitals for general psychiatric patients. Findings from a national survey in Germany.

    PubMed

    Seidler, Klaus-Peter; Garlipp, Petra; Machleidt, Wielant; Haltenhof, Horst

    2006-03-01

    Psychiatric day hospital treatment concepts have to deal with a wide spectrum of mental disorders. We raised the question, if day hospitals can be differentiated concerning their treatment concepts and if so how much this is reflected in their structural and procedural features. In 1999 a survey was initiated concerning structure, concept and method of treatment in psychiatric day hospitals for adults in Germany. Furthermore data concerning rate of utilization, patients' characteristics and aspects of referral and further treatment were ascertained. One hundred and seventy-three (63.4%) of 273-day hospitals contacted took part in the inquiry. The data were interpreted using multivariate as well as non-parametric procedures. The results show that treatment concepts of day hospitals can be specified as three main areas of function (psychotherapy, crisis intervention orientated treatment alternative, rehabilitation) and four therapeutic orientations (psychodynamic social psychiatric, behavioral social psychiatric, psychodynamic, sociotherapeutic). Structural features are predominantly comparable and the differences found concerning the treatment concepts are especially related to patients' characteristics and some procedural features. The conclusion is that the differentiation of day hospital treatment concepts should be taken into consideration in planning psychosocial treatment services as well as in day hospital evaluation research.

  5. Psychiatric treatment outcomes of preschool children in a family day hospital.

    PubMed

    Müller, Jörg Michael; Averbeck-Holocher, Marlies; Romer, Georg; Fürniss, Tilman; Achtergarde, Sandra; Postert, Christian

    2015-04-01

    This study describes the treatment outcomes of preschoolers with severe mental health problems who were treated at the child psychiatric family day hospital for preschool children in Münster, Germany. The eclectic multi-modal treatment combines behavioral and psychodynamic techniques for both parents and children in various settings within an intermittent attendance structure provided by a multi-disciplinary team. This study evaluated 185 children with the Caregiver-Teacher Report Form (C-TRF/1.5-5), which was completed by therapists, and the Child Behavior Checklist (CBCL/1.5-5), which was completed by mothers, at admission and discharge. The mothers' ratings of their children were statistically adjusted for the distortion caused by their own psychopathology. After treatment, the patients showed significant improvement on the C-TRF/CBCL Total Problem score with an average Cohen's d = -0.50 based on therapists' ratings, d = -0.97 for the non-adjusted maternal ratings, and d = -0.68 for the adjusted maternal ratings. We conclude that specialized family day hospitals may successfully treat preschool psychiatric patients.

  6. Education for Life: Assessment of the Role of a Recreational Programme in the Rehabilitation of Day Patients in a Psychiatric Hospital.

    ERIC Educational Resources Information Center

    Hamilton, Robert

    1984-01-01

    With a working definition of rehabilitation, the author assesses the therapeutic recreation program at a psychiatric hospital to determine whether it enabled psychiatric day patients to overcome social disabilities and make a full return to community life. (SK)

  7. [The geriatric psychiatric day hospital: an analysis of 5 years of activities].

    PubMed

    Trifonov, E G; Ognev, A E

    1997-01-01

    233 patients (53 men and 180 women) at the age of 60 years and older were treated in day gerontopsychiatric out-patient clinic for 5 years. 60-69 year old patients prevailed (146 individuals). Nearly all mental diseases characteristic for the old age were found in such patients; majority of patients suffered from schizophrenia (31.3%) and affective pathology (25.8%). Vascular form of dementia prevailed among the patients with dementia while atrophic degenerative dementia was rarely observed (2 patients). Syndromological distribution revealed that the main groups were formed by patients with depressions (41.6%) as well as individuals with neurosis- and psychopathic-like conditions (37.3%). Mental disorders with paranoid syndromes were observed in 8.6% of the patients. It is shown that day gerontopsychiatric out-patient clinic had some preferences in comparison with usual mental hospitals and psychoneurological out-patient clinic.

  8. Psychiatric hospitalization in Poland.

    PubMed

    Frydman, L

    1983-01-01

    An overview of psychiatric hospitalization in Poland is presented in the context of Polish political and socio-cultural developments. The areas addressed include: the characteristics of the patient population; the organization of Polish mental health service; the nature of psychiatric treatment; psychiatric legislation; patients' rights; and the training and social status of the various mental health professionals. In spite of the meager resources allocated to mental health services, and the consequent staff shortages and overcrowded, drab living conditions in psychiatric facilities, the care afforded patients is generally humane and nonoppressive. Polish psychiatry has succeeded in maintaining its professional autonomy and has assumed a leadership role in the modernization of its service delivery system.

  9. [Treatment in psychiatric day hospital in comparison with inpatient wards in different European health care systems--objectives of EDEN project].

    PubMed

    Kiejna, Andrzej; Kallert, Thomas W; Rymaszewska, Joanna

    2002-01-01

    The paper presents the objectives and design of an ongoing multicenter randomized, controlled trial EDEN (European Day Hospital EvaluatioN). The EDEN-study aims to evaluate the efficacy of acute psychiatric treatment in a day hospital setting in five European centres: Dresden, London, Michalovce, Prague and Wroclaw. The main hypothesis is that day hospital treatment for acute psychiatric patients is as effective as conventional inpatient hospital care. The objectives of the study are to evaluate the viability and effectiveness of day hospitals for acute psychiatric treatment, to identify subgroups of patients with a more or less favourable outcome so that the treatment setting might be specifically applied and to ascertain the cost-effectiveness of day hospital treatment compared to conventional inpatient treatment. The study utilises a Randomised Controlled Trial (RCT) design with repeated measures at a maximum of six time points: at admission (t1), one week after admission (t2), four weeks after admission (t3), discharge (t4), three months after discharge (t5), and 12 months after discharge (t6). A combination of well-established standardised assessment instruments and open questions is used in 6 time periods. If the findings accept the main hypothesis of the study, some practical consequences could be inevitable: at a mental health policy level, these results could lead to an increase in the capacity of day hospitals; at the clinical level clinicians could redefine their concepts of care to consider the day hospital as an alternative to conventional inpatient treatment; from economic point of view could lead to reduction of treatment costs.

  10. Effective psychiatric day treatment: historical lessons.

    PubMed

    Rosie, J S; Azim, H F; Piper, W E; Joyce, A S

    1995-10-01

    This paper describes a successful day treatment program that provides four months of intensive psychodynamic group-oriented milieu treatment for patients with long-standing personality disorders, who commonly experience recurrent major depression, dysthymia, and excessive anxiety. The authors outline three factors that have contributed to the success of the program--optimal treatment-patientmatching, judicious use of authority in milieu therapy, and careful attention to maintaining close working relationships with referral sources. They provide an overview of the historical evolution of day treatment programs from earlier day hospital model to show day programs' neglect of these factors may have led to treatment failures. Such failures may have spurred recent suggestions that psychiatric day treatment programs should be replaced entirely by assertive community treatment. The authors argue that such a move could amount to abdication of psychiatry's responsibility to provide intensive milieu treatment that can be effectively offered only on a day treatment basis. PMID:8829782

  11. Service dogs, psychiatric hospitalization, and the ADA.

    PubMed

    Muramatsu, Russ S; Thomas, Kelly Jones; Leong, Stephanie L; Ragukonis, Frank

    2015-01-01

    A service dog is defined as "any dog that is individually trained to do work or perform tasks for the benefit of an individual with a disability, including a physical, sensory, psychiatric, intellectual, or other mental disability." Some psychiatric patients may depend on a service dog for day-to-day functioning. The Americans with Disabilities Act (ADA) established certain rights and responsibilities for individuals with disabilities and health care providers. Psychiatric hospitalization of a patient with a service dog may pose a problem and involves balancing the requirement to provide safe and appropriate psychiatric care with the rights of individuals with disabilities. This Open Forum examines issues that arise in such circumstances, reviews the literature, and provides a foundation for the development of policies and procedures.

  12. Service dogs, psychiatric hospitalization, and the ADA.

    PubMed

    Muramatsu, Russ S; Thomas, Kelly Jones; Leong, Stephanie L; Ragukonis, Frank

    2015-01-01

    A service dog is defined as "any dog that is individually trained to do work or perform tasks for the benefit of an individual with a disability, including a physical, sensory, psychiatric, intellectual, or other mental disability." Some psychiatric patients may depend on a service dog for day-to-day functioning. The Americans with Disabilities Act (ADA) established certain rights and responsibilities for individuals with disabilities and health care providers. Psychiatric hospitalization of a patient with a service dog may pose a problem and involves balancing the requirement to provide safe and appropriate psychiatric care with the rights of individuals with disabilities. This Open Forum examines issues that arise in such circumstances, reviews the literature, and provides a foundation for the development of policies and procedures. PMID:25321094

  13. A CBT Approach to Inpatient Psychiatric Hospitalization

    ERIC Educational Resources Information Center

    Masters, Kim J.

    2005-01-01

    During a psychiatric hospitalization of 5 to 10 days, cognitive-behavioral therapy (CBT) strategies can be used for the management of inpatients and to support the transition to outpatient treatment. This format was chosen after several years of frustration dealing with crisis inpatient care. The use of CBT is well known, and it seemed that an…

  14. Inpatient Suicide in a Chinese Psychiatric Hospital

    ERIC Educational Resources Information Center

    Li, Jie; Ran, Mao-Sheng; Hao, Yuantao; Zhao, Zhenhuan; Guo, Yangbo; Su, Jinghua; Lu, Huixian

    2008-01-01

    Little is known about the risk factors for suicide among psychiatric inpatients in China. In this study we identified the risk factors of suicide among psychiatric inpatients at Guangzhou Psychiatric Hospital. All psychiatric inpatients who died by suicide during the 1956-2005 period were included in this study. Using a case-control design, 64…

  15. Crisis hospitalization on a psychiatric emergency service.

    PubMed

    Breslow, R E; Klinger, B I; Erickson, B J

    1993-09-01

    The availability of short-stay beds for brief admissions to a Psychiatric Emergency Service (PES) is a model that meets a variety of patient and system needs, allowing time to develop alternatives to hospitalization or gain diagnostic clarity, serving a respite function, providing a hospital setting that does not gratify dependency needs, and relieving inpatient census pressures. An eight-bed service for brief inpatient stays of up to 3 days was developed on a PES which serves a large nine-country catchment area in northeastern New York State. Admissions to this unit would otherwise have gone to a medical school teaching hospital psychiatric unit or a state psychiatric center. Fifty-one consecutive admissions were studied. The majority of patients were dischargeable in the short time frame and did not require transfer for longer-term care. The patients as a group showed improvement in psychiatric symptomatology and rated high satisfaction with the program. Most patients were diagnosed with schizophrenia or personality disorder (PD). Suicidality and substance abuse were frequent. The PD patients had a strong association with suicidality and some association with substance abuse, whereas the schizophrenics had more psychiatric symptomatology. PD patients were more likely to be discharged, leading us to propose a rationale for why this group may be uniquely suited to this approach. The study was replicated after a year on another sample of 51 consecutive admissions, confirming the earlier results and providing a 1-year follow-up on the program.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:8307344

  16. Psychiatric Hospitalization after Deliberate Self-Poisoning

    ERIC Educational Resources Information Center

    Carter, Gregory L.; Safranko, Ivan; Lewin, Terry J.; Whyte, Ian M.; Bryant, Jennifer L.

    2006-01-01

    The decision for psychiatric hospitalization after deliberate self-poisoning (DSP) is not well understood. This study, a longitudinal cohort study of 3,148 consecutive DSP patients found 920 (29.2%) subjects were referred for psychiatric hospitalization, 576 (18.3%) on involuntary basis. A logistic regression analysis showed increased risk for:…

  17. 42 CFR 409.63 - Reduction of inpatient psychiatric benefit days available in the initial benefit period.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... Hospital Insurance Benefits § 409.63 Reduction of inpatient psychiatric benefit days available in the... hospital on the first day of Medicare entitlement and for any of the 150 days immediately before that first... participating in Medicare as a psychiatric hospital on the individual's first day of entitlement. (3)...

  18. 42 CFR 409.63 - Reduction of inpatient psychiatric benefit days available in the initial benefit period.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... Hospital Insurance Benefits § 409.63 Reduction of inpatient psychiatric benefit days available in the... hospital on the first day of Medicare entitlement and for any of the 150 days immediately before that first... participating in Medicare as a psychiatric hospital on the individual's first day of entitlement. (3)...

  19. Randomised controlled trial of day patient versus inpatient psychiatric treatment.

    PubMed Central

    Creed, F; Black, D; Anthony, P; Osborn, M; Thomas, P; Tomenson, B

    1990-01-01

    OBJECTIVE--To assess the proportion of acutely ill psychiatric patients who can be treated in a day hospital and compare the outcome of day patient and inpatient treatment. DESIGN--Prospective randomised controlled trial of day patient versus inpatient treatment after exclusion of patients precluded by severity of illness or other factors from being treated as day patients. All three groups assessed at three and 12 months. SETTING--Teaching hospital serving small socially deprived inner city area. Day hospital designed to take acute admissions because of few beds. PATIENTS--175 Patients were considered, of whom 73 could not be allocated. Of the remaining 102 patients, 51 were allocated to each treatment setting but only 89 became established in treatment--namely, 41 day patients and 48 inpatients. 73 Of these 89 patients were reassessed at three months and 70 at one year. INTERVENTIONS--Standard day patient and inpatient treatment. MAIN OUTCOME MEASURES--Discharge from hospital and return to previous level of social functioning; reduction of psychiatric symptoms, abnormal behaviour, and burden on relatives. RESULTS--33 Of 48 inpatients were discharged at three months compared with 17 of 41 day patients. But at one year 9 of 48 inpatients and three of 41 day patients were in hospital. 18 Of 35 day patients and 16 of 39 inpatients were at their previous level of social functioning at one year. The only significant difference at three months was a greater improvement in social role performance in the inpatients. At one year there was no significant difference between day patients and inpatients in present state examination summary scores and social role performance, burden, or behaviour. CONCLUSIONS--Roughly 40% of all acutely ill patients presenting for admission to a psychiatric unit may be treated satisfactorily in a well staffed day hospital. The outcome of treatment is similar to that of inpatient care but might possibly reduce readmissions. The hospital costs

  20. 42 CFR 409.63 - Reduction of inpatient psychiatric benefit days available in the initial benefit period.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... stay was for diagnosis or treatment of mental illness. (2) After entitlement, all psychiatric care days... for a mental condition and, after 10 days, transferred to a participating psychiatric hospital. The... 150-day pre-entitlement period have no effect on the inpatient hospital benefit days available to...

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

    PubMed

    de Mello, Rita Mello; Schneider, Jacó Fernando

    2011-06-01

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

  2. Violent psychiatric inpatients in a public hospital.

    PubMed

    Morrison, E F

    1990-01-01

    Violence in inpatient psychiatric settings is a clinically significant and relevant problem requiring attention by the psychiatric community. Despite the prevalence of research on violent behavior, few nursing studies have been conducted that explore the components of nursing care that may influence the amount of violence occurring in inpatient psychiatric settings. The purpose of the study was to identify the characteristics of violent patients and the components of nursing care that are related to violent patient behavior. A qualitative study was conducted using participant observation and grounded theory methodology. Data were collected in a metropolitan public hospital over a 9-month period. Six categories of violent patients were identified during data analysis: (1) the user, (b) the outlaw, (c) the rebel without a cause, (d) the little big man, (e) the child, and (6) the vamp. Implications of the study for clinicians working in inpatient psychiatric settings are discussed.

  3. Understanding those who seek frequent psychiatric hospitalizations.

    PubMed

    Montgomery, Phyllis; Kirkpatrick, Helen

    2002-02-01

    In the period after deinstitutionalization, there has been a rise in hospital readmission rates. It is estimated that the readmission rate for individuals who are frequent users of psychiatric inpatient services is approximately 40% to 50% within 1 year of hospital discharge. Attempts to determine predictors of recidivism have identified multiple variables, some of which are mutually contradictory. Furthermore, comparison among studies is difficult given methodological and theoretical limitations. Despite such issues, however, one consistent predictor of frequent rehospitalization is a person's history of past psychiatric hospital admissions. It seems that those who have shown a pattern of seeking inpatient services in the past tend to repeat this treatment-seeking behavior. The aim of this report is to critically examine some of the predictors of rehospitalization. A better understanding of those who engage in the persistent pattern of seeking inpatient services may assist nurses in planning care that is more suited for their needs. PMID:11877602

  4. Characteristics and Needs of Psychiatric Patients With Prolonged Hospital Stay

    PubMed Central

    Afilalo, Marc; Soucy, Nathalie; Xue, Xiaoqing; Colacone, Antoinette; Jourdenais, Emmanuelle; Boivin, Jean-François

    2015-01-01

    Objective: To describe the characteristics and needs prior to, on admission, during the first month in hospital, at the thirtieth day of hospitalization and posthospital discharge of psychiatric patients occupying acute beds. Methods: This prospective observational study was conducted in 2 tertiary care hospitals. Adult patients hospitalized on a psychiatric unit for 30 days were identified. Data was collected from their medical charts and interviews with their health care team. The categorization of acute and nonacute status at day 30 was based on the health care professional’s evaluation. Descriptive and univariate analyses were performed. Results: A total of 262 patients were identified (mean age 45 years), 66% lived at home and 11% were homeless. More than one-half were cognitively impaired and a few had special medical needs. Ninety-seven per cent had been admitted from the emergency department. At day 30, 81% of patients required acute care, while 19% (95% CI 15% to 24%) occupied an acute care bed, despite the resolution of their acute condition. The main reason preventing discharge of nonacute patients was the difficulty or inability to find appropriate resources that met patients’ needs. As for patients who required acute care, the most common psychiatric issues were delusions or hallucinations (34%), inability to take medications independently (23.6%), and inadequate control of aggression or impulsivity (16.5%). Conclusions: Prevention of the discharge of nonacute patients is largely due to the difficulty in finding appropriate resources that meet patients’ needs. Improved access to community and subacute care resources could potentially facilitate the hospital discharge of psychiatric nonacute patients. PMID:26174218

  5. Psychiatric hospital challenges for healthcare security officers.

    PubMed

    White, Donald E

    2003-01-01

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

  6. Should psychiatric patients be granted access to their hospital records?

    PubMed

    Sergeant, H

    1986-12-01

    Beginning in September 1987, the British public will have the right to consult their computerized medical records and by extension, it is expected, noncomputerized ones as well. The author analyzed the case notes of 100 consecutive patients admitted under his care to a psychiatric day hospital. He classified material likely to affect patients adversely as puzzling or unintelligible, alarming, apparently insulting or objectionable, or sensitive information from or about others. Sergeant rejects proposals to omit sensitive material, to keep secret notes, or to grant access only to some psychiatric patients or to deny access to psychiatric patients as a class. Maintaining that there is no dividing line between somatic and psychological medicine, he concludes that access to personal health data for all patients should be limited to the disclosure of bare administrative details. Further information should be supplied within the traditional medical consultation.

  7. PSYCHIATRIC ASPECTS OF CLINICAL PRACTICE IN GENERAL HOSPITALS: A SURVEY OF NON-PSYCHIATRIC CLINICIANS

    PubMed Central

    Chadda, R.K.; Shome, S.

    1996-01-01

    The present work was carried out to study the awareness of non-psychiatric clinicians working in a teaching general hospital about the frequency of psychiatric morbidity in their clinical practice, their utilization of psychiatric consultation services, and opinion about utility of liaison psychiatry in general hospitals. A substantial proportion of doctors underestimated the psychiatric morbidity especially about unexplained physical symptoms and specific depressive symptoms in their patients. Psychiatric consultation services were not sufficiently utilised by a large number of clinicians. Most ofthemfelt the need to improve upon undergraduate medical education in psychiatry in India as well as a desire to have consultation - liaison psychiatric units in India. PMID:21584151

  8. Predicting hospital aggression in secure psychiatric care

    PubMed Central

    Priday, Lee J.; Ireland, Carol A.; Chu, Simon; Kilcoyne, Jennifer; Mulligan, Caroline

    2016-01-01

    Background Risk assessment instruments have become a preferred means for predicting future aggression, claiming to predict long-term aggression risk. Aims To investigate the predictive value over 12 months and 4 years of two commonly applied instruments (Historical, Clinical and Risk Management - 20 (HCR-20) and Violence Risk Appraisal Guide (VRAG)). Method Participants were adult male psychiatric patients detained in a high secure hospital. All had a diagnosis of personality disorder. The focus was on aggression in hospital. Results The actuarial risk assessment (VRAG) was generally performing better than the structured risk assessment (HCR-20), although neither approach performed particularly well overall. Any value in their predictive potential appeared focused on the longer time period under study (4 years) and was specific to certain types of aggression. Conclusions The value of these instruments for assessing aggression in hospital among patients with personality disorder in a high secure psychiatric setting is considered. Declaration of interest J.L.I., C.A.M. and J.K. are employed by the trust where the data were collected. Copyright and usage © The Royal College of Psychiatrists 2016. This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) licence. PMID:27703760

  9. Cost effectiveness of day and inpatient psychiatric treatment: results of a randomised controlled trial.

    PubMed Central

    Creed, F.; Mbaya, P.; Lancashire, S.; Tomenson, B.; Williams, B.; Holme, S.

    1997-01-01

    OBJECTIVE: To compare direct and indirect costs of day and inpatient treatment of acute psychiatric illness. DESIGN: Randomised controlled trial with outcome and costs assessed over 12 months after the date of admission. SETTING: Teaching hospital in an inner city area. SUBJECTS: 179 patients with acute psychiatric illness referred for admission who were suitable for random allocation to day hospital or inpatient treatment. 77 (43%) patients had schizophrenia. INTERVENTIONS: Routine inpatient or day hospital treatment. MAIN OUTCOME MEASURES: Direct and indirect costs over 12 months, clinical symptoms, social functioning, and burden on relatives over the follow up period. RESULTS: Clinical and social outcomes were similar at 12 months, except that inpatients improved significantly faster than day patients and burden on relatives was significantly less in the day hospital group at one year. Median direct costs to the hospital were 1923 pounds (95% confidence interval 750 pounds to 3174 pounds) per patient less for day hospital treatment than inpatient treatment. Indirect costs were greater for day patients; when these were included, overall day hospital treatment was 2165 pounds cheaper than inpatient treatment (95% confidence interval of median difference 737 pounds to 3593 pounds). Including costs to informants when appropriate meant that day hospital treatment was 1994 pounds per patient cheaper (95% confidence interval 600 pounds to 3543 pounds). CONCLUSIONS: Day patient treatment is cheaper for the 30-40% of potential admissions that can be treated in this way. Carers of day hospital patients may bear additional costs. Carers of all patients with acute psychiatric illness are often themselves severely distressed at the time of admission, but day hospital treatment leads to less burden on carers in the long term. PMID:9161310

  10. [THE CLINICAL ORGANIZATIONAL SUBSTANTIATION OF NEW TECHNOLOGY OF HOSPITAL PSYCHIATRIC CARE].

    PubMed

    Podsevatkin, V G; Blinov, D S; Podsevatkin, D V; Podsevatkina, S V; Smirnova, O A

    2015-01-01

    The new technology of hospital psychiatric care, developed and implemented in the Mordovia republican clinical hospital, permits resolving problems of hospitalism, lethality, pharmaceutical resistance and others. The essence of this technology is in staging of hospital care under condition of intensification and standardization of curative diagnostic process, implementation of complex approach to treatment of psychiatric disorders. The patient sequentially passes through three stages: intensive diagnostics and intensive treatment (intensive care department, intensive therapy department), supportive therapy (general psychiatric department); rehabilitation measures (curative rehabilitative department). The concentration of resources at the first stage, application of intensive therapy techniques permit in the shortest period to arrest acute psychotic symptomatic. The described new technology of hospital psychiatric care permits enhancing effectiveness of treatment, significantly shorten period of hospitalization (37.5 days), to obtain lasting and qualitative remission, to rehabilitate most fully social working status of patient and to significantly decrease lethality.

  11. Elements of Successful School Reentry after Psychiatric Hospitalization

    ERIC Educational Resources Information Center

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

    2011-01-01

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

  12. Impact of Patients’ Psychiatric Hospitalization on Caregivers: A Systematic Review

    PubMed Central

    Weller, Bridget Elizabeth; Faulkner, Madelaine; Doyle, Otima; Daniel, Stephanie S; Goldston, David B.

    2015-01-01

    Objective The purpose of this article was to systematically review literature on the impact of patients’ psychiatric hospitalizations on caregivers. Implications for practice and research are presented. Methods A systematic search of Web of Knowledge, PsychInfo, and Medline (PubMed) was conducted for peer-reviewed articles published before August 31, 2013. Qualitative, quantitative, and mixed method studies were included if they focused on caregiver outcomes and contained data collected directly from caregivers of patients who had been psychiatrically hospitalized. Results Twenty-nine articles met the inclusion criteria. Caregivers are heterogeneous in their reaction to the psychiatric hospitalization; however, many report distress. Caregivers also often report that they experience stigma, disruptions in daily life, worse physical health, economic strain, and changes in relationships following hospitalization. Negative reactions to the hospitalization may decrease over time, but can remain elevated when compared to the general population. Nonetheless, many caregivers also experience positive changes as a result of the hospitalization. The reaction of caregivers may be influenced by the severity of the patient’s psychiatric problems as well as the caregiver’s demographics and style of coping. Conclusions Caregivers experience a range of reactions to the psychiatric hospitalizations and providing caregivers with psychoeducation on their possible reaction as well as techniques to assist them may improve clinical outcomes for patients. Future research is needed to understand the heterogeneity in caregiver’s reactions to the patient’s psychiatric hospitalization. PMID:25686810

  13. [Psychiatric Hospital San Juan de Dios. One hundred years later].

    PubMed

    Cocula-León, Horacio

    2014-01-01

    Mental health and psychiatric diseases have always attracted people's and health authorities' attention due to its magical approach, the lack of knowledge that surrounds them, and, at the same time, the religious fear they provoke. Both have played an important role in the history of humanity, of public health politics, and of physicians. The places where psychiatric patients were treated are of historical interest, because through the historical knowledge we can identify an approach from the science and the health policies that prevailed in each age. At the beginning of the 20th century, it was developed in México a new model of hospital care attention to psychiatric patients. La Casa de Salud San Juan de Dios para Pacientes Alienados is an example; the concept "alienated patients" suggests a social and cultural perspective. This paper presents a chronological type description of one of the major institutions involved in mental health care in México. Similarly, it shows a review of the events that affected the religious order San Juan de Dios from 1901 to 2012, when the hospitaller order was reinstated in México and established the Casa de Salud San Juan de Dios para Pacientes Alienados in the town of Zapopan, Jalisco, institution that exists up to the present day and keeps participating in the mental health care in the state of Jalisco, with the current name of Servicios de Salud San Juan de Dios.

  14. Psychiatric Hospitalization among Children with Autism Spectrum Disorders

    ERIC Educational Resources Information Center

    Mandell, David S.

    2008-01-01

    This study examined predictors of psychiatric hospitalization among children with autism spectrum disorders (ASD). Data were collected from 760 caregivers of children with ASD. Cox regression was used to determine factors associated with hospitalization. Almost 11% were hospitalized. Youth in single parent homes were more likely to be hospitalized…

  15. Deprivation of liberty in psychiatric hospital care: the patient's perspective.

    PubMed

    Kuosmanen, Lauri; Hätönen, Heli; Malkavaara, Heikki; Kylmä, Jari; Välimäki, Maritta

    2007-09-01

    Deprivation of liberty in psychiatric hospitals is common world-wide. The aim of this study was to find out whether patients had experienced deprivation of their liberty during psychiatric hospitalization and to explore their views about it. Patients (n = 51) in two acute psychiatric inpatient wards were interviewed in 2001. They were asked to describe in their own words their experiences of being deprived of their liberty. The data were analysed by inductive content analysis. The types of deprivation of liberty in psychiatric hospital care reported by these patients were: restrictions on leaving the ward and on communication, confiscation of property, and various coercive measures. The patients' experiences of being deprived of their liberty were negative, although some saw the rationale for using these interventions, considering them as part of hospital care.

  16. Influence of psychiatric comorbidity on 30-day readmissions for heart failure, myocardial infarction, and pneumonia

    PubMed Central

    Ahmedani, Brian K.; Solberg, Leif I.; Copeland, Laurel; Fang, Ying; Stewart, Christine; Hu, Jianhui; Nerenz, David R.; Williams, L. Keoki; Cassidy-Bushrow, Andrea E.; Waxmonsky, Jeanette; Lu, Christine Y.; Waitzfelder, Beth E.; Owen-Smith, Ashli A.; Coleman, Karen J.; Lynch, Frances L.; Ahmed, Ameena T.; Beck, Arne L.; Rossom, Rebecca C.; Simon, Gregory E.

    2014-01-01

    Objective The Centers for Medicare and Medicaid Services (CMS) implemented a policy in 2012 that penalizes hospitals for ‘excessive’ all-cause hospital readmissions within 30 days after discharge for heart failure (HF), acute myocardial infarction (AMI), and pneumonia. The aim of this study is to investigate the influence of psychiatric comorbidities on 30-day all-cause readmissions for heart failure, acute myocardial infarction, and pneumonia. Methods Longitudinal study from 2009-2011 within 11 Mental Health Research Network (MHRN) affiliated health systems. Data were derived from the HMO Research Network Virtual Data Warehouse. Participants were individuals admitted to the hospital for HF, AMI, and pneumonia. All index inpatient hospitalizations for HF, AMI and pneumonia were captured (n=160,169 patient index admissions). Psychiatric diagnoses were measured for the year prior to admission. All-cause readmissions within 30 days of discharge were the outcome variable. Results Approximately 18% of all individuals with these conditions were readmitted within 30-days. The rate was 5% greater for individuals with a past-year psychiatric comorbidity (21.7%) than for those without (16.5%; p<.001). Depression, anxiety, and dementia were associated with more readmissions for those with index hospitalizations for all three conditions independently and combined (p<.05). Substance use and bipolar disorders were linked with higher readmissions for those with initial HF and pneumonia hospitalizations (p<.05). Readmission rates declined overall from 2009-2011. Conclusions Individuals with HF, AMI, and pneumonia experience high rates of readmission, but psychiatric comorbidities appear to increase that risk. Future readmission interventions should consider adding mental health components. PMID:25642610

  17. Improving Psychiatric Hospital Care for Pediatric Patients with Autism Spectrum Disorders and Intellectual Disabilities

    PubMed Central

    Gabriels, Robin L.; Agnew, John A.; Beresford, Carol; Morrow, Mary Ann; Mesibov, Gary; Wamboldt, Marianne

    2012-01-01

    Pediatric patients with autism spectrum disorders (ASD) and/or intellectual disabilities (ID) are at greater risk for psychiatric hospitalization compared to children with other disorders. However, general psychiatric hospital environments are not adapted for the unique learning styles, needs, and abilities of this population, and there are few specialized hospital-based psychiatric care programs in the United States. This paper compares patient outcomes from a specialized psychiatric hospital program developed for pediatric patients with an ASD and/or ID to prior outcomes of this patient population in a general psychiatric program at a children's hospital. Record review data indicate improved outcomes for patients in the specialized program of reduced recidivism rates (12% versus 33%) and decreased average lengths of inpatient stay (as short as 26 days versus 45 days). Available data from a subset of patients (n = 43) in the specialized program showed a decrease in irritability and hyperactivity behaviors from admission to discharge and that 35 previously undetected ASD diagnoses were made. Results from this preliminary study support specialized psychiatric care practices with this population to positively impact their health care outcomes. PMID:22934179

  18. [When you see the light of day at the hospital].

    PubMed

    Llimos, Susana; Pirovani, Carolina; Oszlak, Claudia; Cuini, Marisa

    2012-01-01

    Day Hospital delivers complex treatments to patients with psychiatric illness such as psychosis and severe neurosis. Interdisciplinary work is necessarily required by this device. Our Day Hospital is organized in three sections: community area, clinical area and education and research. Our practice isn't exempt of hindrances, which relate not only to the clinical specifics we deal with, but also with the social, cultural and legal contexts it develops in. Since the approval of the Mental Health National Law (no. 26657) we believe the Day Hospital, our old resource, is given the opportunity to keep fulfilling a space as a proposal both fresh and institutional. The mentioned law states that Day Hospitals are to be promoted as a means for social, labor and community inclusion of patients. We have no doubt on the legal advance this represents but, on daily practice, issues will persist until a strong change decision is shown, implemented as public health policies aligned with the law.

  19. AN ECOLOGICAL ANALYSIS OF PSYCHIATRIC HOSPITALIZATIONS.

    PubMed

    Bloom, B L

    1968-10-01

    In order to develop some understanding of community social structure and its association with psychiatric inpatient medical care patterns, first admission rates for psychiatric disorders into both public and private facilities were determined for each of the 33 census tracts of Pueblo, Colorado. At the same time a cluster analysis was made of the structure of these tracts. Four well- defined clusters were identified (socio-economic affluence, young marrieds, social isolation, and social disequilibrium) and strikingly high differential relationships found between the cluster scores and psychiatric inpatient care patterns. Implications of the findings for preventive strategies and for. social etiology hypotheses are presented.

  20. Psychiatric diagnoses after hospitalization with work-related burn injuries in Washington State.

    PubMed

    Anderson, Naomi J; Bonauto, David K; Adams, Darrin

    2011-01-01

    This study aims to describe workers who were hospitalized with work-related burn injuries and their psychiatric sequelae in Washington State. Psychiatric sequelae of interest were depression, posttraumatic stress disorder, and other anxiety disorders. Workers' compensation claims meeting a definition for a hospitalized burn patient from Washington State from January 2001 through April 2008 were analyzed. The resulting claims were searched for the presence of certain psychiatric diagnoses or treatment codes, and descriptive analyses performed. In Washington State during the time period, the prevalence of claims with psychiatric diagnoses after hospitalization with burn injury was 19%. Claims with psychiatric diagnoses had higher medical costs and more days of time loss than those without these diagnoses. Workers with electrical burns in the construction industry and in construction and extraction occupations had a higher proportion of psychiatric sequelae. Burns are devastating yet preventable injuries. Workers who were hospitalized with work-related burn injuries, particularly those in certain industries and occupations and those with electrical burns, are at high risk for developing serious psychiatric sequelae with major costs to both the individual and the society.

  1. Prevalence and Correlates of Autism in a State Psychiatric Hospital

    ERIC Educational Resources Information Center

    Mandell, David S.; Lawer, Lindsay J.; Branch, Kira; Brodkin, Edward S.; Healey, Kristin; Witalec, Robert; Johnson, Donielle N.; Gur, Raquel E.

    2012-01-01

    This study estimated the ASD prevalence in a psychiatric hospital and evaluated the Social Responsiveness Scale (SRS) combined with other information for differential diagnosis. Chart review, SRS and clinical interviews were collected for 141 patients at one hospital. Diagnosis was determined at case conference. Receiver operating characteristic…

  2. READMIT: a clinical risk index to predict 30-day readmission after discharge from acute psychiatric units.

    PubMed

    Vigod, Simone N; Kurdyak, Paul A; Seitz, Dallas; Herrmann, Nathan; Fung, Kinwah; Lin, Elizabeth; Perlman, Christopher; Taylor, Valerie H; Rochon, Paula A; Gruneir, Andrea

    2015-02-01

    Our aim was to create a clinically useful risk index, administered prior to discharge, for determining the probability of psychiatric readmission within 30 days of hospital discharge for general psychiatric inpatients. We used population-level sociodemographic and health administrative data to develop a predictive model for 30-day readmission among adults discharged from an acute psychiatric unit in Ontario, Canada (2008-2011), and converted the final model into a risk index system. We derived the predictive model in one-half of the sample (n = 32,749) and validated it in the other half of the sample (n = 32,750). Variables independently associated with 30-day readmission (forming the mnemonic READMIT) were: (R) Repeat admissions; (E) Emergent admissions (i.e. harm to self/others); (D) Diagnoses (psychosis, bipolar and/or personality disorder), and unplanned Discharge; (M) Medical comorbidity; (I) prior service use Intensity; and (T) Time in hospital. Each 1-point increase in READMIT score (range 0-41) increased the odds of 30-day readmission by 11% (odds ratio 1.11, 95% CI 1.10-1.12). The index had moderate discriminative capacity in both derivation (C-statistic = 0.631) and validation (C-statistic = 0.630) datasets. Determining risk of psychiatric readmission for individual patients is a critical step in efforts to address the potentially avoidable high rate of this negative outcome. The READMIT index provides a framework for identifying patients at high risk of 30-day readmission prior to discharge, and for the development, evaluation and delivery of interventions that can assist with optimizing the transition to community care for patients following psychiatric discharge.

  3. Day Hospitals' Cost and Effectiveness: A Summary.

    ERIC Educational Resources Information Center

    Eagle, D. Joan; And Others

    1987-01-01

    Review of literature concerning effectiveness and cost of geriatric day hospitals revealed many descriptive studies and four randomized control studies. Of four studies, one demonstrated credible improvement in physical and emotional function in day hospital versus conventional care control group. Three randomized studies in which costs were…

  4. The reimbursement blues. A psychiatric hospital copes with decreasing reimbursement and declining admissions.

    PubMed

    Hume, S K

    1991-03-01

    Beginning in 1989, Harbor View Mercy Hospital, a freestanding psychiatric facility in Fort Smith, AR, saw a flattening of growth in inpatient days and declines in discharges. In addition to decreasing admissions, it faces the problems of decreasing reimbursement, the need to provide more services with fewer resources, and greater government regulations. The greatest problem is inadequate reimbursement. Psychiatric hospitals fare worse than their acute care counterparts under both Medicaid and Medicare. To fulfill its mission to serve those in need, Harbor View has allocated 43 percent of its revenue budget this year to cover charity care, bad debt, etc. Ron Summerhill, the hospital's chief administrative officer, predicts a slowdown in the growth and profitability of psychiatric services in both the for-profit and not-for-profit sectors. But he is combating this trend by increasing use of managed care arrangements, diversifying, offering more outpatient services, and advocating for change in the reimbursement situation. PMID:10109228

  5. Correlates of hopelessness in psychiatrically hospitalized children.

    PubMed

    Kashani, J H; Soltys, S M; Dandoy, A C; Vaidya, A F; Reid, J C

    1991-01-01

    The importance of hopelessness within the study of childhood psychiatric disorders is becoming increasingly apparent. The present study divides a child inpatient sample (age 7 to 12 years) into two groups based on scores from the Kazdin Hopelessness Scale for Children. Comparisons made between the two groups on various measures showed that children with high hopelessness had lower cognitive ability, "difficult child" temperament characteristics, more anxiety, lower self-esteem, and a higher degree of psychopathology than the low-hopelessness group. The role of hopelessness in academic success and future psychopathology are discussed.

  6. Deconstructing the language of psychiatric hospitalization.

    PubMed

    Mohr, W K

    1999-05-01

    The purpose of this study was to deconstruct the language of psychiatric nurses' documentation and charting. Employing concepts developed by post-modern theorists, everyday professional activities can be examined in unique ways that uncover how they conceal or skew rather than reveal and illumine patient conditions. The study design and sample was exploratory; content analysis with first and second level analyses. Nine major categories of charting entry were found. Deconstruction of the language and discourse of nursing through a Foucaultian lens goes beyond what is manifest to what is not said. Professional assumptions about patients and the social construction of patients and patient problems are exposed. PMID:10320487

  7. Serum Dopamine Beta Hydroxylase and Maltreatment in Psychiatrically Hospitalized Boys.

    ERIC Educational Resources Information Center

    Galvin, Matthew; And Others

    1995-01-01

    Males (ages 7 to 17) in a psychiatric hospital were studied while off psychoactive medication to determine how serum dopamine beta hydroxylase (DBH) activity varies with childhood maltreatment experiences. Lowest DBH levels were found in boys maltreated before 72 months of age or with the principal diagnosis of conduct disorder solitary aggressive…

  8. Children in Foster Care: Before, during, and after Psychiatric Hospitalization

    ERIC Educational Resources Information Center

    Persi, Joe; Sisson, Megan

    2008-01-01

    Although it is generally accepted that foster children are at greater risk for mental health problems than are children in the general population, very little is known about the smaller group of foster children admitted to psychiatric hospitals. The present study sought to determine whether foster children admitted to inpatient care are a distinct…

  9. The Pathway to Excellence Experience: One Psychiatric Hospital's Journey.

    PubMed

    Mahoney, Jane S; Jackson, Jennifer M; Palyo, Nancy

    2016-01-01

    Psychiatric nurse executives and managers face an ongoing challenge to create positive professional work environments that support the recruitment and retention of the best nurses. The Pathway to Excellence program is an organizational credentialing program that designates a hospital as a workplace of choice for nursing. This article describes one psychiatric hospital's journey to become and maintain a Pathway to Excellence designation in the midst of transition. Challenges faced and novel approaches used, along the journey, are shared. The use of Appreciative Inquiry techniques has led to positive changes and heightened energy among nurses. Our experiences suggest that effective shared governance is central to a hospital's Pathway to Excellence success. We attribute the steady increase in the retention rate of nurses, in large part, to the Pathway to Excellence program.

  10. Risk Factors for Seclusion and Restraint in a Pediatric Psychiatry Day Hospital.

    PubMed

    Timbo, Wuroh; Sriram, Aishwarya; Reynolds, Elizabeth K; DeBoard-Lucas, Renee; Specht, Matthew; Howell, Carolyn; McSweeney, Colleen; Grados, Marco A

    2016-10-01

    The use of seclusion and restraints (SR) in acute hospital settings remains a controversial practice. Despite the focus on SR in the psychiatric services literature, data on SR use in pediatric day hospital settings is lacking. A case-control retrospective analysis for children admitted into a pediatric psychiatry day hospital in a 2-year span examined predictors of SR use. Demographic and clinical descriptors were examined in relation to SR events using univariate and multivariate regression models. Significant univariate risk factors for SR use were psychiatric morbidity, history of physical abuse, post-traumatic stress disorder, having any anxiety disorder, and younger age. Knowledge of risk factors for SR use in pediatric psychiatric day hospitals can avert use of SR and lead to improved safety in a trauma-informed care model.

  11. 42 CFR 482.62 - Condition of participation: Special staff requirements for psychiatric hospitals.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... requirements for psychiatric hospitals. 482.62 Section 482.62 Public Health CENTERS FOR MEDICARE & MEDICAID... PARTICIPATION FOR HOSPITALS Requirements for Specialty Hospitals § 482.62 Condition of participation: Special staff requirements for psychiatric hospitals. The hospital must have adequate numbers of...

  12. 42 CFR 482.60 - Special provisions applying to psychiatric hospitals.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... hospitals. 482.60 Section 482.60 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF... HOSPITALS Requirements for Specialty Hospitals § 482.60 Special provisions applying to psychiatric hospitals. Psychiatric hospital must— (a) Be primarily engaged in providing, by or under the supervision of a doctor...

  13. Day Hospital Treatment for Borderline Adolescents.

    ERIC Educational Resources Information Center

    Simon, Jerald I.

    1986-01-01

    Presents a literature review on the day treatment of borderline patients and discusses the diagnosis and dynamics of borderline adolescents. Describes methods used in a day hospital program whose goal was to potentiate a successful start of a longer-term psychotherapeutic process that would continue after discharge. Difficulties in prognosis and…

  14. Doing participant observation in a psychiatric hospital-- research ethics resumed.

    PubMed

    Oeye, Christine; Bjelland, Anne Karen; Skorpen, Aina

    2007-12-01

    Social scientists who employ participant observation methods in medical settings are often held accountable for their research methods, specifically in regard to medical research ethics. However, the medical research ethics tradition rubs uneasily against participant observation and the anthropological understanding of the research process. The underlying premise for considering research ethics in the current case is the notion of the vulnerability of psychiatric patients as a participant group. Based on this notion of vulnerability among psychiatric patients, this article discusses the epistemological grounds for vulnerability in anthropological and medical research ethics. The authors draw on their experience with the Regional Committee for Medical Research Ethics in Norway, and the consequences of the guidelines used for participant observation as a research method in a psychiatric hospital. Social science researchers are required to follow medical ethical guidelines, such as informed consent, the principle of voluntariness, and estimation of risks and benefits. Ethnographers have found these guidelines to be obstructive when doing social science research in a psychiatric hospital. The article suggests the need for reformulation of research guidelines for participant observation in medical settings.

  15. End-of-life care in a psychiatric hospital

    PubMed Central

    Waterman, Lauren Z.; Denton, David; Minton, Ollie

    2016-01-01

    Since the Liverpool Care Pathway has been withdrawn in the UK, clinicians supporting the palliative needs of patients have faced further challenges, particularly for patients with dementia who are unable to go to a hospice owing to challenging behaviours. It is becoming more important for different services to provide long-term palliative care for patients with dementia. Mental health trusts should construct end-of-life care policies and train staff members accordingly. Through collaborative working, dying patients may be kept where they are best suited. We present the case study of a patient who received end-of-life care at a psychiatric hospital in the UK. We aim to demonstrate how effective end-of-life care might be provided in a psychiatric hospital, in accordance with recent new palliative care guidelines, and highlight potential barriers. PMID:27280036

  16. Psychiatric hospitalization of children in Florida. Legal aspects.

    PubMed

    Mutch, S A; Myers, W C

    1994-07-01

    The hospitalization of children in psychiatric hospitals and their associated rights or lack thereof remains an important issue. Much attention has been focused on children's rights in Florida, most recently with the cases of Gregory K. and Kimberly Mays. On a national level, Hillary Rodham Clinton has drawn attention to children's rights through her advocacy for children. The commitment of children to mental health facilities in Florida deserves examination. This is an important issue, not only to the psychiatrist who tests youths, but also to the family practitioner, internist, or any other referring physician who is involved in the case of the child and the family. It is imperative that the primary care physician as well as the psychiatrist know and understand the limitations and requirements for civil commitment of a child in a psychiatric setting.

  17. Nurse-police coalition: improves safety in acute psychiatric hospital.

    PubMed

    Allen, Diane E; Harris, Frank N; de Nesnera, Alexander

    2014-09-01

    Although police officers protect and secure the safety of citizens everywhere, nurses are the primary guardians of patient safety within the treatment milieu. At New Hampshire Hospital, both nurses and police officers share ownership of this responsibility, depending on the needs that arise specific to each profession. Psychiatric nurses take pride in their ability to de-escalate agitated and potentially aggressive patients; however, times arise when the best efforts of nurses fail, or when a situation requires intervention from police officers. Nurses and police officers at New Hampshire Hospital have worked together for many years to develop a trusting, respectful alliance. This coalition has resulted in a safe, clear, orderly process for transfer of authority from nurses to police during violent, clinically unmanageable psychiatric emergencies. Nurses and police officers work collaboratively toward the common goal of ensuring safety for patients and staff, while also acknowledging the unique strengths of each profession.

  18. Psychiatric hospitalization of children in Florida. Legal aspects.

    PubMed

    Mutch, S A; Myers, W C

    1994-07-01

    The hospitalization of children in psychiatric hospitals and their associated rights or lack thereof remains an important issue. Much attention has been focused on children's rights in Florida, most recently with the cases of Gregory K. and Kimberly Mays. On a national level, Hillary Rodham Clinton has drawn attention to children's rights through her advocacy for children. The commitment of children to mental health facilities in Florida deserves examination. This is an important issue, not only to the psychiatrist who tests youths, but also to the family practitioner, internist, or any other referring physician who is involved in the case of the child and the family. It is imperative that the primary care physician as well as the psychiatrist know and understand the limitations and requirements for civil commitment of a child in a psychiatric setting. PMID:7964573

  19. 42 CFR 424.13 - Requirements for inpatient services of hospitals other than psychiatric hospitals.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 3 2010-10-01 2010-10-01 false Requirements for inpatient services of hospitals other than psychiatric hospitals. 424.13 Section 424.13 Public Health CENTERS FOR MEDICARE & MEDICAID... PAYMENT Certification and Plan Requirements § 424.13 Requirements for inpatient services of...

  20. 42 CFR 482.61 - Condition of participation: Special medical record requirements for psychiatric hospitals.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... requirements for psychiatric hospitals. 482.61 Section 482.61 Public Health CENTERS FOR MEDICARE & MEDICAID... PARTICIPATION FOR HOSPITALS Requirements for Specialty Hospitals § 482.61 Condition of participation: Special medical record requirements for psychiatric hospitals. The medical records maintained by a...

  1. Characteristics of psychiatric hospitalizations with multiple mechanical restraint episodes versus hospitalization with a single mechanical restraint episode.

    PubMed

    Guzman-Parra, Jose; Guzik, Justyna; Garcia-Sanchez, Juan A; Pino-Benitez, Isabel; Aguilera-Serrano, Carlos; Mayoral-Cleries, Fermin

    2016-10-30

    We investigated the characteristics of multiple episodes of mechanical restraint versus a single episode in a psychiatric ward of a public general hospital. The following characteristics were associated with multiple restraints: young age, length of hospital stay, not being readmitted within 30 days from previous discharge, and admission in the previous year before the implementation of an intervention program to reduce mechanical restraint. The study suggests that both organizational factors and patients' disturbed behaviour are associated with the risk of being mechanically restrained several times.

  2. Characteristics of psychiatric hospitalizations with multiple mechanical restraint episodes versus hospitalization with a single mechanical restraint episode.

    PubMed

    Guzman-Parra, Jose; Guzik, Justyna; Garcia-Sanchez, Juan A; Pino-Benitez, Isabel; Aguilera-Serrano, Carlos; Mayoral-Cleries, Fermin

    2016-10-30

    We investigated the characteristics of multiple episodes of mechanical restraint versus a single episode in a psychiatric ward of a public general hospital. The following characteristics were associated with multiple restraints: young age, length of hospital stay, not being readmitted within 30 days from previous discharge, and admission in the previous year before the implementation of an intervention program to reduce mechanical restraint. The study suggests that both organizational factors and patients' disturbed behaviour are associated with the risk of being mechanically restrained several times. PMID:27497291

  3. [Historicizing nursing and patients at a psychiatric hospital].

    PubMed

    Borenstein, Miriam Süsskind; Pereira, Valdete Preve; Ribas, Dorotéa Löes; Ribeiro, Anesilda Alves de Almeida

    2003-01-01

    This is a historical research whose objective is to historicize the nursing team and the patients at the Hospital Colônia Sant'Ana (HCS), in the period from 1941 to 1960. Five employees that worked at the Hospital in the period of the study were interviewed and other documental sources were used. To analyze the data Foucault's theory was used. HCS was the main pole of psychiatric care in the Santa Catarina. The nursing team was constituted by the nuns, "male nurses" and "watchmen". The institution received indigent, private, and health insurance covered patients, who were diagnosed with many different problems, and some who were more of a social case than anything else. The general conditions of the Hospital were precarious. The studied period made possible visualize that the treatment given to the patients, as well as the work conditions offered to the workers, were distant from the ideal, and that it was part of a national policy, characterized by the creation of state macro psychiatric hospitals.

  4. The Use of Physical Restraint in Norwegian Adult Psychiatric Hospitals

    PubMed Central

    Wynn, Rolf

    2015-01-01

    Background. The use of coercion within the psychiatric services is problematic and raises a range of ethical, legal, and clinical questions. “Physical restraint” is an emergency procedure used in psychiatric hospitals to control patients that pose an imminent physical danger. We wished to review the literature published in scientific peer-reviewed journals describing studies on the use of physical restraint in Norway, in order to identify the current state of knowledge and directions for future research. Design. The databases PubMed, PsycINFO, CINAHL, Web of Science, and Embase were searched for studies relating to physical restraint (including holding) in Norwegian psychiatric hospitals, supplemented with hand searches. Results. 28 studies were included. Most of the studies were on rates of restraint, but there were also some studies on perceptions of patients and staff, case studies, and ethnographic studies. There was only one intervention study. There are differences in use between wards and institutions, which in part may be explained by differences in patient populations. Staff appear to be less negative to the use of restraint than patients. Conclusions. The studies that were identified were primarily concerned with rates of use and with patients' and staff's perspectives. More interventional studies are needed to move the field forward. PMID:26682211

  5. [Suicide in psychiatric hospitals : Results, risk factors and therapeutic measures].

    PubMed

    Wolfersdorf, M; Vogel, R; Vogl, R; Grebner, M; Keller, F; Purucker, M; Wurst, F M

    2016-05-01

    Suicide prevention is a core responsibility of psychiatry and psychotherapy. Periods of change in psychiatric inpatient treatment concepts are usually also accompanied by an increase in psychopathological behavior and with increased suicide rates in psychiatric hospitals, as seen in the 1970s and 1980s in Germany. That this represented a real increase of inpatient suicides during those years was confirmed and subsequently the number and rate of inpatient suicides has decreased from approximately 280 out of 100,000 admissions of patients in 1980 to approximately 50 in 2014. Death can also occur in psychiatric hospitals and an absolute prevention is not possible even under optimal conditions of therapy and nursing, communication and security. The suicide rate has clearly decreased over the last two decades in relation to admissions. The group of young male schizophrenic patients newly identified as having a high clinical suicide risk has decreased among the suicide victims whereas the percentage of severely depressed patients with delusions has increased. This reduction could be associated with the comprehensive improvements in educational and training programs in the field of suicide and suicide prevention, objectification of coping methods, development of diagnostic and therapeutic strategies, improvements in therapy and relationship possibilities and a general reduction in the number of suicides in Germany. PMID:27090898

  6. [Psychiatric hospitalization for mental illness: past, present and future].

    PubMed

    Martínez Ferretti, José María

    2011-01-01

    The use of psychiatric hospitalization for mental illness has evolved through Modernity. In the last century, indefinite and involuntary committal was a widespread practice but has now become an extraordinary and short-term therapeutic recourse. Even though law experts, doctors and other mental health professionals agree on the benefits of this shift, in practice there are disagreements rooted in the shortcomings of health service providers. The current medical and legal criteria for hospitalization of patients with mental disorders should move away from the concept of endangerment and embrace therapeutic procedures and social care. New contemporary challenges, such as drugs and violence, require the implementation of a social strategy that is more comprehensive than medical treatment. This article presents a series of case studies describing the circumstances that led to the hospitalization of mental health patients, mostly in the city of Buenos Aires. PMID:22091456

  7. Clinical outcomes and mortality associated with weekend admission to psychiatric hospital

    PubMed Central

    Patel, Rashmi; Chesney, Edward; Cullen, Alexis E.; Tulloch, Alex D.; Broadbent, Matthew; Stewart, Robert; McGuire, Philip

    2016-01-01

    Background Studies indicate that risk of mortality is higher for patients admitted to acute hospitals at the weekend. However, less is known about clinical outcomes among patients admitted to psychiatric hospitals. Aims To investigate whether weekend admission to a psychiatric hospital is associated with worse clinical outcomes. Method Data were obtained from 45 264 consecutive psychiatric hospital admissions. The association of weekend admission with in-patient mortality, duration of hospital admission and risk of readmission was investigated using multivariable regression analyses. Secondary analyses were performed to investigate the distribution of admissions, discharges, in-patient mortality, episodes of seclusion and violent incidents on different days of the week. Results There were 7303 weekend admissions (16.1%). Patients who were aged between 26 and 35 years, female or from a minority ethnic group were more likely to be admitted at the weekend. Patients admitted at the weekend were more likely to present via acute hospital services, other psychiatric hospitals and the criminal justice system than to be admitted directly from their own home. Weekend admission was associated with a shorter duration of admission (B coefficient −21.1 days, 95% CI −24.6 to −17.6, P<0.001) and an increased risk of readmission in the 12 months following index admission (incidence rate ratio 1.13, 95% CI 1.08 to 1.18, P<0.001), but in-patient mortality (odds ratio (OR) = 0.79, 95% CI 0.51 to 1.23, P = 0.30) was not greater than for weekday admission. Fewer episodes of seclusion occurred at the weekend but there was no significant variation in deaths during hospital admission or violent incidents on different days of the week. Conclusions Being admitted at the weekend was not associated with an increased risk of in-patient mortality. However, patients admitted at the weekend had shorter admissions and were more likely to be readmitted, suggesting that they may represent a

  8. Physician Prescribing Practices of Vitamin D in a Psychiatric Hospital

    PubMed Central

    Trigoboff, Eileen; Opler, Lewis; Demler, Tammie Lee

    2016-01-01

    Vitamin D supplementation has become an increasingly popular prescribing practice, despite our limited knowledge of both the definition and degree of deficiency as well as the expected benefits or risks of exogenous administration. Many of the hypothesized benefits of vitamin D supplementation include a variety of improvements in mental health; however, these claims are not consistently or robustly supported by current research. In this paper, we provide a brief overview of what is currently known about vitamin D deficiency and about outcomes of supplementation as well as a summary of the data relative to prescribing practices for inpatients in an urban psychiatric hospital. PMID:27803841

  9. Psychiatric disorders and clinical correlates of suicidal patients admitted to a psychiatric hospital in Tokyo

    PubMed Central

    2010-01-01

    Background Patients admitted to a psychiatric hospital with suicidal behavior (SB) are considered to be especially at high risk of suicide. However, the number of studies that have addressed this patient population remains insufficient compared to that of studies on suicidal patients in emergency or medical settings. The purpose of this study is to seek features of a sample of newly admitted suicidal psychiatric patients in a metropolitan area of Japan. Method 155 suicidal patients consecutively admitted to a large psychiatric center during a 20-month period, admission styles of whom were mostly involuntary, were assessed using Structured Clinical Interviews for DSM-IV Axis I and II Disorders (SCID-I CV and SCID-II) and SB-related psychiatric measures. Associations of the psychiatric diagnoses and SB-related characteristics with gender and age were examined. Results The common DSM-IV axis I diagnoses were affective disorders 62%, anxiety disorders 56% and substance-related disorders 38%. 56% of the subjects were diagnosed as having borderline PD, and 87% of them, at least one type of personality disorder (PD). SB methods used prior to admission were self-cutting 41%, overdosing 32%, self-strangulation 15%, jumping from a height 12% and attempting traffic death 10%, the first two of which were frequent among young females. The median (range) of the total number of SBs in the lifetime history was 7 (1-141). Severity of depressive symptomatology, suicidal intent and other symptoms, proportions of the subjects who reported SB-preceding life events and life problems, and childhood and adolescent abuse were comparable to those of the previous studies conducted in medical or emergency service settings. Gender and age-relevant life-problems and life events were identified. Conclusions Features of the studied sample were the high prevalence of affective disorders, anxiety disorders and borderline PD, a variety of SB methods used prior to admission and frequent SB repetition

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

    PubMed Central

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

    2010-01-01

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

  11. Effectiveness of a geriatric day hospital.

    PubMed Central

    Eagle, D J; Guyatt, G H; Patterson, C; Turpie, I; Sackett, B; Singer, J

    1991-01-01

    OBJECTIVE: To determine whether there is a difference in the quality of life between elderly patients managed in a day hospital and those receiving conventional care. DESIGN: Randomized controlled trial; assessment upon entry to study and at 3, 6 and 12 months afterward. SETTING: Geriatrician referral-based secondary care. PATIENTS: A total of 113 consecutively referred elderly patients with deteriorating functional status believed to have rehabilitation potential; 55 were assessed and treated by an interdisciplinary team in a day hospital (treatment group), and 58 were assessed in an inpatient unit or an outpatient clinic or were discharged early with appropriate community services (control group). OUTCOME MEASURES: Barthel Index, Rand Questionnaire, Global Health Question and Geriatric Quality of Life Questionnaire (GQLQ). MAIN RESULTS: Eight study subjects and four control subjects died; the difference was insignificant. Functional status deteriorated over time in the two groups; although the difference was not significant there was less deterioration in the control group. The GQLQ scores indicated no significant difference between the two groups in the ability to perform daily living activities and in the alleviation of symptoms over time but did show a trend favouring the control group. The GQLQ scores did indicate a significant difference in favour of the control group in the effect of treatment on emotions (p = 0.009). CONCLUSION: The care received at the day hospital did not improve functional status or quality of life of elderly patients as compared with the otherwise excellent geriatric outpatient care. PMID:1998929

  12. A comparison of olanzapine and risperidone on the risk of psychiatric hospitalization in the naturalistic treatment of patients with schizophrenia

    PubMed Central

    Ascher-Svanum, Haya; Zhu, Baojin; Faries, Douglas; Ernst, Frank R

    2004-01-01

    Background Decreasing hospital admissions is important for improving outcomes for people with schizophrenia and for reducing cost of hospitalization, the largest expenditure in treating this persistent and severe mental illness. This prospective observational study compared olanzapine and risperidone on one-year psychiatric hospitalization rate, duration, and time to hospitalization in the treatment of patients with schizophrenia in usual care. Methods We examined data of patients newly initiated on olanzapine (N = 159) or risperidone (N = 112) who continued on the index antipsychotic for at least one year following initiation. Patients were participants in a 3-year prospective, observational study of schizophrenia patients in the US. Outcome measures were percent of hospitalized patients, total days hospitalized per patient, and time to first hospitalization during the one-year post initiation. Analyses employed a generalized linear model with adjustments for demographic and clinical variables. A two-part model was used to confirm the findings. Time to hospitalization was measured by the Kaplan-Meier survival formula. Results Compared to risperidone, olanzapine-treated patients had significantly lower hospitalization rates, (24.1% vs. 14.4%, respectively, p = 0.040) and significantly fewer hospitalization days (14.5 days vs. 9.9 days, respectively, p = 0.035). The mean difference of 4.6 days translated to $2,502 in annual psychiatric hospitalization cost savings per olanzapine-treated patient, on average. Conclusions Consistent with prior clinical trial research, treatment-adherent schizophrenia patients who were treated in usual care with olanzapine had a lower risk of psychiatric hospitalization than risperidone-treated patients. Lower hospitalization costs appear to more than offset the higher medication acquisition cost of olanzapine. PMID:15175112

  13. Transnational Disorders: Returned Migrants at Oaxaca's Psychiatric Hospital.

    PubMed

    Duncan, Whitney L

    2015-03-01

    This article examines experiences of returned migrants seeking mental health care at the public psychiatric hospital in Oaxaca, Mexico. Approximately one-third of the hospital's patients have migration experience, and many return to Oaxaca due to mental health crises precipitated by conditions of structural vulnerability and "illegality" in the United States. Once home, migrants, their families, and their doctors struggle to interpret and allay these "transnational disorders"-disorders structurally produced and personally experienced within the borders of more than one country. Considering how space and time shape illness and treatment among transnational migrants, I contend that a critical phenomenology of illegality must incorporate migrant experience and political economy on both sides of the border before, during, and after migration.

  14. A review of offenders remanded in a State Psychiatric Hospital.

    PubMed

    Lim, L E; Chan, K L; Tan, L L; Sung, M; Loh, M I; Straughan, P T

    2000-03-01

    Patients remanded over a two-year period to Woodbridge Hospital by Court Order were studied retrospectively. Schizophrenia was the most common diagnosis, theft and robbery the most prevalent offences. Males greatly outnumbered females. There were important gender differences, with males tending to commit sexual offences and females, theft and mischief. Males were less likely to be acquainted with their victims but those who caused hurt were more likely to know their victims. Outrage of modesty and theft were more likely to be committed against strangers. The reconviction rate was 26%, with repeat offenders more likely to commit sexual offences and theft. Patients who had previous psychiatric hospitalisation were more likely to be attending follow-up prior to and after release from remand and were more likely to have schizophrenia. Those assessed to be fit to plead were either fined or given jail sentences. Unsoundness of mind and unfitness to plead were associated with further remand in this hospital.

  15. Robert Schumann in the psychiatric hospital at Endenich.

    PubMed

    Steinberg, Reinhard

    2015-01-01

    Robert Schumann (1810-1856) spent the last two-and-a-half years of his life in the private psychiatric hospital in Endenich. His medical records emerged in 1991 and were published by B. R. Appel in 2006. Daily entries document the treatment typical at that time for what was at first considered to be "melancholy with delusions": Shielding from stimuli, physical procedures, and a dietary regimen. The feared, actual diagnosis, a "general (incomplete) paralysis," becomes a certainty in the course of the paranoid-hallucinatory symptoms with cerebro-organic characteristics and agitated states, differences in pupil size, and increasing speech disturbances. In the medicine of the time, syphilis is just emerging as the suspected cause, and the term "progressive paralysis" is coined as typical for the course. Proof of the Treponema pallidum infection and the serologic reaction is not obtained until 1906. People close to Robert, in particular his wife Clara and the circle of friends around Brahms and Joachim, cared intensively for him and suffered under the therapeutic isolation. The medical records and illness-related letters contradict the theory that Schumann was disposed of by being put into the psychiatric hospital; they show the concern of all during the unfavorable illness course. PMID:25684293

  16. Robert Schumann in the psychiatric hospital at Endenich.

    PubMed

    Steinberg, Reinhard

    2015-01-01

    Robert Schumann (1810-1856) spent the last two-and-a-half years of his life in the private psychiatric hospital in Endenich. His medical records emerged in 1991 and were published by B. R. Appel in 2006. Daily entries document the treatment typical at that time for what was at first considered to be "melancholy with delusions": Shielding from stimuli, physical procedures, and a dietary regimen. The feared, actual diagnosis, a "general (incomplete) paralysis," becomes a certainty in the course of the paranoid-hallucinatory symptoms with cerebro-organic characteristics and agitated states, differences in pupil size, and increasing speech disturbances. In the medicine of the time, syphilis is just emerging as the suspected cause, and the term "progressive paralysis" is coined as typical for the course. Proof of the Treponema pallidum infection and the serologic reaction is not obtained until 1906. People close to Robert, in particular his wife Clara and the circle of friends around Brahms and Joachim, cared intensively for him and suffered under the therapeutic isolation. The medical records and illness-related letters contradict the theory that Schumann was disposed of by being put into the psychiatric hospital; they show the concern of all during the unfavorable illness course.

  17. Bedding, not boarding. Psychiatric patients boarded in hospital EDs create crisis for patient care and hospital finances.

    PubMed

    Kutscher, Beth

    2013-11-18

    As the supply of psychiatric beds dwindles, hospitals are devising innovative ways handle psych patients who come through the emergency department. Some collaborate with other hospitals, use separate pysch EDs or refer patients to residential treatment centers.

  18. Treatment of a Psychotic Trainable Retarded Child in a Day Hospital for Children with Average Intelligence.

    ERIC Educational Resources Information Center

    Zang, Louis C.; Cohen, Jonathan L.

    The case study describes the progress of a psychotic trainable mentally retarded child who at age seven entered a day psychiatric hospital for disturbed children with average intelligence. The boy's therapist describes changes in the child's peer interaction, academic performance, group psychotherapy participation, and psychological test…

  19. The process of whistleblowing in a Japanese psychiatric hospital.

    PubMed

    Ohnishi, Kayoko; Hayama, Yumiko; Asai, Atsushi; Kosugi, Shinji

    2008-09-01

    This study aims to unveil the process of whistleblowing. Two nursing staff members who worked in a psychiatric hospital convicted of large-scale wrongdoing were interviewed. Data were analyzed using a modified grounded theory approach. Analysis of the interviews demonstrated that they did not decide to whistleblow when they were suspicious or had an awareness of wrongdoing. They continued to work, driven by appreciation, affection, and a sense of duty. Their decision to whistleblow was ultimately motivated by firm conviction. Shortly after whistleblowing, wavering emotions were observed, consisting of a guilty conscience, fear of retribution, and pride, which subsequently transformed to stable emotions containing a sense of relief and regret for delayed action. It is necessary for nurses to recognize that their professional responsibility is primarily to patients, not to organizations. Nurses should also have professional judgment about appropriate allegiance and actions.

  20. [Wish to change smoking behaviour among staff and patients of a psychiatric hospital].

    PubMed

    Grempler, Julia; Droste-Arndt, Hildegard; Flammer, Erich; Steinert, Tilman

    2012-05-01

    Objective To examine smoking behaviour and motivation to reach abstinence among staff and patients of a psychiatric hospital.Methods In two due day surveys all in-patients and staff of the Centre for Psychiatry Weissenau were interviewed by a questionnaire.Results The response rate was 78.5 %. 442 (48 %) out of 933 subjects (523 patients, 410 staff) were smokers. Patients were smoking more frequently than staff (58 % vs. 34 %) and were more severely nicotine-dependent. Significant gender differences were observed with regard to prevalence and nicotin dependence. 57 % said they wanted to stop smoking and 34 % would appreciate therapeutic offers. There were no significant differences between patients and staff.Conclusions Psychiatric patients are as motivated as staff for offers about smoking cessation. There is a need for therapeutic offers. PMID:22422161

  1. Psychiatric hospitalization in Ontario: the revolving door in perspective.

    PubMed Central

    Woogh, C. M.; Meier, H. M.; Eastwood, M. R.

    1977-01-01

    Ontario government statistics have indicated that during the 1960s the proportion of readmissions to psychiatric hospitals doubled to form two thirds of all admissions. Since this pertained to events rather than to individuals, a cohort of patients first admitted in 1969 was followed for 4 years to trace the pattern of readmission and the characteristics of patients at risk of readmission. Routinely returned data were linked and a sample from the greater metropolitan Toronto area was randomly selected. Of the cohort, 31% were readmitted, 8% three or more times. Age and diagnosis distinguished those readmitted. Most with multiple readmissions were under 25 years of age. Although diagnoses were equally distributed on first admission among psychotic, neurotic and other nonpsychotic disorders, with no significant change on readmission or multiple readmission, there was a predictably greater proportion of functional psychoses among the high-risk group and also an equal representation of personality, addictive and the remaining nonpsychotic conditions. The vulnerable few are identifiable early in their intermittent hospital career. It can be concluded that statistics suggesting that two thirds of admissions are readmissions are misleading. PMID:856431

  2. The social worker as primary psychiatric consultant to the general hospital emergency room.

    PubMed

    Wallace, S R; Ward, J T; Goldberg, R J; Slaby, A E

    1985-01-01

    Providing coverage for the increasing number of psychiatric and social crises presenting in general hospital emergency rooms presents a challenge during this era of economic contraction. A model is presented for the development of a crisis team without additional funding, utilizing half-day shifts contributed by clinical social workers who hold full-time positions elsewhere in the hospital. Effective and efficient emergency clinical work required that the social workers be taught about biomedical issues pertinent to presentations, along with instruction as to why and when to seek consultation from backup psychiatrists. Quality of care and continued skill development are addressed through the use of a systematic data base and interdisciplinary case conferences using the psychiatrist as a consultant regarding psychopharmacological and diagnostic issues.

  3. Daily weather variables and affective disorder admissions to psychiatric hospitals

    NASA Astrophysics Data System (ADS)

    McWilliams, Stephen; Kinsella, Anthony; O'Callaghan, Eadbhard

    2014-12-01

    Numerous studies have reported that admission rates in patients with affective disorders are subject to seasonal variation. Notwithstanding, there has been limited evaluation of the degree to which changeable daily meteorological patterns influence affective disorder admission rates. A handful of small studies have alluded to a potential link between psychiatric admission rates and meteorological variables such as environmental temperature (heat waves in particular), wind direction and sunshine. We used the Kruskal-Wallis test, ARIMA and time-series regression analyses to examine whether daily meteorological variables—namely wind speed and direction, barometric pressure, rainfall, hours of sunshine, sunlight radiation and temperature—influence admission rates for mania and depression across 12 regions in Ireland over a 31-year period. Although we found some very weak but interesting trends for barometric pressure in relation to mania admissions, daily meteorological patterns did not appear to affect hospital admissions overall for mania or depression. Our results do not support the small number of papers to date that suggest a link between daily meteorological variables and affective disorder admissions. Further study is needed.

  4. Smoking bans in secure psychiatric hospitals and prisons.

    PubMed

    Sullivan, Danny H; Rees, Megan A

    2014-09-01

    The proposal of complete smoking bans in closed institutions, such as prisons and psychiatric hospitals, creates a tension between individual "rights" and the health of all members of that community. Smokers in closed institutions generally smoke more, suffer more health consequences and are less likely to quit than smokers in other settings. Complete smoking bans do not cause an increase in behavioural problems, nor do bans cause worsening of mental illness or quality of life. Although infrequently tested, the responsibility of public institutions to protect others from second-hand smoke has usually outweighed any individual "right to smoke" in legal judgments. A substantial cultural shift may be required from considering smoking a "rare pleasure" during detention to the realisation that smoking is the most significant reversible health risk factor for this population. The implementation of complete smoking bans in closed institutions is challenging and requires careful and proactive planning by staff. As complete smoking bans are being considered in many institutions and jurisdictions, this column presents a review of the evidence base and ethical issues involved.

  5. Daily weather variables and affective disorder admissions to psychiatric hospitals.

    PubMed

    McWilliams, Stephen; Kinsella, Anthony; O'Callaghan, Eadbhard

    2014-12-01

    Numerous studies have reported that admission rates in patients with affective disorders are subject to seasonal variation. Notwithstanding, there has been limited evaluation of the degree to which changeable daily meteorological patterns influence affective disorder admission rates. A handful of small studies have alluded to a potential link between psychiatric admission rates and meteorological variables such as environmental temperature (heat waves in particular), wind direction and sunshine. We used the Kruskal-Wallis test, ARIMA and time-series regression analyses to examine whether daily meteorological variables--namely wind speed and direction, barometric pressure, rainfall, hours of sunshine, sunlight radiation and temperature--influence admission rates for mania and depression across 12 regions in Ireland over a 31-year period. Although we found some very weak but interesting trends for barometric pressure in relation to mania admissions, daily meteorological patterns did not appear to affect hospital admissions overall for mania or depression. Our results do not support the small number of papers to date that suggest a link between daily meteorological variables and affective disorder admissions. Further study is needed.

  6. Smoking bans in secure psychiatric hospitals and prisons.

    PubMed

    Sullivan, Danny H; Rees, Megan A

    2014-09-01

    The proposal of complete smoking bans in closed institutions, such as prisons and psychiatric hospitals, creates a tension between individual "rights" and the health of all members of that community. Smokers in closed institutions generally smoke more, suffer more health consequences and are less likely to quit than smokers in other settings. Complete smoking bans do not cause an increase in behavioural problems, nor do bans cause worsening of mental illness or quality of life. Although infrequently tested, the responsibility of public institutions to protect others from second-hand smoke has usually outweighed any individual "right to smoke" in legal judgments. A substantial cultural shift may be required from considering smoking a "rare pleasure" during detention to the realisation that smoking is the most significant reversible health risk factor for this population. The implementation of complete smoking bans in closed institutions is challenging and requires careful and proactive planning by staff. As complete smoking bans are being considered in many institutions and jurisdictions, this column presents a review of the evidence base and ethical issues involved. PMID:25341317

  7. Antipsychotic Medication Prescribing Practices Among Adult Patients Discharged From State Psychiatric Inpatient Hospitals

    PubMed Central

    HOLLEN, VERA; SCHACHT, LUCILLE

    2016-01-01

    Objectives: The goal of this study was to explore antipsychotic medication prescribing practices in a sample of 86,034 patients discharged from state psychiatric inpatient hospitals and to find the prevalence of patients discharged with no antipsychotic medications, on antipsychotic monotherapy, and on antipsychotic polypharmacy. For patients discharged on antipsychotic polypharmacy, the study explored the adjusted rates of antipsychotic polypharmacy, the reasons patients were discharged on antipsychotic polypharmacy, the proportion of antipsychotic polypharmacy by mental health disorder, and the characteristics associated with being discharged on antipsychotic polypharmacy. Methods: This cross-sectional study analyzed all discharges for adult patients (18 to 64 y of age) from state psychiatric inpatient hospitals between January 1 and December 31, 2011. The relationship among variables was explored using χ2, t test, and analysis of variance. Logistic regression was used to determine predictors of antipsychotic polypharmacy. Results: The prevalence of antipsychotic polypharmacy was 12%. Of the discharged patients receiving at least 1 antipsychotic medication (adjusted rate), 18% were on antipsychotic polypharmacy. The strongest predictors of antipsychotic polypharmacy being prescribed were having a diagnosis of schizophrenia and a length of stay of 90 days or more. Patients were prescribed antipsychotic polypharmacy primarily to reduce their symptoms. Conclusions: Antipsychotic polypharmacy continues at a high enough rate to affect nearly 10,000 patients with a diagnosis of schizophrenia each year in state psychiatric inpatient hospitals. Further analysis of the clinical presentation of these patients may highlight particular aspects of the illness and its previous treatment that are contributing to practices outside the best-practice guideline. An increased understanding of trend data, patient characteristics, and national benchmarks provides an opportunity for

  8. Recidivism risk factors are correlated with a history of psychiatric hospitalization among sex offenders.

    PubMed

    Lee, Seung C; Hanson, R Karl

    2016-08-01

    Sexual offenders are more likely to have a history of psychiatric hospitalization compared with the general population. This finding suggests that a history of psychiatric hospitalization is a plausible risk factor for the initiation of sexual crimes. It is less clear, however, whether psychiatric hospitalization is associated with risk factors for criminal recidivism. Consequently, the current study examined the correlates of psychiatric hospitalization and its relevance for risk assessment in a sample of sexual offenders on community supervision (N = 947). In this sample, a history of psychiatric hospitalization significantly increased the rate of sexual recidivism (hazard ratio = 1.95). After controlling for well-established risk factors, however, the association was no longer statistically significant. Consequently, this study supported an indirect effect of a history of psychiatric hospitalization, such that the association between psychiatric symptoms and recidivism was mediated by criminogenic needs (e.g., poor general self-regulation, loneliness, and social rejection). Replication studies are needed to confirm this association, and to further understand the link between mental illness and recidivism for sexual offenders. (PsycINFO Database Record PMID:27504645

  9. Recidivism risk factors are correlated with a history of psychiatric hospitalization among sex offenders.

    PubMed

    Lee, Seung C; Hanson, R Karl

    2016-08-01

    Sexual offenders are more likely to have a history of psychiatric hospitalization compared with the general population. This finding suggests that a history of psychiatric hospitalization is a plausible risk factor for the initiation of sexual crimes. It is less clear, however, whether psychiatric hospitalization is associated with risk factors for criminal recidivism. Consequently, the current study examined the correlates of psychiatric hospitalization and its relevance for risk assessment in a sample of sexual offenders on community supervision (N = 947). In this sample, a history of psychiatric hospitalization significantly increased the rate of sexual recidivism (hazard ratio = 1.95). After controlling for well-established risk factors, however, the association was no longer statistically significant. Consequently, this study supported an indirect effect of a history of psychiatric hospitalization, such that the association between psychiatric symptoms and recidivism was mediated by criminogenic needs (e.g., poor general self-regulation, loneliness, and social rejection). Replication studies are needed to confirm this association, and to further understand the link between mental illness and recidivism for sexual offenders. (PsycINFO Database Record

  10. Detection, occurrence and fate of 22 psychiatric pharmaceuticals in psychiatric hospital and municipal wastewater treatment plants in Beijing, China.

    PubMed

    Yuan, Shengliu; Jiang, Xiaoman; Xia, Xinghui; Zhang, Haixia; Zheng, Shaokui

    2013-03-01

    The liquid chromatography-electrospray ionization-tandem mass spectrometer (LC-MS/MS) method coupled with an automated solid-phase extraction procedure has been developed to identify 22 psychiatric pharmaceuticals, including seven anxiolytic-sedative-hypnotics, six antidepressants, and nine anti-schizophrenia drugs, in wastewater samples from two psychiatric hospital wastewater treatment plants (P-WWTPs) and three municipal wastewater treatment plants (M-WWTPs) in Beijing, China. Analyte recoveries from spiking experiments in the WWTP influent and effluent at three concentrations ranged from 70% to 110%, excluding sulpiride, ziprasidone, and olanzapine. Method detection limits for five, eight, and nine analytes in the WWTP influent and effluent were 20-80, 1-16, and <1 ng L(-1), respectively. High psychiatric pharmaceutical concentrations (e.g., ∼942 ng L(-1) oxazepam, 5552-12,782 ng L(-1) clozapine, 2762-9832 ng L(-1) sulpiride, and 2030-4967 ng L(-1) quetiapine) were frequently observed in P-WWTP influent compared to M-WWTPs. Although P-WWTPs typically had higher removal rates, significantly higher concentrations of the target compounds were observed in the P-WWTP secondary effluent than in the M-WWTP influent (e.g., ∼752 ng L(-1) oxazepam, ∼8183 ng L(-1) clozapine, ∼10,833 ng L(-1) sulpiride, and ∼1168 ng L(-1) quetiapine). Thus, the discharge control of psychiatric pharmaceuticals from psychiatric hospitals requires improvement. PMID:23228908

  11. Defining the Needs of Patients with Intellectual Disabilities in the High Security Psychiatric Hospitals in England

    ERIC Educational Resources Information Center

    Thomas, S. D.; Dolan, M.; Johnston, S.; Middleton, H.; Harty, M. A.; Carlisle, J.; Thornicroft, G.; Appleby, L.; Jones, P.

    2004-01-01

    Previous studies have suggested that a substantial proportion of the patients with intellectual disabilities (ID) in the high security psychiatric hospitals (HSPHs) should be transferred to more appropriate services to cater for their specific needs in the longer term. The individual and placement needs of high secure psychiatric patients detained…

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

    PubMed

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

    1987-09-01

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

  13. [The schooling of children in a day hospital].

    PubMed

    Coupé, Catherine; Vanderveck, Véronique

    2015-01-01

    At Robert-Debré hospital in Paris, a state education centre and an association "L'école à l'hôpital" ("school at hospital") assure the schooling of hospitalised children and teenagers. Teachers work in twelve of the hospital's departments. A full-time specialist teacher is devoted to the medical day hospital.

  14. The Measurement, Analysis and Implementation of a Corporate Image Program: The Case of a Psychiatric Hospital.

    ERIC Educational Resources Information Center

    Elbeck, Matt A.; Buchanan, Gary W.

    1987-01-01

    Measured a psychiatric hospital's image, using qualitative and quantitative methods. Used data from the consumer public to illustrate the development and implementation of an image program stressing multi-public awareness, preference and utilization of the hospital's services vis-a-vis the hospital's mission statement. This study demonstrated…

  15. [Collaboration of the general practitioner and the psychiatrist with the psychiatric hospital. A literature review].

    PubMed

    Spiessl, H; Cording, C

    2000-05-01

    Co-operation of physicians in private practice with psychiatric hospitals was investigated in Germany scarcely until now, although evaluation of consumer satisfaction is of great importance to quality assurance in psychiatry. In this paper, findings from previous studies are presented together with data from interviews with general practitioners and psychiatrists, evaluating their expectations regarding psychiatric hospitals. Substantial problem area in collaboration is referral to the psychiatric hospital. Apart from sociodemographic and disease-related variables, referral practice depends on referring physician's attitudes and competence in psychiatry, and provider influences like delay of admission, communication with referring physician, and competence of the hospital. As conclusion, constructive collaboration must be developed at the interface of outpatient and inpatient care. On account of increasing diversification of psychiatric services, functional network should be an ongoing goal to improve treatment continuity of patients with mental disorders. PMID:10858945

  16. Treatment of forensic patients: an expanding role for public psychiatric hospitals.

    PubMed

    Linhorst, D M; Turner, M A

    1999-02-01

    This article explores the increased role of state-operated public psychiatric hospitals in treating forensic patients. Patients with a forensic legal status have a mental illness and are involved with the criminal justice system. Using data from Missouri's forensic system, the article compares the characteristics of voluntary hospital patients with those of the largest hospitalized group of forensic patients--those found not guilty by reason of insanity (NGRI). Overall, NGRI patients tended to be higher functioning, less likely to have committed assaultive acts, and more likely to have substance abuse and personality disorder diagnoses. The article explores the treatment needs of forensic patients who reside in public psychiatric hospitals and discusses the effect of the strong presence of forensic patients in public psychiatric hospitals on social work practice, including clinical work with forensic patients, social work administration, and social work advocacy.

  17. Restless leg syndrome in hospitalized psychiatric patients in Lebanon: a pilot study

    PubMed Central

    Talih, Farid; Ajaltouni, Jean; Kobeissy, Firas

    2016-01-01

    Objectives To characterize and describe the prevalence of restless leg syndrome (RLS) in hospitalized psychiatric patients and to investigate the correlations between patient profile and RLS. Methods Demographic information, psychiatric diagnoses, psychotropic medication use, and history of substance use were collected from hospitalized psychiatric patients at the American University of Beirut Medical Center; Beirut, Lebanon. A validated questionnaire to evaluate RLS symptomatology was also administered to 126 participants who agreed to participate, as well as questionnaires for insomnia, depression, and anxiety symptoms. Statistical analysis was conducted to detect the prevalence of RLS among the participants and to examine correlations with RLS in a hospitalized psychiatric population. Results Out of the 126 participants who completed the survey, RLS was detected in 18% of the participants. Of interest, RLS was also found to be associated with higher depressive symptomatology, suicidal ideation, and working night shifts. PMID:27785035

  18. A Community Day Care Programme for Psychiatric Patients: The Role of Occupational Therapy.

    ERIC Educational Resources Information Center

    Pradad, Akanksha; And Others

    1991-01-01

    This paper examines the need for and role of occupational therapy in the organization and functioning of a community day care center for psychiatric patients in India. The occupational therapy program involves client evaluation, determination of therapeutic activities, physical exercise, recreational activities, group sessions, family involvement,…

  19. Through the lens of the hospital magazine: Downshire and Holywell psychiatric hospitals in the 1960s and 1970s.

    PubMed

    Prior, Pauline; McClelland, Gillian

    2013-12-01

    An exploration of the pages of two psychiatric hospital magazines, Speedwell from Holywell Hospital, Antrim, and The Sketch from Downshire Hospital, Downpatrick, reveals the activity-filled lives of patients and staff during the 1960s and 1970s. This was a time of great change in mental health care. It was also a time of political turbulence in Northern Ireland. With large in-patient populations, both hospitals had a range of occupational and sporting activities available to patients and staff. The magazines formed part of the effort to promote the ethos of a therapeutic community. While hospital magazines may be viewed as one aspect of an institutional system that allowed people to cut themselves off from the wider society, they also provided opportunities for budding writers to express their views on life in a hospital from the service-user perspective. As such, they offer some valuable insights into the lives of psychiatric patients.

  20. [Clinical trial of bromazepam in psychiatric hospital practice (author's transl)].

    PubMed

    Brunner, H; Patris, M F

    1982-05-13

    An open trial of bromazepam (Lexomil) was conducted in 35 patients (23 men and 12 women, aged from 18 to 76 years) admitted to a psychiatry unit for various, usually old-standing, conditions associated with major anxiety. The mean effective dosage was 18 mg/day. The effectiveness of the drug administered alone was assessed in 25 patients at the end of the second week of treatment, using the Hamilton and Pull-Guelfi scales. A satisfactory response was obtained in 81% of the cases. Reactional anxiety in alcoholic and neurotic patients was found to constitute the best indication for bromazepam, the value of which during weaning from alcohol in patients admitted with threatening delirium tremens must be stressed. Bromazepam was well tolerated in 83% of the patients; side-effects (daytime somnolence and fatigue) were rare. The drug proved a potent and quick-acting tranquillizer and often resulted in a shorter stay in hospital. PMID:6124935

  1. The Use of Movies to Facilitate Family Engagement in Psychiatric Hospitalization

    ERIC Educational Resources Information Center

    Garrison, David

    2007-01-01

    Studies indicate that the impact of family involvement may be the most important predictor of successful psychiatric hospitalization of adolescents. Yet the ability to engage both an adolescent and his or her family in family therapy in the context of what is often an involuntary hospitalization is a major challenge. A number of promising…

  2. [Comparative study of the operation of two day's Hospitals in Athens].

    PubMed

    Mantonakis, J; Karakatsanis, N; Spilioti, E; Karanikoli, I; Stentoumis, C; Stefanis, C

    2014-01-01

    The present paper describes the preparation for the commencement of services by the University Mental Health Research Institute (UMHRI) Day Hospital and Eginition Day Hospital whose operation (in 1977) signifies the beginning of the Psychiatric Reform in our country. The two units' functional characteristics and the type of offered services are mentioned. Psychotherapeutic, biological and sociotherapeutic approaches are practiced on a daily basis within a framework of Therapeutic Community services. Moreover, relations, similarities and differences among the two day hospitals are pointed out. Special mention is given to the problems and difficulties that these two units faced upon their commencement, which took place at different time periods, set 32 years apart. The lack of legislative framework with regards to the operation of Day Hospitals, the bureaucratic obstacles and the skepticism towards the new treatment approach of patients, were the basic obstacles that had to be overcome in order for the first Day Hospital to become operational in 1977. Licensing and funding were the main obstacles that the creation of UMHRI's Day Hospital faced, although these two units had already been established. Emphasis was placed on the staff's training, which mainly consisted of young professionals and at the social environment's and all those services' (health-care, community etc) attitude, in the specific catchment area (6th Mental Health Sector). The study of patients' characteristics hospitalized in Eginition's Day Hospital throughout its first year of operation (1977-1978) and of patients hospitalized at UMHRI's Day Hospital, also at its first year of operation (2009-2010), showed, among other things, that in both cases, the number of hospitalized male patients is larger than the number of female patients. This constitutes an exception compared to other countries, whereby female patients outnumber male patients in Day Hospitals. Especially at UMHRI's Day Hospital, the

  3. The quality of psychiatric services provided by an Australian tertiary hospital emergency department: a client perspective.

    PubMed

    Summers, Monica; Happell, Brenda

    2002-10-01

    The mainstreaming of psychiatric services within the general health care system has created fundamental changes to the manner in which clients access acute psychiatric services. A review of the literature suggests that this process has been problematic. The current study involved the conduct of telephone interviews with psychiatric clients (n = 136) to ascertain their level of satisfaction with the services received in the emergency department of a Melbourne Metropolitan Hospital. The results were analysed using descriptive statistics. The study participants indicated a high level of satisfaction. Particular emphasis was placed upon the availability of staff with psychiatric qualifications and experience to provide treatment, support and care. Dissatisfaction was noted by some clients regarding lengthy waiting times, lack of privacy in the triage area and negative attitudes of emergency department staff. These findings support the value of psychiatric consultancy services in the emergency department, and further identify the need for triage guidelines to be tailored to the needs of mental health clients.

  4. Validation of the Children's Interview for Psychiatric Syndromes (ChIPS) with Psychiatrically Hospitalized Adolescents

    ERIC Educational Resources Information Center

    Swenson, Lance P.; Esposito-Smythers, Christianne; Hunt, Jeffrey I.; Hollander, Beth L. G.; Dyl, Jennifer; Rizzo, Christie J.; Steinley, Douglas L.; Spirito, Anthony

    2007-01-01

    A study was conducted to examine the concurrent validity of the Children's Interview for Psychiatric Syndromes (ChIPS) for adolescent inpatients aged 12 to 18. The results reveal moderate agreement between ChIPS diagnoses and Schedule for Affective Disorder sand Schizophrenia for School-Age Children-Present and Lifetime version diagnoses.

  5. Prognostic Patterns in Self-Report, Relative Report, and Professional Evaluation Measures for Hospitalized and Day-Care Patients

    ERIC Educational Resources Information Center

    Sappington, A. A.; Michaux, Mary H.

    1975-01-01

    This study attempted to determine differences between patients who relapse and those who do not in both hospital and day-care settings. Subjects were 142 adult psychiatric patients. Three groups of measures were used: one based on professional evaluation, one based on self-report, and one based on relative report. (Author)

  6. Effects of Multiple Maltreatment Experiences among Psychiatrically Hospitalized Youth

    ERIC Educational Resources Information Center

    Boxer, Paul; Terranova, Andrew M.

    2008-01-01

    Objective: Relying on indicators coded from information collected routinely during intake assessments at a secure inpatient psychiatric facility, this study examined the extent to which different forms of maltreatment accounted for variations in youths' emotional and behavioral problems. Methods: Clinical information was reviewed for a large (N =…

  7. Geriatric day hospitals--changing emphasis in costs.

    PubMed

    Hildick-Smith, M

    1984-03-01

    One of the factors which may have influenced day hospital expansion is that day hospital treatment was earlier found to be cheaper than in-patient treatment, as some of the 'hotel' costs were avoided. The increasing price of ambulance transport has reduced this advantage. Further reduction occurs if the expenses of keeping a patient at home (community services, share of housing, etc.) are set against in-patient costs. Using such detailed comparisons, treatment up to twice weekly at a Day Hospital provides good value for money, but more frequent treatments can prove costlier than in-patient or residential care. Realistic attempts are now being made to cost a complete course of treatment, for example three months' visits to a day hospital. Depending on whether this is regarded as equivalent to 15 or 10 weeks as an in-patient, the relative cost of day hospital treatment is 32-90% of in-patient costs. 'Throughput' is as vital to day hospitals as to wards, and the average number of visits for day hospital treatment has decreased over the years from 40-20, and the recommended size from 50 to 30 places. Critics of comparisons between in-patient and day patient treatment emphasize that we are not comparing like with like. Day hospital treatment relates more closely to independence and accords with the preferred wishes of most patients and families. Costing involves not only money but staffing and here the day hospital continues to show advantage.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:6428186

  8. Mortality, Rehospitalisation and Violent Crime in Forensic Psychiatric Patients Discharged from Hospital: Rates and Risk Factors

    PubMed Central

    Fazel, Seena; Wolf, Achim; Fimińska, Zuzanna; Larsson, Henrik

    2016-01-01

    Objectives To determine rates and risk factors for adverse outcomes in patients discharged from forensic psychiatric services. Method We conducted a historical cohort study of all 6,520 psychiatric patients discharged from forensic psychiatric hospitals between 1973 and 2009 in Sweden. We calculated hazard ratios for mortality, rehospitalisation, and violent crime using Cox regression to investigate the effect of different psychiatric diagnoses and two comorbidities (personality or substance use disorder) on outcomes. Results Over mean follow-up of 15.6 years, 30% of patients died (n = 1,949) after discharge with an average age at death of 52 years. Over two-thirds were rehospitalised (n = 4,472, 69%), and 40% violently offended after discharge (n = 2,613) with a mean time to violent crime of 4.2 years. The association between psychiatric diagnosis and outcome varied—substance use disorder as a primary diagnosis was associated with highest risk of mortality and rehospitalisation, and personality disorder was linked with the highest risk of violent offending. Furthermore comorbid substance use disorder typically increased risk of adverse outcomes. Conclusion Violent offending, premature mortality and rehospitalisation are prevalent in patients discharged from forensic psychiatric hospitals. Individualised treatment plans for such patients should take into account primary and comorbid psychiatric diagnoses. PMID:27196309

  9. Impact of the Syrian Crisis on the Hospitalization of Syrians in a Psychiatric Setting.

    PubMed

    Lama, Souaiby; François, Kazour; Marwan, Zoghbi; Sami, Richa

    2016-01-01

    Determine the impact of the Syrian crisis on the hospitalization of Syrians in a psychiatric setting. All Syrians admitted to a psychiatric hospital in Lebanon between the 1st of January 2009 and the 31st of December 2013 were included. Number of admissions, psychiatric disorders and demographic and clinical data relative to patients were compared between those admitted before and after the crisis. 44 patients were admitted before the crisis and 106 after it. The distribution of diagnosis varied significantly after the crisis (p = 0.056) with the majority of patients being admitted for schizophrenia (37.7 %). The prevalence of suicidal ideation was higher after the crisis (p = 0.03) but suicidal attempts, need for electroconvulsive therapy and length of hospitalization did not differ significantly between both groups. Clinicians should be aware of the possible burden of mental illness in Syrians after the beginning of the Syrian crisis.

  10. [Developmental status and goals in occupational therapy. The "Guidelines for Occupational Therapy in Psychiatric Hospitals"].

    PubMed

    Lehmann, K; Kunze, H

    1987-01-01

    Work therapy, or ergotherapy, is a recognised and permanent part of psychiatric treatment and medical rehabilitation. It is also an essential part of psychiatric diagnosis and therapy; furthermore, it enables the patient to develop and stabilise a realistic image of himself and contributes to the prevention and reduction of damage caused by hospitalism. The present status of work therapy was checked in 74 psychiatric hospitals throughout the Federal Republic of Germany, resulting in the need for further development of present practical procedures. A working group was created by the Federal Ministry of Labour and National Welfare within the framework of the model programme for psychiatry, at the suggestion of a Federal Working Group of the organisations running public mental hospitals in the FRG. The aim of this working group was to develop a specialised concept of work therapy. The group consisted of experts from clinical practice as well as from the Federal German Labour Office Institution, psychiatric consultants of the Federal Government and the Land Governments, as well as from the Land Government sponsors of state social welfare services. The "Guidelines for Work Therapy in Psychiatric Hospitals and Departments of Psychiatry" are officially considered to be a suitable basis for further development work in the field of ergotherapy.

  11. A crisis management quality improvement initiative in a children's psychiatric hospital: design, implementation, and outcome.

    PubMed

    Paccione-Dyszlewski, Margaret R; Conelea, Christine A; Heisler, Walter C; Vilardi, Jodie C; Sachs, Henry T

    2012-07-01

    Behavioral crisis management, including the use of seclusion and restraint, is the most high risk process in the psychiatric care of children and adolescents. The authors describe hospital-wide programmatic changes implemented at a children's psychiatric hospital that aimed to improve the quality of crisis management services. Pre/post quantitative and qualitative data suggest reduced restraint and seclusion use, reduced patient and staff injury related to crisis management, and increased patient satisfaction during the post-program period. Factors deemed beneficial in program implementation are discussed.

  12. The Jewish psychiatric hospital, Zofiówka, in Otwock, Poland.

    PubMed

    Seeman, Mary V

    2015-03-01

    The T4 euthanasia programme within Nazi Germany has been well researched, but much less is known about the extermination of psychiatric patients in Nazi-occupied territories during the same period. In Poland 20,000 mentally ill patients were deliberately killed during the German occupation. This paper traces the history of one psychiatric hospital, Zofiówka, in Otwock, south-east of Warsaw. The hospital once served the Jewish population of Poland and was the largest, most prestigious neuropsychiatric centre in the country. It is now in ruins and said to be haunted by ghosts.

  13. Borderline Personality Disorder and Posttraumatic Stress Disorder at Psychiatric Discharge Predict General Hospital Admission for Self-Harm.

    PubMed

    Mellesdal, Liv; Gjestad, Rolf; Johnsen, Erik; Jørgensen, Hugo A; Oedegaard, Ketil J; Kroken, Rune A; Mehlum, Lars

    2015-12-01

    We investigated whether posttraumatic stress disorder (PTSD) was predictor of suicidal behavior even when adjusting for comorbid borderline personality disorder (BPD) and other salient risk factors. To study this, we randomly selected 308 patients admitted to a psychiatric hospital because of suicide risk. Baseline interviews were performed within the first days of the stay. Information concerning the number of self-harm admissions to general hospitals over the subsequent 6 months was retrieved through linkage with the regional hospital registers. A censored regression analysis of hospital admissions for self-harm indicated significant associations with both PTSD (β = .21, p < .001) and BPD (β = .27, p < .001). A structural model comprising two latent BPD factors, dysregulation and relationship problems, as well as PTSD and several other variables, demonstrated that PTSD was an important predictor of the number of self-harm admissions to general hospitals(B = 1.52, p < .01). Dysregulation predicted self-harm directly (B = 0.28, p < .05), and also through PTSD [corrected]. These results suggested that PTSD and related dysregulation problems could be important treatment targets for a reduction in the risk of severe self-harm in high-risk psychiatric patients.

  14. Discharge Outcomes in Seniors Hospitalized for More than 30 Days

    ERIC Educational Resources Information Center

    Kozyrskyj, Anita; Black, Charlyn; Chateau, Dan; Steinbach, Carmen

    2005-01-01

    Hospitalization is a sentinel event that leads to loss of independence for many seniors. This study of long-stay hospitalizations (more than 30 days) in seniors was undertaken to identify risk factors for not going home, to characterize patients with risk factors who did go home and to describe one year outcomes following home discharge. Using…

  15. Adult Day Care and Medical and Hospital Claims.

    ERIC Educational Resources Information Center

    Chappell, Neena L.; Blandford, Audrey A.

    1987-01-01

    Examined effect of adult day care (ADC) on utilization of health care practitioner and inpatient hospital services. Data from three separate ADC studies revealed that, when operative for some time, ADC may result in dramatic decreases in hospital inpatient stays. Findings warrant further research. (Author/NB)

  16. Time of the year and absconding from a psychiatric hospital in Trinidad

    PubMed Central

    Ali, Akleema; Maharajh, Hari D.

    2003-01-01

    Personal characteristics of patients and environmental factors at psychiatric hospitals have been identified as predictors of absconding. This study seeks to establish a relationship between time of the year and absconding. All characteristics of absconders were analysed over a two-year period using hospital records (N= 104). Public holidays and lunar phases were obtained through almanacs for each year; and school vacation period was determined by reference to a school academic calendar. Friday was the most popular day of the week for absconding, males tend to escape more on the weekends compared to females, females tend to escape more during the wet season, and Christmas was the most popular holiday season for absconding to take place. The full moon phase had the largest percentage of absconding when compared to other phases. Recommendations are that the system of patient care should be client driven at all times and greater supervision of patients is needed on weekends, vacation periods and during the full moon phase. PMID:21206811

  17. Time of the year and absconding from a psychiatric hospital in Trinidad.

    PubMed

    Ali, Akleema; Maharajh, Hari D

    2003-01-01

    Personal characteristics of patients and environmental factors at psychiatric hospitals have been identified as predictors of absconding. This study seeks to establish a relationship between time of the year and absconding. All characteristics of absconders were analysed over a two-year period using hospital records (N= 104). Public holidays and lunar phases were obtained through almanacs for each year; and school vacation period was determined by reference to a school academic calendar. Friday was the most popular day of the week for absconding, males tend to escape more on the weekends compared to females, females tend to escape more during the wet season, and Christmas was the most popular holiday season for absconding to take place. The full moon phase had the largest percentage of absconding when compared to other phases. Recommendations are that the system of patient care should be client driven at all times and greater supervision of patients is needed on weekends, vacation periods and during the full moon phase.

  18. [Fates at the psychiatric hospital of Klagenfurt during National Socialism].

    PubMed

    Oberlerchner, Herwig; Stromberger, Helge

    2013-01-01

    In this article the fate of Mr. B. is described as an example for the fate of hundreds of mentally ill patients of the "Landes-Irrenanstalt of Klagenfurt", murdered during the era of National Socialism. This extraordinary fate marks two outstanding aspects of history of medicine, the treatment of syphilis with malaria and the organised mass murder of mentally ill people during the cynic era of National Socialism. Beyond this historical perspective reconstructive biographical work together with relatives is presented as a proactive duty of psychiatric institutions.

  19. Hospitalization due to drug use did not change after a decade of the Psychiatric Reform

    PubMed Central

    Balbinot, Alexandre Dido; Horta, Rogério Lessa; da Costa, Juvenal Soares Dias; Araújo, Renata Brasil; Poletto, Simone; Teixeira, Marina Bressaneli

    2016-01-01

    ABSTRACT OBJECTIVE To investigate whether the psychiatric hospitalization rates due to use of psychoactive substances and average time of hospitalization suffered any changes after the first decade of effective implementation of the psychiatric reform in Brazil. METHODS This article examines the evolution of hospitalizations due to disorders arising from the use of alcohol or other substances in the state of Santa Catarina, Southern Brazil, from 2000 to 2012. This is an ecological, time-series study, which uses data from admissions obtained by the Informatics Service of the Brazilian Unified Health System. Hospitalization rates by 100,000 inhabitants and average time of occupancy of beds were estimated. Coefficients of variation of these rates were estimated by Poisson Regression. RESULTS The total and male hospitalization rates did not vary (p = 0.056 and p = 0.244, respectively). We observed an increase of 3.0% for the female sex (p = 0.049). We did not observe any significant variation for occupancy time of beds. CONCLUSIONS The deployment of services triggered by the Brazilian psychiatric reform was not accompanied by a reduction of hospitalization rates or mean occupancy time of hospitalized patients during this first decade of implementation of the reform. PMID:27253902

  20. Clinical Presentation of General Paralysis of the Insane in a Dutch Psychiatric Hospital, 1924-1954.

    PubMed

    Daey Ouwens, Ingrid M; Lens, C Elisabeth; Fiolet, Aernoud T L; Ott, Alewijn; Koehler, Peter J; Verhoeven, Willem M A

    2015-01-01

    General paralysis of the insane (GPI) or dementia paralytica was once a fatal complication of syphilitic infection and a major reason for psychiatric hospitalization. Nowadays, physicians consider GPI to be exceptional. It should be noted, however, that syphilis re-emerged worldwide at the turn of the 20th to 21st century and a revival of GPI can, therefore, be expected. Advanced diagnosis is crucial in that treatment in the early, inflammatory phase is warranted before irreversible tissue damage occurs. Therefore, a renewed clinical awareness of the broad spectrum of psychiatric and neurologic signs and symptoms of GPI is needed. In this historical cohort study, comprising 105 patients with GPI admitted to the Dutch Vincent van Gogh Psychiatric Hospital in the period 1924-1954, the clinical presentation of this invalidating disorder is investigated and described in detail.

  1. Clinical Features, Psychiatric Assessment, and Longitudinal Outcome of Suicide Attempters Admitted to a Tertiary Emergency Hospital.

    PubMed

    Ferreira, Alcinéia Donizeti; Sponholz, Alcion; Mantovani, Célia; Pazin-Filho, Antônio; Passos, Afonso Dinis Costa; Botega, Neury José; Del-Ben, Cristina Marta

    2016-01-01

    The objective of this study was to characterize admissions to an emergency hospital due to suicide attempts and verify outcomes in 2 years. Data were collected from medical records and were analyzed using descriptive statistics and logistic regression. The sample consisted of 412 patients (58.7% women; mean age = 32.6 years old, SD = 14.3). Self-poisoning was the most frequent method (84.0%), and they were diagnosed mainly as depressive (40.3%) and borderline personality disorders (19.1%). Previous suicide attempts and current psychiatric treatment were reported by, respectively, 32.0% and 28.4%. Fifteen patients (3.6%, 9 males) died during hospitalization. At discharge, 79.3% were referred to community-based psychiatric services. Being male (OR = 2.11; 95% CI = 1.25-3.55), using violent methods (i.e., hanging, firearms, and knives) (OR = 1.96; 95% CI = 1.02-3.75) and psychiatric treatment history (OR = 2.58; 95% CI = 1.53-4.36) were predictors for psychiatric hospitalization. Of 258 patients followed for 2 years, 10 (3.9%) died (3 suicide), and 24 (9.3%) undertook new suicide attempts. Patients with a history of psychiatric treatment had higher risks of new suicide attempts (OR = 2.46, 95% CI = 1.07-5.65). Suicide attempters admitted to emergency hospitals exhibit severe psychiatric disorders, and despite interventions, they continue to present high risks for suicide attempts and death. PMID:25961847

  2. Reducing Maladaptive Family Interaction by Involving Significant Others of Hospitalized Psychiatric Patients.

    ERIC Educational Resources Information Center

    Mabel, Sanford

    The program was set up to involve, on a continuing basis, the significant other of frequently-readmitted hospitalized psychiatric VA patients. The couples identified their characteristic strengths, and their maladaptive ways of functioning, and were expected to make use of alternative ways of behaving which were recommended by the staff. A…

  3. A Functional Model of Quality Assurance for Psychiatric Hospitals and Corresponding Staffing Requirements.

    ERIC Educational Resources Information Center

    Kamis-Gould, Edna; And Others

    1991-01-01

    A model for quality assurance (QA) in psychiatric hospitals is described. Its functions (general QA, utilization review, clinical records, evaluation, management information systems, risk management, and infection control), subfunctions, and corresponding staffing requirements are reviewed. This model was designed to foster standardization in QA…

  4. 42 CFR 482.62 - Condition of participation: Special staff requirements for psychiatric hospitals.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... program. (d) Standard: Nursing services. The hospital must have a qualified director of psychiatric nursing services. In addition to the director of nursing, there must be adequate numbers of registered nurses, licensed practical nurses, and mental health workers to provide nursing care necessary under...

  5. 42 CFR 482.62 - Condition of participation: Special staff requirements for psychiatric hospitals.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... program. (d) Standard: Nursing services. The hospital must have a qualified director of psychiatric nursing services. In addition to the director of nursing, there must be adequate numbers of registered nurses, licensed practical nurses, and mental health workers to provide nursing care necessary under...

  6. Working Models of Attachment in Psychiatrically Hospitalized Adolescents: Relation to Psychopathology and Personality.

    ERIC Educational Resources Information Center

    Rosenstein, Diana S.; Horowitz, Harvey A.

    This study examined the role of attachment in adolescent psychopathology among psychiatrically hospitalized adolescents. Subjects consisted of 60 adolescents and 27 of their mothers. Measures included the Adult Attachment Interview classification for both the adolescents and their mothers, and a battery of diagnostic and personality assessment of…

  7. Task and structural correlates of organizational effectiveness in private psychiatric hospitals.

    PubMed

    Mark, B

    1985-06-01

    This exploration of the relationships between task and structural variables and two dimensions of organizational effectiveness in 76 private psychiatric hospitals revealed that high levels of centralization were associated with patient care effectiveness. High levels of centralization and formalization were associated with administrative effectiveness. An enhancing effect of organizational structure is suggested as contributing to organizational effectiveness.

  8. [How the Feast of Corpus Christi at the psychiatric hospital of Sarthe became a historical event].

    PubMed

    Guillemain, Hervé

    2010-01-01

    Can the historian, passionate about archives, build a historical narrative based mainly on the memories of nurses? Could the caregivers, who are themselves players in the history of psychiatry write it? When the former hears the individual accounts of the latter, history is written. The history of the Feast of Corpus Christi at the psychiatric hospital of Le Mans.

  9. Assaultive Behavior in State Psychiatric Hospitals: Differences Between Forensic and Nonforensic Patients

    ERIC Educational Resources Information Center

    Linhorst, Donald M.; Scott, Lisa Parker

    2004-01-01

    Forensic patients are occupying an increasingly large number of beds in state psychiatric hospitals. The presence of these mentally ill offenders has raised concerns about the risk they present to nonforensic patients. This study compared the rate of assaults and factors associated with assaultive behavior among 308 nonforensic patients and two…

  10. Predictors of Treatment Response for Suicidal Youth Referred for Emergency Psychiatric Hospitalization

    ERIC Educational Resources Information Center

    Huey, Jr., Stanley J.; Henggeler, Scott W.; Rowland, Melisa D.; Halliday-Boykins, Colleen A.; Cunningham, Phillippe B.; Pickrel, Susan G.

    2005-01-01

    This study evaluated factors that predicted poor treatment response for 70 suicidal youth (ages 10 to 17 years; 67% African American) who received either multisystemic therapy (MST) or inpatient psychiatric hospitalization. Following treatment, suicidal youth were classified as either treatment responders or nonresponders based on caregiver or…

  11. Mothers with Severe Psychiatric Illness and Their Newborns: A Hospital-Based Model of Perinatal Consultation

    ERIC Educational Resources Information Center

    Almeida, Ana; Merminod, Gaelle, Schechter, Daniel S.

    2009-01-01

    Women with severe psychiatric illness face numerous risks and challenges during pregnancy and as parents. Mental health professionals can help these mothers and their infants by supporting the attachment relationship and by providing the external supports that are necessary for successful parenting. The authors describe a hospital-based…

  12. White Matter Hyperintensities and Their Associations with Suicidality in Psychiatrically Hospitalized Children and Adolescents.

    ERIC Educational Resources Information Center

    Ehrlich, Stefan; Noam, Gil G.; Lyoo, In Kyoon; Kwon, Bae J.; Clark, Megan A.; Renshaw, Perry F.

    2004-01-01

    Objective: Increasingly, researchers and clinicians are recognizing that there may be biological markers associated with increased risk of suicide. The objective of this study was to compare white matter hyperintensities in psychiatrically hospitalized children and youth with and without a history of suicide attempt while controlling for other…

  13. Racial Disparities in Mental Health Outcomes after Psychiatric Hospital Discharge among Individuals with Severe Mental Illness

    ERIC Educational Resources Information Center

    Eack, Shaun M.; Newhill, Christina E.

    2012-01-01

    Racial disparities in mental health outcomes have been widely documented in noninstitutionalized community psychiatric samples, but few studies have specifically examined the effects of race among individuals with the most severe mental illnesses. A sample of 925 individuals hospitalized for severe mental illness was followed for a year after…

  14. A Four-Year Analysis of Adolescent Self-Destructive Behavior and Psychiatric Hospitalization.

    ERIC Educational Resources Information Center

    Ward, Alan J.

    Data were gathered on a statewide basis in 102 Illinois counties on both the incidence and prevalence of adolescent public psychiatric hospitalizations and the identified self-destructive behaviors: (1) completed suicides; (2) assaultive behaviors; (3) runaway behavior; (4) substance abuse; and (5) teenage births, from fiscal year 1985 through…

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

    PubMed

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

    2010-06-01

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

  16. Outpatient mental health service use by older adults after acute psychiatric hospitalization.

    PubMed

    Li, Hong; Proctor, Enola; Morrow-Howell, Nancy

    2005-01-01

    This study described outpatient mental health service used by elderly patients discharged from acute inpatient psychiatric treatment for depression, assessed services barriers, and identified factors related to the use of outpatient mental health services. The sample consisted of 199 elderly patients discharged home from a geropsychiatric unit of an urban midwestern hospital. Multivariate logistic regression was used to identify factors associated with use of various mental health services. Almost three quarters of the elderly patients saw a psychiatrist within 6 weeks postdischarge, but few used other outpatient mental health services. The most frequently reported barriers to use included (1) cost of services, (2) personal belief that depression would improve on its own, and (3) lack of awareness of available services. The use of various outpatient services was differentially related to predisposing, need, and enabling factors. Female patients, those residing in rural areas, and those who wanted to solve their problems on their own were less likely to use outpatient mental health services. Patients who reported greater levels of functional impairment, resided in rural areas, and perceived that getting services required too much time were less likely to see a psychiatrist in the postacute period. African American patients were more likely than whites to use day treatment programs. This may be related to the fact that most day treatment centers were located in areas where the majority of residents were African Americans.

  17. [Initial psychiatric experiences of Philippe Pinel at the Belhomme Hospital].

    PubMed

    Postel, J

    1983-11-01

    The purpose of this paper is to investigate Philippe Pinel's psychiatric experience, his practice in "la maison de santé Belhomme" and his first publications which were concerned with the treatment of mental patients and appeared in "La Gazette de Santé" which he edited between 1785 and 1789. During that time, the main preoccupation of the future head doctor of "La Salpétrière" had been to ensure the application and the development of moral treatment, in its practical modalities as well as its theoretic rationalization. Meanwhile, the institutional aspect of this therapy had the upper hand over the individual cure. This evolution brought Pinel and his successors to neglect the latter. In this connection we can regret that Philippe Pinel did not continue to have more private practice for this allowed him to follow first his experience and research (individual cure) in this field of rational psychotherapy, that of moral treatment. PMID:6360324

  18. Psychiatric Disorders in Children and Adolescents Attending Pediatric Out Patient Departments of Tertiary Hospitals

    PubMed Central

    Jesmin, Akhter; Rahman, Khan Muhammad Zillur; Muntasir, Maruf Mohammad

    2016-01-01

    Objectives Psychiatric disorders are increasingly recognized among children and adolescents in Bangladesh. Psychiatric disorders are more common in children with chronic and acute pediatric disorders. Our study was designed to determine the psychiatric disorders among children and adolescents attending pediatric outpatient departments of tertiary care hospitals. Methods This cross-sectional study was carried out from July 2012 to February 2013 in pediatric outpatient departments of three prime tertiary level hospitals of Dhaka, Bangladesh. A purposive sampling technique was used. A total of 240 male and female children aged 5 to 16 years old were included in the study. We used a semi-structured questionnaire to obtain sociodemographic and other relevant clinical information about the children and their families from their parents or caregivers and a validated parent version of the Bangla Development and Well-Being Assessment (DAWBA) for measuring psychopathology. Results The mean age of the children was 9.0± 2.6 years. The majority (71%) of children were in the 5–10 year age group. The male/female ratio was 1.2:1. Among the respondents, 18% were found to have a psychiatric disorder. Behavioral disorders, emotional disorders, and developmental disorders were found in 9.0%, 15.0% and 0.4% respectively. Hyperkinetic disorder was the single most frequent (5.0%) psychiatric disorder. Conclusions A significant number of children were found to have psychiatric disorders. Our study indicates the importance of identification and subsequent management of psychiatric conditions among the pediatric population. PMID:27403237

  19. Characteristics of psychiatric admissions and aspects of overcrowding at the general Hospital, Kuala Lumpur.

    PubMed

    Chin, C N; Kadir, A B; Jeyarajah, S

    1993-06-01

    This study examined admissions, final diagnoses and mean duration of stay of patients in the Psychiatric Wards at the General Hospital, Kuala Lumpur. The male ward was severely overcrowded by 125% over the maximum bed capacity. The majority were psychotic, mainly schizophrenic. The female ward had 76% occupancy, also mainly psychotic. Neurotics, alcohol dependents and personality disorders formed less than 5% of the admissions. There was no difference in the mean duration of stay of patients of both UKM and GHKL Units stratified for diagnosis and disposal except for newly diagnosed schizophrenics. There is an urgent need for more male psychiatric beds/wards.

  20. From the psychiatric hospital to the community: integrating conditional release and contingency management.

    PubMed

    Elbogen, E B; Tomkins, A J

    2000-01-01

    Psychiatric hospital recidivism has been and continues to be a persistent problem in treating individuals with chronic mental illness. Conditional release, a form of involuntary outpatient commitment, has been suggested as one possible solution. Guided by therapeutic jurisprudence, this article presents a proposal about conditional release that would maximize convergence of social values and would be empirically testable. Specifically, a scientifically validated treatment intervention for individuals with chronic mental illness, contingency management, is integrated with conditional release. From this proposal, a number of empirical hypotheses and legal questions about discharging psychiatric patients are generated and discussed.

  1. Schizophrenia and tobacco smoking in a Spanish psychiatric hospital.

    PubMed

    LLerena, Adrián; de la Rubia, Alfredo; Peñas-Lledó, Eva M; Diaz, Francisco J; de Leon, Jose

    2003-04-01

    This study in a Spanish hospital replicated two US studies suggesting that schizophrenia is associated with smoking when compared with other severe mental illnesses. Neither antipsychotics nor institutionalism could explain this relationship. Seventy of the 100 schizophrenic and 53 of the 100 non-schizophrenic inpatients were current smokers. After correcting for confounding factors, schizophrenia increased the risk of smoking by 2- to 3-fold. Heavy smoking was not associated with schizophrenia.

  2. [Evaluation of Treatment of Mothers at the Family Day Hospital in Münster, Germany].

    PubMed

    Liwinski, Timur; Romer, Georg; Müller, Jörg Michael

    2015-01-01

    Evaluation of Treatment of Mothers at the Family Day Hospital in Münster, Germany. Mothers of preschool children have limited access to mental health treatment services. The Family Day Hospital for Preschool Children at the University Hospital Münster, Germany, offers therefore a specialized treatment for mothers with their preschool children. The therapy outcome of mothers is evaluated in effectiveness study by a pre-post-design. For mothers, therapy was composed of individual session and couple sessions with the partner, video-based parent-child-interaction therapy, and parent group sessions. We evaluated the psychiatric symptom burden of N = 103 mothers at admission and discharge with the Symptom Checklist-90-Revised (SCL-90-R) above the clinical cut-off ≥ 0.57. After treatment the mothers showed significant improvement on the global severity index (GSI) with an average Cohen's d = 1.64 (p0.001). We identified the following positively associated moderator variables of maternal improvement by a multiple regression analysis: the initial symptom burden, the educational level of the mother, not restricted housing conditions, and the age of the child. We conclude that especially distressed parents benefit from the treatment in the Family Day Hospital for Preschool Children.

  3. Psychiatric commitment and involuntary hospitalization: an ethical perspective.

    PubMed

    Levenson, J L

    As a psychiatrist, I have focused in this paper on the medical model view of commitment. Directed against the medical model is the civil liberties position, mostly put forward by attorneys, which values autonomy over beneficence and sees psychiatric decision-making as biased, imprecise, and too paternalistic. Like the moral principles they champion, neither of these positions is "wrong." The tension between them is inevitable and sometimes beneficial. The conflict is inevitable because the proponents differ in their missions and how they think. Attorneys (and philosophers) think in terms of the general case, of classes of situations, whereas psychiatrists focus on individuals as unique. Chodoff has also pointed out that the medical model is a utilitarian one, i.e. the morality of an act is determined by, on balance, whether it increases the good for the individual or society. The civil liberties position, on the other hand, is a deontological one, i.e. the end does not justify the means; some moral principles must be considered even if they do not lead to maximally good outcomes. This conflict between positions can be ultimately beneficial, if we recognize that each is fighting for a good. As a society, we should expect psychiatrists and other mental health professionals to try their utmost to treat the mentally ill, and attorneys to protect their rights. When we view it as such a moral dilemma, "we are confronted not with melodrama, a contest of right against wrong, but rather with tragedy, a conflict of one right--to be at physical liberty--against another right--to be free dehumanizing disease."

  4. Patients' lived seclusion experience in acute psychiatric hospital in the United States: a qualitative study.

    PubMed

    Ezeobele, I E; Malecha, A T; Mock, A; Mackey-Godine, A; Hughes, M

    2014-05-01

    The findings revealed that the patients perceived seclusion as an intervention that is punitive and a means used by the staff to exert control. Patients perceived that staff incitements and lack of communication skills led to their being secluded. The findings provided recommendations and strategies for seclusion reduction that were based on the patients' first-hand seclusion experiences. This phenomenological study used Husserlian's philosophy to explore and describe the lived experiences of psychiatric patients who were secluded at a free-standing acute care hospital located in South-western United States (US). The study is crucial because very few studies have been conducted in this area in the US. The study examined a purposive sample of 20 patients, 3 days post-seclusion. Data were generated through face-to-face, semi-structured interviews incorporating open-ended questions and probes to facilitate discussion until saturation was reached. Interviews were transcribed verbatim and data analysed using Colaizzi's seven steps method. Results were described according to the themes and subthemes identified. Findings uncovered four themes: (1) alone in the world; (2) staff exert power and control; (3) resentment towards staff; and (4) time for meditation. The findings from this study illuminated the views surrounding patients' seclusion experience. It provided first-hand information on the patients' seclusion experience that might be helpful to the mental health professionals in the seclusion reduction process.

  5. Reassessing the high proportion of involuntary psychiatric hospital admissions in South Korea.

    PubMed

    Bola, John R; Park, Eon-Ha; Kim, Seong-Yeon

    2011-10-01

    The 2007 WHO-AIMS report on the mental health system of South Korea documented progress towards a national mental health plan, protection of human rights, and growth of community based services. Yet concern was expressed that the high proportion of involuntary to total psychiatric hospitalizations (92%) may indicate an excessively coercive system. Involuntary hospitalization in Korea rose from 117 to 132 (per 100,000) between 2000 and 2006. In 2000, the median rate in the European Union (EU) was 74 per 100,000 (Range: 6-218). While Korea's involuntary hospitalization rate is within the EU range, its proportion of involuntary hospitalizations is three times that of the highest EU country (30%, Sweden). Underdevelopment of voluntary psychiatric services and culturally mandated family referrals resulting in involuntary hospitalization are apparent reasons for the high proportion of involuntary hospitalizations. Population-based rates per 100,000 more accurately describe involuntary hospitalization than the proportion (ratio) measure used in the WHO-AIMS reports. PMID:21416122

  6. Vitamin D status of adolescent inpatients in a secure psychiatric hospital

    PubMed Central

    Hill, Simon A.; Riordan-Eva, Elliott; Bhandari, Bharathi; Ferdinandez, Uresh

    2016-01-01

    Objective: The objective of the study was to use routinely collected data on vitamin D levels of adolescents detained in a secure psychiatric hospital to see if this at-risk group for vitamin D deficiency do in fact have low vitamin D levels. Methods: Vitamin D blood levels were collated from clinical records of inpatients admitted to Bluebird House, a medium secure adolescent unit, since 2012. Corresponding data were gathered to include gender, ethnic status and age. Blood levels were assessed on admission to the unit and after treatment with vitamin D supplementation, if indicated. Results: Only 3 out of the 35 patients (8.6%) had adequate vitamin D levels (serum 25-hydroxyvitamin D [25-OHD] > 50 nmol/l). A total of 23 patients (65.7%) had levels consistent with deficiency (25-OHD < 30 nmol/l) with the remaining 9 patients (25.7%) showing levels indicating possible deficiency (25-OHD 30–50 nmol/l. Conclusions: Vitamin D levels were low in our sample of young people admitted to a secure psychiatric hospital. This is the first published study of vitamin D levels in a secure adolescent psychiatric hospital. The results point to the need for routine prescription of vitamin D to adolescents held in secure conditions such as hospitals, secure children’s homes and youth offender institutes. PMID:27536343

  7. [A wide-ranging project to the best use of S. Niccolo Psychiatric Hospital].

    PubMed

    Vannozzi, Francesca

    2007-01-01

    The S. Niccolò Psychiatric Hospital was one of the most important health institutions not only for Siena but for the entire Tuscan district and beyond. It was known to serve all the catchment area for mentally ill patients coming from other cities. At a national level, it is also one of the most beautiful models of hospital architecture of the "village" type, the expression of a late nineteenth-century tendency to perceive mental disorders as illnesses that could be improved and cured through "moral treatment", with work and distraction as the principal therapeutic instruments. The closure of the psychiatric hospital in Siena provided for by the Italian psychiatric reform of 1978 actually took place over an extremely long period of time. It was definitively closed only on 30 September 1999 and was the last psychiatric hospital in Tuscany to cease its activity. Its history, the importance it had for the considerable number of committed patients, the extension of the area of the hospital over 183,574 m2 and its organization in 16 edifices, mean that S. Niccolò is now an architectonic complex of great value and interest but also subject to progressive deterioration. This reality, together with the urgency of salvaging the collections of books from its very rich library and its archives of administrative documents and medical records, has led the author to prepare a wide-ranging and extremely complex project that aims at the best use of S. Niccolò. Thanks to the collaboration of a group of experts from various Faculties of the University of Siena, and beginning with a multidisciplinary study of S. Niccolò's history, the project proceeds to the identification of concrete actions of cultural policy as well. PMID:18450025

  8. Emotional reactions to involuntary psychiatric hospitalization and stigma-related stress among people with mental illness.

    PubMed

    Rüsch, Nicolas; Müller, Mario; Lay, Barbara; Corrigan, Patrick W; Zahn, Roland; Schönenberger, Thekla; Bleiker, Marco; Lengler, Silke; Blank, Christina; Rössler, Wulf

    2014-02-01

    Compulsory admission to psychiatric inpatient treatment can be experienced as disempowering and stigmatizing by people with serious mental illness. However, quantitative studies of stigma-related emotional and cognitive reactions to involuntary hospitalization and their impact on people with mental illness are scarce. Among 186 individuals with serious mental illness and a history of recent involuntary hospitalization, shame and self-contempt as emotional reactions to involuntary hospitalization, the cognitive appraisal of stigma as a stressor, self-stigma, empowerment as well as quality of life and self-esteem were assessed by self-report. Psychiatric symptoms were rated by the Brief Psychiatric Rating Scale. In multiple linear regressions, more self-stigma was predicted independently by higher levels of shame, self-contempt and stigma stress. A greater sense of empowerment was related to lower levels of stigma stress and self-contempt. These findings remained significant after controlling for psychiatric symptoms, diagnosis, age, gender and the number of lifetime involuntary hospitalizations. Increased self-stigma and reduced empowerment in turn predicted poorer quality of life and reduced self-esteem. The negative effect of emotional reactions and stigma stress on quality of life and self-esteem was largely mediated by increased self-stigma and reduced empowerment. Shame and self-contempt as reactions to involuntary hospitalization as well as stigma stress may lead to self-stigma, reduced empowerment and poor quality of life. Emotional and cognitive reactions to coercion may determine its impact more than the quantity of coercive experiences. Interventions to reduce the negative effects of compulsory admissions should address emotional reactions and stigma as a stressor.

  9. Occupational stressors, burnout and coping strategies between hospital and community psychiatric nurses in a Dublin region.

    PubMed

    McTiernan, K; McDonald, N

    2015-04-01

    Burnout negatively impacts the delivery of mental health services. Psychiatric nurses face stressors that are distinct from other nursing specialities. The research was conducted in Ireland and captured a relatively large sample of respondents. The results compared the stressors, coping strategies and burnout levels between hospital and community-based psychiatric nurses. Occupational stress can negatively impact on the well-being of psychiatric nurses, which in turn can lead to poor client care. There is a dearth of published research conducted in Ireland that examines stress within the discipline. A between-groups study, undertaken in February 2011, investigated stressors, burnout and coping strategies between hospital and community-based psychiatric nurses in a Dublin region. Sixty-nine participants (8 males and 61 females), aged between 18 to 60 years voluntarily completed the Mental Health Professional Stress Scale, the Maslach Burnout Inventory and the PsychNurse Methods of Coping Scale. The findings revealed that nurses were operating in a moderately stressful environment. Stressors focused on organizational issues as opposed to client issues. The main stressors identified were lack of resources, workload and organizational structures/processes. Both groups reported average levels of emotional exhaustion, low levels of depersonalization and average levels of personal accomplishment. A Mann-Whitney U-test and Independent Samples t-test found significant differences between hospital and community-based nurses regarding depersonalization and personal accomplishment, respectively. Hospital nurses reported higher depersonalization scores, and community nurses had a greater sense of personal accomplishment. The personal accomplishment scores of hospital nurses were below mental health professional norms. No significant differences emerged regarding coping strategies. Avoidant coping strategies were favoured by both groups. It is recommended that interventions

  10. Two hospitals join forces to sponsor "A Woman's Comfort Day".

    PubMed

    1995-01-01

    Two Baton Rouge, La., hospitals--usually strong competitors--decided to join forces and collaborate on a special event for the women of the community. "A Woman's Comfort Day," now in its third year, was the successful result. If they're feeling good about themselves, can the Super Bowl be far behind?

  11. Psychiatric comorbidity and mortality among veterans hospitalized for congestive heart failure.

    PubMed

    Banta, Jim E; Andersen, Ronald M; Young, Alexander S; Kominski, Gerald; Cunningham, William E

    2010-10-01

    A Behavioral Model of Health Services Utilization approach was used to examine the impact of comorbid mental illness on mortality of veterans admitted to Veterans Affairs medical centers in fiscal year 2001 with a primary diagnosis of congestive heart failure (n = 15,497). Thirty percent had a psychiatric diagnosis, 4.7% died during the index hospitalization, and 11.5% died during the year following discharge. Among those with mental illness, 23.6% had multiple psychiatric disorders. Multivariable logistic regression models found dementia to be positively associated with inpatient mortality. Depression alone (excluding other psychiatric disorders) was positively associated with one-year mortality. Primary care visits were associated with a reduced likelihood of both inpatient and one-year mortality. Excepting dementia, VA patients with a mental illness had comparable or higher levels of primary care visits than those having no mental illness. Patients with multiple psychiatric disorders had more outpatient care than those with one psychiatric disorder. PMID:20968262

  12. A brief behavioral activation treatment for depression. A randomized pilot trial within an inpatient psychiatric hospital.

    PubMed

    Hopko, Derek R; Lejuez, C W; LePage, James P; Hopko, Sandra D; McNeil, Daniel W

    2003-09-01

    The brief behavioral activation treatment for depression (BATD) is a relatively uncomplicated, time-efficient, and cost-effective method for treating depression. Because of these features, BATD may represent a practical intervention within managed care-driven, inpatient psychiatric hospitals. Based on basic behavioral theory and empirical evidence supporting activation strategies, we designed a treatment to increase systematically exposure to positive activities and thereby help to alleviate depressive affect. This study represents a pilot study that extends research on this treatment into the context of an inpatient psychiatric unit. Results demonstrate effectiveness and superiority of BATD as compared with the standard supportive treatment provided within the hospital. A large effect size was demonstrated, despite a limited sample size. The authors discuss the limitations of the study and future directions.

  13. The involvement of a consumer council in organizational decision making in a public psychiatric hospital.

    PubMed

    Linhorst, D M; Eckert, A; Hamilton, G; Young, E

    2001-11-01

    This article describes a consumer group within a public psychiatric hospital that serves primarily a forensic population. Some barriers to participation included the severity of some clients' mental illness, an organizational culture that does not fully support participation, the lack of clients' awareness of problems or alternative actions, and inherent power imbalances between clients and staff. Despite these barriers, the consumer group has made improvements for facility clients. Some factors associated with this success included strong administrative support, the allocation of a highly qualified staff liaison to work with the group, and the integration of the group into the facility's formal decision-making structure. Lessons are offered for the development of similar groups within public psychiatric hospitals and community-based mental health agencies.

  14. Self-Determination Theory and Outpatient Follow-Up After Psychiatric Hospitalization.

    PubMed

    Sripada, Rebecca K; Bowersox, Nicholas W; Ganoczy, Dara; Valenstein, Marcia; Pfeiffer, Paul N

    2016-08-01

    The objective of this study was to assess whether the constructs of self-determination theory-autonomy, competence, and relatedness-are associated with adherence to outpatient follow-up appointments after psychiatric hospitalization. 242 individuals discharged from inpatient psychiatric treatment within the Veterans Health Administration completed surveys assessing self-determination theory constructs as well as measures of depression and barriers to treatment. Medical records were used to count the number of mental health visits and no-shows in the 14 weeks following discharge. Logistic regression models assessed the association between survey items assessing theory constructs and attendance at mental healthcare visits. In multivariate models, none of the self-determination theory factors predicted outpatient follow-up attendance. The constructs of self-determination theory as measured by a single self-report survey may not reliably predict adherence to post-hospital care. Need factors such as depression may be more strongly predictive of treatment adherence.

  15. An instrument assessing patient satisfaction with day care in hospitals

    PubMed Central

    2012-01-01

    Background Patient satisfaction is an important indicator of quality of care in hospitals. Reliable and valid instruments to measure clinical and outpatient satisfaction already exist. Recently hospitals have increasingly provided day care, i.e., admitting patients for one day without an overnight stay. This article describes the adaption of the ‘Core questionnaire for the assessment of Patient Satisfaction’ (COPS) for general Day care (COPS-D), and the subsequent validation of the COPS-D. Methods The clinical COPS was supplemented with items to cover two new dimensions: Pre-admission visit and Operation Room. It was sent to a sample of day care patients of five general Dutch hospitals to investigate dimensionality, acceptability, reliability, construct and external validity. Construct validity was established by correlating the dimensions of the COPS-D with patients’ overall satisfaction. Results The COPS-D was returned by 3802 patients (response 46%). Factor analysis confirmed its’ structure: Pre-intake visit, Admission, Operation room, Nursing care, Medical care, Information, Autonomy and Discharge and aftercare (extraction communality 0.63-0.90). The internal consistency of the eight dimensions was good (α = 0.82-0.90); the item internal consistency corrected for overlap was satisfactory (>0.40); all inter-item correlations were higher than 0.45 but not too high (<0.90). The construct validity of all dimensions was good (r from 0.52-0.62, p < 0.01). The Information dimension had the strongest correlation with overall day care satisfaction. Conclusions The COPS-D is a reliable and valid instrument for measuring satisfaction with day care. It complements the model of measuring patient satisfaction with clinical and outpatient care given in hospitals. It also fulfils the conditions made while developing the clinical and outpatient COPS: a short, core instrument to screen patient satisfaction. PMID:22624677

  16. [A social psychiatric study on foreign-born inpatients at Tokyo Metropolitan Matsuzawa hospital].

    PubMed

    Igarashi, Y; Hayashi, N; Ebata, K; Kaneko, T

    1994-01-01

    The authors carried out a chart review study of 293 foreign-born patients who were admitted to Tokyo Metropolitan Matsuzawa Hospital from January 1986 to December 1992. We divided the subjects into three groups according to their living status in Japan, Immigrant group: 66 long-term residents, Resident group: 188 short-term residents with purposes of work or study, and Visitor group: 39 temporary visitors for sightseeing or business. The subjects came from 43 countries in the world, 70.3% (206/293) of whom were those from Asian countries. The subjects grew in number every year and the noticeable feature was a drastic increase in the number of Resident group (e.g. 6 patients in 1986, 63 in 1992). The mean duration (SD) of hospitalization for Immigrant group was the longest among the groups (Immigrant group: 58.7 (55.0) days, Resident group: 31.9 (35.0) days, Visitor group: 19.0 (16.3) days). The frequent diagnoses at discharge based on ICD-9, were schizophrenia (59.7%) and reactive psychosis (19.1%). The significantly larger proportion of Visitor group had previous psychiatric histories in their homeland than other groups (Visitor group: 56.4%, Immigrant group: 24.2%, Resident group: 23.9%). 70.0% (205/293) of the subjects could not use Japanese in usual settings and the number of them had been increasing every year. This communication difficulty had caused serious inconvenience in the treatment. All of Visitor group, and 71.8% (135/188) of Resident group could not receive social securities, and there were difficulties for them to raise money for their medical treatment and living expenses. 92.3% among Visitor group, 91.0% of Resident group and 21.2% of Immigrant group returned to their homeland after inpatient treatment. The result indicated that we must immediately establish the interpreter dispatch system for foreign-born patients and that of the social securities guaranteeing their medical care and living expenses.

  17. [DRGs in psychiatric hospital financing exemplified by Hungary. A model for Germany?].

    PubMed

    Maylath, E

    2000-12-01

    One of the most important provisions incorporated in the reform of the German health sector has been the introduction of a per case prospective payment system for hospitals with the exception of admissions to psychiatric care. The reasons for the exclusion of psychiatric care are unclear, but it is as a result all the more interesting to look at the experience of Hungary, where in-patient psychiatric care has been financed on the basis of diagnosis-related groups (DRGs) for the past seven years. The article describes how in the early 1990's the funding of the Hungarian health service was reorganized from being a state-financed system with a set budget to a system financed by contributions. Parallel to this development, service-related financing was introduced. In the hospital sector this involved DRGs. At the beginning of 1993 the Hungarian DRGs comprised only 437 categories, but this has since increased to 758. Furthermore, other characteristics are listed which, apart from the number of groups, differentiate the Hungarian DRGs from the AP-DRGs. Among other things, service-related financing includes non-typical areas such as psychiatry. In this case, it covers in-patient psychiatric care in an unusual combination of DRGs in the acute case category (50% of all beds in psychiatric units in Hungary are for acute cases) with daily nursing charges in the chronic case category. An analysis is given in the article of 16 homogeneous diagnostic categories in psychiatric care, followed by experiences gathered in conjunction with the application of this approach in this particular sphere, with special reference to three problem areas. These are as follows: the trend towards diagnoses with a relatively high weighting; the practice of charging for psychiatric DRGs in somatic wards; and, finally, the perpetuation of poor service structures and practices through DRGs. In general, evidently the introduction of psychiatric DRGs may also be recommended in Germany because of the

  18. Effort-reward imbalance and burnout among German nurses in medical compared with psychiatric hospital settings.

    PubMed

    Schulz, M; Damkröger, A; Heins, C; Wehlitz, L; Löhr, M; Driessen, M; Behrens, J; Wingenfeld, K

    2009-04-01

    The aim of this study was to investigate whether nurses' efforts and rewards, as well as the effort-reward imbalance (ERI) and burnout, differ between subjects working in psychiatric vs. medical hospitals and between nurses under education and examined nurses respectively. Furthermore, the relationship between ERI and burnout was evaluated. Nursing is associated with high levels of emotional strain and heavy workloads. Burnout and a negative ERI can result in high absenteeism and turnover and have been identified as reasons why nurses leave their profession. In the last decade, working conditions of the nursing profession have changed in Germany, but somatic and psychiatric hospitals developed in different ways. This development may lead to different profiles. A sample of 389 nurses (78.8% female) in four German hospitals was investigated. A total of 147 nurses worked in psychiatric hospitals and 236 nurses worked in medical (somatic) hospitals. Fifty participants were still under education. The Effort-Reward Imbalance Inventory measures effort, reward and overcommitment at job and provides an imbalance score between effort and reward. The Maslach Burnout Inventory with the subscales, emotional exhaustion, lack of accomplishment and depersonalization, was also used. Nurses working in medical hospitals reported more burnout and had higher ERI scores. Subjects under education were comparable to examined nurses in terms of burnout but had lower ERI scores. Multiple regression analyses showed all ERI scales to be significant predictors for emotional exhaustion, while age, field of work and educational status further predict effort or ERI respectively. At present, the working situation of nurses in different settings appears to be characterized by a perceived imbalance of effort and reward and is associated with a high risk of developing burnout symptoms.

  19. Using Claims Data to Generate Clinical Flags Predicting Short-term Risk of Continued Psychiatric Hospitalizations

    PubMed Central

    Stein, Bradley D.; Pangilinan, Maria; Sorbero, Mark J; Marcus, Sue; Donahue, Sheila; Xu, Yan; Smith, Thomas E; Essock, Susan M

    2014-01-01

    Objective As health information technology advances, efforts to use administrative data to inform real-time treatment planning for individuals are increasing, despite few empirical studies demonstrating that such administrative data predict subsequent clinical events. Medicaid claims for individuals with frequent psychiatric hospitalizations were examined to test how well patterns of service use predict subsequent high short-term risk of continued psychiatric hospitalizations. Methods Medicaid claims files from New York and Pennsylvania were used to identify Medicaid recipients aged 18-64 with two or more inpatient psychiatric admissions during a target year ending March 31, 2009. Definitions from a quality-improvement initiative were used to identify patterns of inpatient and outpatient service use and prescription fills suggestive of clinical concerns. Generalized estimating equations and Markov models were applied to examine claims through March, 2011, to see what patterns of service use were sufficiently predictive of additional hospitalizations to be clinically useful. Results 11,801 unique individuals in New York and 1,859 in Pennsylvania identified met the cohort definition. In both Pennsylvania and New York, multiple recent hospitalizations, but not failure to use outpatient services or failure to fill medication prescriptions, were significant predictors of high risk of continued frequent hospitalizations, with odds ratios greater than 4.0. Conclusions Administrative data can be used to identify individuals at high risk of continued frequent hospitalizations. Such information could be used by payers and system administrators to authorize special services (e.g., mobile outreach) for such individuals as part of efforts to promote service engagement and prevent rapid rehospitalizations. PMID:25022360

  20. Staff representations and tobacco-related practices in a psychiatric hospital with an indoor smoking ban.

    PubMed

    Keizer, Ineke; Gex-Fabry, Marianne; Bruegger, Aurélia; Croquette, Patrice; Khan, Aqal Nawaz

    2014-04-01

    The present study describes representations about smoking and practices related to patient smoking among staff of a large public psychiatric hospital. A survey was performed using a specially designed questionnaire. The return rate was 72.4% (n = 155). A large proportion of staff recognized the importance of both smoking status and mental health for patient's well-being (46.9%), and believed that smoking cessation was possible for psychiatric patients (58.6%). However, the role of the psychiatric hospital was perceived as providing information (85.3%) and helping to diminish cigarette consumption (51%), rather than proposing smoking cessation (29.5%). Staff daily practice included reminding patients of smoking restrictions (43.9%), managing cigarettes (46.5%), and nicotine replacement therapy (24.3%). A principal component analysis of tobacco-related practices revealed two main factors (59.8% of variance): basic hospital actions (factor 1) and more specialized interventions (factor 2), which were significantly associated with higher worries about personally developing smoke-related illnesses (Spearman r = 0.38, P < 0.0001). Compared with non-smokers, smokers reported higher perceived vulnerability to develop an illness due to tobacco and a higher level of worry about this. The discussion highlights the need to redefine roles and expectancies of mental health staff, and improve training and collaboration with experts, in order to improve efficiency concerning tobacco issues.

  1. [The psychiatric hospital: a place where language is reconstructed through the group].

    PubMed

    Herrera, F

    2015-09-16

    Within the psychiatric hospital, the caregiver is faced with difficult choices regarding the to respond to the suffering of the patient, to accompany him and sometimes forcing him to accept care. The hospital is a place of pressures from within and from outside, where the caregiver must perform a balancing act, with multiple conflicting roles. He must respect patient rights and his resources, his safety and those of others, the understanding of his difficulties, the expectations of the family and the limits of reality. This care has a fundamental ethical dimension. The team discussion allows for a conflictual cooperation between caregivers, which makes possible caring for our patients in crisis.

  2. Treatment satisfaction and recovery in Saami and Norwegian patients following psychiatric hospital treatment: a comparative study.

    PubMed

    Sørlie, Tore; Nergård, Jens-Ivar

    2005-06-01

    Treatment, treatment satisfaction and recovery in Saami and Norwegian patients treated in a psychiatric hospital were compared. Although half of the Saami patients preferred to speak Saami with their therapists, only one patient did. The extensive use of traditional helpers was only partly recognized. Despite no differences in type and amount of treatment or symptom-change during the hospital stay, the Saami patients showed less satisfaction with all investigated treatment parameters including contact with staff, treatment alliance, information and global treatment satisfaction. There was less agreement between the ratings of the therapists and the Saami patients. Suggestions for improvements are made.

  3. Assessing health status and outcomes in a geriatric day hospital.

    PubMed

    Fowler, R W; Congdon, P; Hamilton, S

    2000-11-01

    The study objective was to assess the feasibility and usefulness of recommended outcome measures in older people attending a geriatric day hospital for multidisciplinary assessment and rehabilitation. We used the 'Short Form 36' (SF36) questionnaire which had been proposed as a suitable outcome tool for the elderly, as well as standard assessment scales (eg Barthel index). These were administered by interviewers at the start of day hospital attendance and repeated by postal survey three and six months later. Change in overall health status was rated by the clinical team. The study took place in a geriatric day unit based in a support hospital, specialising in assessment and rehabilitation of older people. Participants were older people referred directly from the community, or following an inpatient day, whose assessment indicated a need for multidisciplinary rehabilitation. Stroke and musculo-skeletal disorders were the commonest underlying conditions. There was a high incidence of non-completion on SF36 questions relating to physical and mental function. Subsequent interviews showed that patients found some questions irrelevant. Floor effects were common. In contrast, the standard scales were invariably fully completed. Compared with local population survey data, respondents had low baseline scores on all SF36 dimensions. Differences over time were probably explained by varying methods of administration. In spite of a clinical perception of improved health status during day hospital attendance, both standard and SF36 scores showed overall deterioration. Two conclusions could be drawn from this study. 1. Measures of physical and mental disability and quality of life gave lower results than expected and continued declining over a six month period, even when the clinical team felt that the patient had improved. 2. Administration of SF36 by an interviewer is essential to obtain meaningful results in older people with poor physical health, which should be interpreted

  4. Deliberate Self-harm seen in a Government Licensed Private Psychiatric Hospital and Institute.

    PubMed

    Krishnaram, Vaithiyam Devendran; Aravind, Vaithiyam Krishnaram; Vimala, A Rupavathy

    2016-01-01

    Majority of the published studies on suicide deal with identifying the sociodemographic and psychosocial aspects of suicide attempters and those who have completed suicide or to identify the characteristic differences between the two groups. There are very few studies focusing mainly or only on deliberate self harm. Most of these are hospital based studies or in a setting of general hospital psychiatry units. The present study is from Ram Psychiatry Hospital and Institute, a government licensed private psychiatric institute at Madurai, Tamil Nadu. It is a prospective study of individuals with self harm behavior mostly without the intention to kill, attending the psychiatry outpatient department of the hospital for the period of one year (January to December 2014) a total number of 140 cases are registered. Sociodemographic, clinical profiles with Axis I or Axis II diagnosis or otherwise, and the initiating or precipitating cause or mode of self-injury or self-harm are studied. The results are presented and discussed.

  5. Periodontal Health among Non-Hospitalized Chronic Psychiatric Patients in Mangaluru City-India

    PubMed Central

    Singh, Rashmi; Kota, Keshava Pai

    2016-01-01

    Introduction A substantial section of society constituting the mentally ill and psychiatric patients deserve special attention. Evidence has suggested that psychological factors have contributed to an increase in the susceptibility to periodontal disease. Aim The aim of the study was to evaluate the gingival and periodontal health of chronically non-hospitalized psychiatric patients in Mangaluru city, India. Materials and Methods Forty one psychiatric patients having chronic psychiatric illness and on neuroleptic medications for a minimum of 2 years were included in the study. The control group consisted of 41 healthy dental patients who were selected to match the study group by age and gender, and for both groups 20 teeth excluding the third molars should be present. Demographic characteristics, dental examination including gingival index and periodontal health according to the community periodontal index were recorded for each patient in both the groups. Results In the psychiatric patient group (Group A) 47.1% subjects were suffering from schizophrenia and 17.6% subjects were having mood disorder. Gingivitis varied from mild to severe among the patients of both the groups. Bleeding on probing (CPI 1) was recorded in 23.5% in Group A and 14.6% in Group B. Dental calculus (CPI 2) in 38.2% in Group A and 58.5% in Group B of the subjects, 20.6% with at least one 4mm to 5mm pocket (CPI 3), and 17.6% with at least one 6mm pocket (CPI 4). Conclusion The present study underlines a considerable need for prevention and treatment of periodontal disease among chronic psychiatric patients in Mangaluru city. Every effort should be made to increase the awareness of this cohort regarding the importance of oral hygiene practices and on the early diagnosis of periodontal problems. PMID:27656561

  6. [How should be a psychiatric hospital to take in and utilize the psycho-social approaches in Japan? -- From the view point of psychiatry, medical model, medical system and economical management system].

    PubMed

    Horikawa, Kohei; Horikawa, Yuriko

    2012-01-01

    The author developed argument that a cause of the present condition of our country, in which psycho-social approaches have not fully spread though its clinical efficacy has been well recognized, is in the medical institution side. Because, our psychiatric reforms over 17 years, that reduced the average duration of hospitalization from about 2156 days to 61 days, has attained by deployment of various psycho-social approaches based on "therapeutic community model" and "psychodynamic team treatment". Furthermore, it has done by the affinity, continuity and complementarities of "psychodynamic team treatment" and psychosocial approaches with following special features. That is, since psycho-social approaches is 1. techniques to acquire the social life skill and to prevent re-hospitalization, 2. the group psychotherapy by facilitating the patient's mutual help capability, 3. based on "acceptance of the disease" by "noticing the diagnosis". Even if the therapeutic orientation or assumption of the psychiatric hospital does not comprehend above all of 1-3, it is important whether it is in the same direction or not. In other words, it is the issue of the medical-economical-management system, medical model and also the kind of psychiatry that is the source of them. Our hospital is for short term hospitalization and in focus on the outpatient treatment with "psychodynamic team treatment" based on "therapeutic community model". That is why our hospital has a potential advantage to take in and utilize the psycho-social approaches. On the other hand, there is the same reason why it is difficult for the traditional psychiatric hospital for long term hospitalization with higher hierarchical "physical medicine model" based on the descriptive psychiatry. The further problem is that both psychiatric hospital staff and psycho-social therapists do not realize it. The most important issue for us is having the recognition and exploring the method not to adapt to a psychiatric hospital but

  7. [Closing forensic psychiatric hospitals in Italy: a new deal for mental health care?].

    PubMed

    Casacchia, Massimo; Malavolta, Maurizio; Bianchini, Valeria; Giusti, Laura; Di Michele, Vittorio; Giosuè, Patricia; Ruggeri, Mirella; Biondi, Massimo; Roncone, Rita

    2015-01-01

    The date of March 31, 2015, following the Law 81/2014, has marked a historical transition with the final closure of the six forensic psychiatric hospitals in Italy. This law identifies a new pathway of care that involves small-scale high therapeutic profile facilities (Residenze per la Esecuzione della Misura di Sicurezza, REMS) instead of the old forensic psychiatric hospitals. The Law promotes a new recovery-oriented rehabilitation approach for the persons with mental disorders who committed a criminal offence, but lack criminal responsibility and deemed as socially dangerous. After a brief description of what happens abroad, this article highlights the positive aspects of the law that, as a whole, has to be considered innovative and unavoidable. The main debated problems are also reviewed, including the lack of changes to the Criminal Code; the improper equation between insanity and mental illness and social dangerousness; the evaluation of "socially dangerousness", based solely on "subjective qualities" of the person, assessed out of his/her context, without paying attention to family and social conditions suitable for discharge; the expensive implementation of the REMS, mainly based on security policies and less on care and rehabilitation, the delay in their construction, and the search for residential alternatives structures; the uncertain boundaries of professional responsibility. Finally, several actions are suggested that can support the implementation of the law: information programs addressed to the general population; training activities for mental health professionals; systematic monitoring and evaluation of the outcomes of the care provided to the forensic psychiatric population; implementation of Agreement Protocols and a better cooperation with the judiciary. Scientific societies dealing with psychosocial rehabilitation need to be involved in such issues relating to the identification of the best care and rehabilitation pathways, which should be

  8. [Closing forensic psychiatric hospitals in Italy: a new deal for mental health care?].

    PubMed

    Casacchia, Massimo; Malavolta, Maurizio; Bianchini, Valeria; Giusti, Laura; Di Michele, Vittorio; Giosuè, Patricia; Ruggeri, Mirella; Biondi, Massimo; Roncone, Rita

    2015-01-01

    The date of March 31, 2015, following the Law 81/2014, has marked a historical transition with the final closure of the six forensic psychiatric hospitals in Italy. This law identifies a new pathway of care that involves small-scale high therapeutic profile facilities (Residenze per la Esecuzione della Misura di Sicurezza, REMS) instead of the old forensic psychiatric hospitals. The Law promotes a new recovery-oriented rehabilitation approach for the persons with mental disorders who committed a criminal offence, but lack criminal responsibility and deemed as socially dangerous. After a brief description of what happens abroad, this article highlights the positive aspects of the law that, as a whole, has to be considered innovative and unavoidable. The main debated problems are also reviewed, including the lack of changes to the Criminal Code; the improper equation between insanity and mental illness and social dangerousness; the evaluation of "socially dangerousness", based solely on "subjective qualities" of the person, assessed out of his/her context, without paying attention to family and social conditions suitable for discharge; the expensive implementation of the REMS, mainly based on security policies and less on care and rehabilitation, the delay in their construction, and the search for residential alternatives structures; the uncertain boundaries of professional responsibility. Finally, several actions are suggested that can support the implementation of the law: information programs addressed to the general population; training activities for mental health professionals; systematic monitoring and evaluation of the outcomes of the care provided to the forensic psychiatric population; implementation of Agreement Protocols and a better cooperation with the judiciary. Scientific societies dealing with psychosocial rehabilitation need to be involved in such issues relating to the identification of the best care and rehabilitation pathways, which should be

  9. [Homicide on first day after commitment to the closed ward of psychiatric clinic--report of a successful rehabilitation against all odds].

    PubMed

    Frei, Andreas

    2003-04-01

    The Swiss penal code provides quite a sophisticated system of rules concerning the assessment and management of mentally ill offenders--there is, however, a substantial lack of treatment places. This means a challenge for hospitals of general psychiatry if these patients should not be referred to common law prisons. We report of a young man who killed another patient on the day of his referral to a psychiatric clinic. The treatment and his rehabilitation was performed successfully in a clinic of general psychiatry--in spite of the scepticism of the legal authorities.

  10. [Discharge Dynamics and Related Factors of Long-stay Patients in Psychiatric Hospitals].

    PubMed

    Kono, Toshiaki; Shiraishi, Hiromi; Tachimori, Hisateru; Koyama, Asuka; Naganuma, Yoichi; Takeshima, Tadashi

    2015-01-01

    A longstanding challenge in Japan is prolonged psychiatric hospitalization and the associated difficulty of discharge, lost opportunities for patients' social participation, and stagnant reallocation of medical resources. Although the length of stay has been shortened recently on average, its distribution tends to be polarized into high-turnover and long-stay groups. To resolve these problems, we must understand the discharge dynamics of long-stay patients. Three questionnaires were sent to 733 randomly selected psychiatric hospitals (response rate: 24.3%; 178 hospitals, 2,480 patients). One questionnaire was on hospitalized patient numbers for one-year or longer stays as at the end of June 2007, recording each combination of Group (A or B), diagnosis, and hospitalization type. Group A referred to patients continuously hospitalized as at the end of June 2008; Group B referred to those discharged between July 2007 and June 2008. The second questionnaire was on hospital characteristics (founder, bed number, medical function, etc.), and the third questionnaire was on detailed patient characteristics (residential setting post-discharge, etc., for each Group B patient; a maximum of 20 patients per hospital consecutively in order of discharge). Valid data were obtained from 171 hospitals and 2,419 patients, with the latter increasing to 3,543 after weighting. The annual discharge rate (ADR; B/[A+B]) for the entire sample was 16.3%. Regarding the diagnosis, dementia showed the highest ADR (27.8%) and schizophrenia the lowest (13.5%). The ADRs for depression, bipolar disorder, and alcoholism were 23.9, 20.6, and 23.7% respectively. Regarding the hospitalization type, voluntary hospitalization (16.0%) and hospitalization for medical care and protection (16.8%) showed similar ADRs. Regarding the district, ADRs were high in Kinki (19.9%) and Kyushu (18.8%), and low in Kanto (14.1%) and Chugoku/Shikoku (14.2%). Multivariate analyses revealed that discharge within one year was

  11. Qualitative study on the placement of Huntington disease patients in a psychiatric hospital: perceptions of Maltese nurses.

    PubMed

    Scerri, Josianne; Cassar, Rebecca

    2013-12-01

    Individuals with adult or juvenile Huntington disease can be cared for within psychiatric hospitals. In this paper, nurses' perceptions about the appropriateness of a psychiatric setting for these patients were explored. Semistructured interviews were conducted with 10 Maltese nurses involved in the care of these individuals. Their responses were analyzed using thematic analysis. Three main themes were identified from this study: (i) Huntington disease is not a mental illness; (ii) the lack of specialized staff and equipment within a psychiatric setting; and (iii) a need for alternative care options. The findings provide an insight into the perceptions of nurses, as they play a key role in the care and management of individuals with Huntington disease in a psychiatric setting. The findings demonstrated the need to provide alternative residential options in the community, and to improve the care and support provided both within psychiatric hospitals and the community through staff education and the provision of necessary facilities and equipment.

  12. Patients Discharged Against Medical Advice from a Psychiatric Hospital in Iran: A Prospective Study

    PubMed Central

    Sheikhmoonesi, Fatemeh; Khademloo, Mohammad; Pazhuheshgar, Samaneh

    2014-01-01

    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

  13. Psychiatric morbidity, phenomenology and management in hospitalized female foreign domestic workers in Lebanon.

    PubMed

    Zahreddine, Nada; Hady, Rima Talaat; Chammai, Rabih; Kazour, François; Hachem, Dory; Richa, Sami

    2014-07-01

    40 million female domestic workers worldwide experience the inhumane conditions associated with this unregulated occupation, a situation that induces psychiatric morbidities in many. The case in Lebanon is not any better where it is estimated that one foreign domestic worker (FDW) commits suicide weekly. 33 female FDW and 14 female Lebanese (control group, CG) were enrolled. Brief Psychotic Rating Scale (BPRS) and Clinical Global Impression (CGI) scales were administered on admission and discharge and socio-demographic, living conditions, mental health care data and phenomenological observations were collected. Sexual, physical, and verbal abuses were detected in FDW (12.5, 37.5, and 50.0 %. respectively). 66.7 % of them were diagnosed with brief psychotic episode. The mean duration of hospital stay (13.1 days) was significantly lower in the FDW group. The mean cumulative antipsychotic dose of the FDW was 337.1 mg of chlorpromazine equivalent and the mean BPRS total pre-score of FDW was 66.4 with a much improved state on the CGI global improvement scale, all of which were nonsignificantly different from the CG. Striking phenomenological findings among FDW were acute anorexia (39.4 %), nudity (30.3 %), catatonic features (21.2 %), and delusion of pregnancy (12.1 %). Inpatient FDW are more diagnosed with psychotic than affective disorders and receive approximately similar treatment as controls in spite of the trend to rapidly discharge and deport the worker to limit the costs. Both groups presented with similar severity, although the FDW had peculiar phenomenological observations.

  14. Psychiatric morbidity, phenomenology and management in hospitalized female foreign domestic workers in Lebanon.

    PubMed

    Zahreddine, Nada; Hady, Rima Talaat; Chammai, Rabih; Kazour, François; Hachem, Dory; Richa, Sami

    2014-07-01

    40 million female domestic workers worldwide experience the inhumane conditions associated with this unregulated occupation, a situation that induces psychiatric morbidities in many. The case in Lebanon is not any better where it is estimated that one foreign domestic worker (FDW) commits suicide weekly. 33 female FDW and 14 female Lebanese (control group, CG) were enrolled. Brief Psychotic Rating Scale (BPRS) and Clinical Global Impression (CGI) scales were administered on admission and discharge and socio-demographic, living conditions, mental health care data and phenomenological observations were collected. Sexual, physical, and verbal abuses were detected in FDW (12.5, 37.5, and 50.0 %. respectively). 66.7 % of them were diagnosed with brief psychotic episode. The mean duration of hospital stay (13.1 days) was significantly lower in the FDW group. The mean cumulative antipsychotic dose of the FDW was 337.1 mg of chlorpromazine equivalent and the mean BPRS total pre-score of FDW was 66.4 with a much improved state on the CGI global improvement scale, all of which were nonsignificantly different from the CG. Striking phenomenological findings among FDW were acute anorexia (39.4 %), nudity (30.3 %), catatonic features (21.2 %), and delusion of pregnancy (12.1 %). Inpatient FDW are more diagnosed with psychotic than affective disorders and receive approximately similar treatment as controls in spite of the trend to rapidly discharge and deport the worker to limit the costs. Both groups presented with similar severity, although the FDW had peculiar phenomenological observations. PMID:24370752

  15. The outcomes of psychiatric inpatients by proportion of experienced psychiatrists and nurse staffing in hospital: New findings on improving the quality of mental health care in South Korea.

    PubMed

    Han, Kyu-Tae; Kim, Sun Jung; Jang, Sung-In; Hahm, Myung-Il; Kim, Seung Ju; Lee, Seo Yoon; Park, Eun-Cheol

    2015-10-30

    Readmission rates for mental health care are higher in South Korea than other Organization for Economic Development (OECD) countries. Therefore, it is worthwhile to continue investigating how to reduce readmissions. Taking a novel approach, we determined the relationship between psychiatrist experience and mental health care readmission rates. We used National Health Insurance claim data (N=21,315) from 81 hospitals to analyze readmissions within 30 days of discharge for "mood disorders" or "schizophrenia, schizotypal and delusional disorders" during 2010-2013. In this study, multilevel models that included both patient and hospital-level variables were analyzed to examine associations with readmission. Readmissions within 30 days of discharge accounted for 1079 (5.1%) claims. Multilevel analysis demonstrated that the proportion of experienced psychiatrists at a hospital was inversely associated with risk of readmission (OR: 0.79, 95% CI: 0.74-0.84 per 10% increase in experienced psychiatrists). Readmission rates for psychiatric disorders within 30 days of discharge were lower in hospitals with a higher number of nurses (OR: 0.95, 95% CI: 0.94-0.96 per 10 nurses). In conclusion, health policymakers and hospital managers should make an effort to reduce readmissions for psychiatric disorders and other diseases by considering the role that physician experience plays and nurse staffing. PMID:26260566

  16. Admission to psychiatric hospital in the early and late postpartum periods: Scottish national linkage study

    PubMed Central

    Langan Martin, Julie; McLean, Gary; Cantwell, Roch; Smith, Daniel J

    2016-01-01

    Objective To describe weekly admission rates for affective and non-affective psychosis, major depression and other psychiatric disorders in the early and late postpartum periods. To assess the impact of socioeconomic status, age and parity on admission rates. Methods Scottish maternity records were linked to psychiatric hospital admissions. 3290 pregnancy-related psychiatric admissions were assessed. Weekly admission rates were calculated for the pregnancy period, early postpartum period (6 weeks after birth) and late postpartum period (up to 2 years after birth), and compared with pre-pregnancy rates (up to 2 years before pregnancy). Admission rates were generated by calculating the total number of admissions for each time period divided by the number of weeks in the period. Incidence rate ratios (IRRs) were generated for each time period, using deprivation, age, parity and record of previous psychiatric hospital care-adjusted Poisson regression models. Results Women from more deprived social quintiles accounted for the largest proportion of admissions across all time periods. Compared with pre-pregnancy period, admission rates fell during pregnancy, increased markedly during the early postpartum period, and remained elevated for 2 years after childbirth. Within the most affluent quintile, admission IRRs were higher in the early postpartum period (IRR=1.29, 95% CI 1.02 to 1.59) than in the late postpartum period (IRR=0.87, 95% CI 0.74 to 0.98). For the late postpartum period, there was a positive association between higher maternal age and admission IRRs (ages 20–35 years, IRR=1.35, 95% CI 1.16 to 1.54 and age>40 years IRR=1.72, 95% CI 1.41 to 2.09). Conclusions Rates of psychiatric admission fell during pregnancy and increased in the early postpartum period (particularly during the first 2 weeks after birth), and remained elevated above baseline during the 2-year late postpartum period. An understanding of how social deprivation, age and parity

  17. 42 CFR 424.13 - Requirements for inpatient services of hospitals other than psychiatric hospitals.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... hospitalization when a SNF bed is not available. (1) A physician may certify or recertify need for continued hospitalization if the physician finds that the patient could receive proper treatment in a SNF but no bed is available in a participating SNF. (2) If this is the basis for the physician's certification...

  18. [Plastic surgery in day hospital conditions: comparison between two hospital models].

    PubMed

    Faga, A; Carminati, M; Falconi, D; Gatti, S; Rottino, A

    2003-12-01

    Personal experience of plastic surgery carried out in Day Hospital conditions is reported. The experience took place within the hospital structure through two different organisational models called here transversal and divisional organisation models: characteristic of the former is that it uses a dedicated interdivisional structure within the hospital involving the centralization of all day-surgery activities, whereas the latter organizes Day Surgery activities within the operating unit whose structures it shares. On the basis of a comparison between the two models we were able to note advantages and disadvantages. We can review our experience in brief by stating that our own preference went to the transversal model which presents the indubitable advantage of being a logistic structure which is hinged on daytime activity and is ready therefore to satisfy on the one hand the needs of this type of patient and, on the other, the needs of the structure itself in efficiency terms. We propose to correct the disadvantages of the transversal model which can be outlined in its lack of homogeneity in the pathology treated and in the subtraction of the criterion of clinical priority in waiting lists through the attainment of a critical dimensional threshold such as to permit programmable sessions with patients with homogeneous pathology (i.e. belonging to the same hospital unit) and through the maintenance of a certain number of Day Hospital beds (around 25%) reserved for new emergency clinical cases.

  19. Dromokaition Psychiatric Hospital of Athens: from its establishment in 1887 to the era of deinstitutionalization.

    PubMed

    Fiste, Markella; Ploumpidis, Dimitrios; Tsiamis, Costas; Poulakou-Rebelakou, Effie; Liappas, Ioannis

    2015-01-01

    Dromokaition Psychiatric Hospital opened its doors in 1887, following the donation made by Zorzis Dromokaitis from the island of Chios. Private donations and all forms of charities had contributed to a large extent in the establishment of hospitals across Greece, during the late 19th and the early 20th century. Dromokaition was one of them but it was also unique, as it was the first psychiatric hospital in Athens, admitting patients from every part of the country. This paper aimed at highlighting the long service of the institution through the different historical periods the country went through. We present the chronicle of its foundation, the development of its inner structure, and the medical and organizational influences which it received, along the way. The therapeutic methods used during the first decades of its operation reflected the corresponding European standards of the time. As a model institution from its foundation, it followed closely the prevailing European guidelines, throughout its historical path, either as an independent institution or as an integrated one within the National Health Service. PMID:25694790

  20. Utility of an integrated electronic suicide alert system in a psychiatric hospital.

    PubMed

    Madan, Alok; Mahoney, Jane; Allen, Jon G; Ellis, Thomas; Hardesty, Susan; Oldham, John M; Fowler, J Christopher

    2015-01-01

    Management of suicide-related behaviors in a hospital is challenging. This article (1) describes integration of an electronic suicide risk notification system to improve assessment of psychiatric inpatients, (2) details the manner in which these alerts complement standard of care, and (3) provides support of using aggregate data to inform administrative decision-making. Complementing routine clinical care and under the supervision of an assessment coordinator, adult inpatients at a specialty psychiatric hospital complete a computerized battery of outcome assessments throughout the course of their hospitalization. A critical-item response notification system for suicide-related behaviors was implemented within the larger, assessment architecture, sending an alert e-mail to unit staff if patients endorsed suicidal ideation on any 1 of 6 critical items. Analysis of aggregate data over a 19-month period reveal a linear trend of increasing rate of suicide alerts from October 2012 to April 2013 (Phase A) with a stabilization at the heightened level from July 2013 to April 2014 (Phase B), R = 0.697, P = .007. Findings suggest that more nuanced training in the management of suicide-related behavior may be necessary and that traditional approaches to staffing may need to accommodate patient acuity. The communication innovation of this system is in line with the Joint Commission's emphasis on designing and implementing patient-centered systems that enhance quality of care, including improved safety. PMID:25830616

  1. Analytic and Special Studies Reports; Utilization of Psychiatric Facilities by Children: Current Status, Trends, Implications. Mental Health Statistics, Series B, Number 1.

    ERIC Educational Resources Information Center

    Rosen, Beatrice M.; And Others

    Data are presented concerning the total number of children served in psychiatric facilities and the utilization of specific facilities, including outpatient psychiatric clinics, state and county mental hospitals, private mental hospitals, inpatient psychiatric services of general hospitals, psychiatric day-night services, private psychiatric…

  2. Justice at work and psychiatric morbidity among the personnel of an Italian hospital.

    PubMed

    Gigantesco, Antonella

    2011-06-01

    This study evaluated the association between justice in the workplace (and other psychosocial factors) and mental health among healthcare professionals. It was conducted in a sample of hospital employees in Italy. The prevalence of mental disorders was assessed and the relationships between having a disorder and the level of perceived justice, job control and effort-reward imbalance were investigated. Psychiatric morbidity among professionals with higher perceived justice were 0.3-0.9 times lower than those among those with lower perceived justice. This finding suggests that improving fairness at work does matter for disease prevention and mental health promotion policy.

  3. [Core principles for the regulation of placement subject to public law in psychiatric hospitals - with explanations].

    PubMed

    2016-03-01

    While the provisions of the highest courts concerning the involuntary commitment and treatment in psychiatric hospitals of people unable to give their consent are being implemented, in many federal states corresponding adjustments to the rules governing involuntary commitment in accordance with the mental health laws and laws on involuntary commitment are still pending. In states where new regulations do exist, legal experts express doubts that they conform to the Constitution and the UN Convention on the Rights of Persons with Disabilities. The DGPPN has formulated key parameters for involuntary commitment from a clinical perspective, which should be taken into account in the new regulations of the individual federal states. PMID:26868108

  4. A Qualitative Analysis Exploring Explanatory Models of Aggression and Violence in a Small Cohort of Rural Psychiatrically Hospitalized Adolescents, Their Parents, and Selected Hospital Staff

    ERIC Educational Resources Information Center

    Johnson, Daniel C.

    2010-01-01

    The purpose of this study was to examine the etiology and cultural underpinnings of adolescent violence as collective case study analysis of three inter-related groups: psychiatrically hospitalized rural adolescents, their parent/guardian, and various hospital staff. Violence among adolescents is a serious societal issue that has had varying…

  5. Psychiatric Morbidity and Correlates in Postpartum Women in a Tertiary Care Hospital

    PubMed Central

    Kumar, Narendra; Nagaraj, Anil Kumar Mysore; Koudike, Umashree; Majgi, Sumanth Mallikarjuna

    2016-01-01

    Background: A range of psychological disorders occur in women in the postpartum period apart from the traditional blues, postpartum depression and psychosis. These include obsession of infanticide, PTSD, morbid preoccupations regarding child birth and disorders of mother-infant relationships, though they are under emphasized. Methods: it is a cross-sectional study conducted in the tertiary maternity care hospital. A total of 152 study subjects were interviewed on MINI (Mini International Neuropsychiatric Inventory) and GAF (Global Assessment of Functioning) within 2 weeks after delivery. Results: The psychiatric morbidity was seen in 67 (44%) of the study subjects. About 26% of subjects had Depressive disorder NOS. Obsessive harm to the child, Panic disorder, Social phobia were the other disorders identified. There were no cases of Mania, Bipolar disorder, psychosis, post traumatic stress disorder or substance use disorder diagnosed across the sample. The Global Assessment of Functioning (GAF) score averaged 87.8. Statistically significant association was seen to be present between psychiatric illness and number of previous still births and dead children before this delivery (P = 0.045). Conclusions: The study reveals that psychiatric co-morbidity is very common in the postpartum period and can be detected as early as first week after delivery. Social phobia identified as a common association is a new finding and needs further replication. It needs a larger sample with a prospective assessment to generalize the findings of our study. PMID:27570341

  6. The association between depressive symptoms in the community, non-psychiatric hospital admission and hospital outcomes: A systematic review

    PubMed Central

    Prina, A. Matthew; Cosco, Theodore D.; Dening, Tom; Beekman, Aartjan; Brayne, Carol; Huisman, Martijn

    2015-01-01

    Objectives This paper aims to systematically review observational studies that have analysed whether depressive symptoms in the community are associated with higher general hospital admissions, longer hospital stays and increased risk of re-admission. Methods We identified prospective studies that looked at depressive symptoms in the community as a risk factor for non-psychiatric general hospital admissions, length of stay or risk of re-admission. The search was carried out on MEDLINE, PsycINFO, Cochrane Library Database, and followed up with contact with authors and scanning of reference lists. Results Eleven studies fulfilled our inclusion and exclusion criteria, and all were deemed to be of moderate to high quality. Meta-analysis of seven studies with relevant data suggested that depressive symptoms may be a predictor of subsequent admission to a general hospital in unadjusted analyses (RR = 1.36, 95% CI: 1.28–1.44), but findings after adjustment for confounding variables were inconsistent. The narrative synthesis also reported depressive symptoms to be independently associated with longer length of stay, and higher re-admission risk. Conclusions Depressive symptoms are associated with a higher risk of hospitalisation, longer length of stay and a higher re-admission risk. Some of these associations may be mediated by other factors, and should be explored in more details. PMID:25466985

  7. [The psychiatric hospital: a place where language is reconstructed through the group].

    PubMed

    Herrera, F

    2015-09-16

    Within the psychiatric hospital, the caregiver is faced with difficult choices regarding the to respond to the suffering of the patient, to accompany him and sometimes forcing him to accept care. The hospital is a place of pressures from within and from outside, where the caregiver must perform a balancing act, with multiple conflicting roles. He must respect patient rights and his resources, his safety and those of others, the understanding of his difficulties, the expectations of the family and the limits of reality. This care has a fundamental ethical dimension. The team discussion allows for a conflictual cooperation between caregivers, which makes possible caring for our patients in crisis. PMID:26591080

  8. Assaultive behavior in state psychiatric hospitals: differences between forensic and nonforensic patients.

    PubMed

    Linhorst, Donald M; Scott, Lisa Parker

    2004-08-01

    Forensic patients are occupying an increasingly large number of beds in state psychiatric hospitals. The presence of these mentally ill offenders has raised concerns about the risk they present to nonforensic patients. This study compared the rate of assaults and factors associated with assaultive behavior among 308 nonforensic patients and two groups of forensic patients including 469 patients found not guilty by reason of insanity and 76 pretrial patients. Consistent with other studies, nonforensic patients had higher rates of assaults than either group of forensic patients. However, being a forensic patient did not affect the odds of assault when controlling for the effects of demographic and clinical variables in a multivariate logistic regression analysis. Factors associated with assaults in each of the three patient groups were identified using multivariate analyses. Implications are presented for treatment of assaultive behavior, mixing of forensic and nonforensic patients within state hospitals, forensic release policies, and future research.

  9. Recycling former psychiatric hospitals in New Zealand: echoes of deinstitutionalisation and restructuring.

    PubMed

    Joseph, Alun E; Kearns, Robin A; Moon, Graham

    2009-03-01

    This paper addresses a gap in the understanding of the geography of deinstitutionalisation: the fate of closed asylums. We contend that the closure process was an exercise in both deinstitutionalisation and welfare state restructuring, and examine discourses surrounding the re-use of two former psychiatric hospitals in New Zealand-Seaview in Hokitika and Kingseat near Auckland. Drawing on an analysis of media coverage and field observation, we consider former asylums as sites of celebrity. We find the shadow of stigma to be prominent, manifested directly in suggestions that the former hospitals be used as prisons and in the partial redevelopment of one as a 'horror theme park'. Indirectly, we see stigma reflected in the physical deterioration of the asylums prior to closure. While this stigmatising is attributable in the first instance to deinstitutionalisation, the evidence suggests strongly that it was co-opted and exploited by the forces of restructuring. PMID:18499501

  10. Distinctiveness of management in a university psychiatric hospital as a public health institution.

    PubMed

    Koncina, Miroslav

    2008-06-01

    The distinctiveness of management of a university psychiatric hospital which has the status of a public health institution is manifested in the following ways: * Distinctive features and characteristics of managing service provider organizations compared to those whose operational results involve tangible products; * Distinctive features of management which originate from its role as a regional hospital and a tertiary research and educational institution in the field of psychiatry, with special importance for the Republic of Slovenia as a whole; * Distinctive features of management that are defined by the social and legal framework of operation of public health institutions and their special social mission. This paper therefore discusses the specific theoretical and practical findings regarding management of service provider organizations from the viewpoint of their social mission and significance, as well as their legal organization, internal structure and values.

  11. Distinctiveness of management in a university psychiatric hospital as a public health institution.

    PubMed

    Koncina, Miroslav

    2008-06-01

    The distinctiveness of management of a university psychiatric hospital which has the status of a public health institution is manifested in the following ways: * Distinctive features and characteristics of managing service provider organizations compared to those whose operational results involve tangible products; * Distinctive features of management which originate from its role as a regional hospital and a tertiary research and educational institution in the field of psychiatry, with special importance for the Republic of Slovenia as a whole; * Distinctive features of management that are defined by the social and legal framework of operation of public health institutions and their special social mission. This paper therefore discusses the specific theoretical and practical findings regarding management of service provider organizations from the viewpoint of their social mission and significance, as well as their legal organization, internal structure and values. PMID:18587280

  12. Substance abuse and the risk of readmission of people with schizophrenia at Amanuel Psychiatric Hospital, Ethiopia.

    PubMed

    Bimerew, M S; Sonn, F C T; Kortenbout, W P

    2007-06-01

    Frequent readmissions of people with schizophrenia pose considerable pressure on the psychiatric service provision of Amanuel Psychiatric Hospital. The purpose of the study was to ascertain factors mainly contributing to the rate of readmissions of people with schizophrenia. Descriptive survey methods and qualitative focus group interviews were employed to conduct the study. Random sampling techniques were used to select 43 respondents of people with schizophrenia from 231 people with schizophrenia who were readmitted for two or more times in the last two years and who gained access during the time of the study. Structured interviews were used for respondents of people with schizophrenia. Fourteen (N=14) family members/caregivers were selected using purposive sampling methods for focus group discussions. Quantitative data was analyzed using the SPSS Version 11.00 program and the qualitative data was analyzed by generating themes and categories. The results suggest that alcohol and khat abuse were contributing factors for the rate of readmissions of people with schizophrenia into the Amanuel Psychiatric Hospital. It was found that communities contribute to the problems of substance abuse by providing and/or selling it to those mentally ill people. The study also revealed that patients use alcohol and khat in order to tolerate the severe side effects of the anti-psychotic drugs, to suppress hunger due to shortage of food and to avoid drowsiness. Raising community awareness, psycho-education, strengthening the capacities of caretakers and laws to prevent substance abuse, as well as campaigning to prevent people from abusing mentally ill sufferers, should be established. PMID:17703825

  13. Police referrals to a psychiatric hospital: experiences of nurses caring for police-referred admissions.

    PubMed

    Maharaj, Reshin; O'Brien, Louise; Gillies, Donna; Andrew, Sharon

    2013-08-01

    Police are a major source of referral to psychiatric hospitals in industrialized countries with mental health legislation. However, little attention has been paid to nurses' experience of caring for police-referred patients to psychiatric hospitals. This study utilized a Heideggerian phenomenological framework to explore the experiences of nine nurses caring for patients referred by the police, through semistructured interviews. Two major themes emerged from the hermeneutic analyses of interviews conducted with nurse participants: (i) 'expecting "the worst" '; and (ii) 'balancing therapeutic care and forced treatment'. Expecting 'the worst' related to the perceptions nurse participants had about patients referred by the police. This included two sub-themes: (i) 'we are here to care for whoever they bring in'; and (ii) 'but who deserves care?' The second theme balancing therapeutic care and forced treatment included the sub-themes: (i) 'taking control, taking care'; and (ii) 'managing power'. The study raises ethical and skill challenges for nursing including struggling with the notion of who deserves care, and balancing the imperatives of legislation with the need to work within a therapeutic framework. PMID:23009594

  14. Nursing interventions for substance use during psychiatric hospital admissions: Clinical context and predictors.

    PubMed

    Stewart, Duncan; Warren, Jonathan; Odubanwo, Adewunmi; Bowers, Len

    2015-12-01

    Empirical information about how nurses manage substance use on psychiatric wards is lacking. The aims of the study were to identify the frequency and clinical features of incidents among a sample of inpatients over a 12-month period and how nursing staff intervened. Electronic, anonymized inpatient records were searched for incidents of substance use on 17 acute psychiatric wards in four hospitals in London. Searches were conducted for all patients admitted during 2012 and details of incidents and patient characteristics were extracted for analysis. Substance use was reported for 291 patients, with 25 incidents per 100 patients admitted to hospital. Only half of the incidents were followed by a response that specifically addressed the patients' substance use behaviour. These interactions usually concerned the circumstances and reasons for use, but rarely involved specific support for patients' substance use problems. The likelihood of staff taking any form of action was increased if the patient had been formally admitted, and was reduced if the patient was subject to containment during the shift or had a history of self-harm. The results demonstrate that nurses require specific training and guidance on supporting substance using patients. PMID:26300518

  15. A comparison of studies from the United States and western Europe on psychiatric hospitalization referrals for youths exhibiting suicidal behavior.

    PubMed

    Safer, D J

    1996-09-01

    A comprehensive literature review that rates of adolescent suicide-behavior based referrals from emergency rooms (ER) to psychiatric impatient facilities in the United States (U.S.) and in Western Europe (WE). Also compared on both sides of the Atlantic were the characteristics of suicidal youths seen at the ER and those admitted to psychiatric hospital units. The major findings were as follows. (1) Youths at both geographical locations who were seen at the ERs for suicidal behavior were very similar with respect to age and gender. (2) A median of 39% of youths seen in U.S. ERs for suicidal behavior were referred for inpatient psychiatric treatment; in WE, the median was 12%. (3) In the U.S., suicidal youths referred from the ER to psychiatric inpatient care were predominantly female (2.5:1) and mainly midadolescent in age (median age = 15). (4) In WE, the majority of those suicidal youths referred for psychiatric hospitalization were male (1:1.2) and in their late adolescent years (median age = 17). Thus, far fewer but more at risk youths presenting with suicidal behavior were admitted to psychiatric hospitals in WE than in the U.S. Presumably this is due largely to cross-Atlantic differences in malpractice patterns, academic perspectives, and medical care financing. PMID:8899134

  16. 42 CFR 424.13 - Requirements for inpatient services of hospitals other than psychiatric hospitals.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... for posthospital care, if appropriate. (b) Certification of need for hospitalization when a SNF bed is... physician finds that the patient could receive proper treatment in a SNF but no bed is available in a participating SNF. (2) If this is the basis for the physician's certification or recertification, the...

  17. Deliberate Self-harm seen in a Government Licensed Private Psychiatric Hospital and Institute

    PubMed Central

    Krishnaram, Vaithiyam Devendran; Aravind, Vaithiyam Krishnaram; Vimala, A. Rupavathy

    2016-01-01

    Majority of the published studies on suicide deal with identifying the sociodemographic and psychosocial aspects of suicide attempters and those who have completed suicide or to identify the characteristic differences between the two groups. There are very few studies focusing mainly or only on deliberate self harm. Most of these are hospital based studies or in a setting of general hospital psychiatry units. The present study is from Ram Psychiatry Hospital and Institute, a government licensed private psychiatric institute at Madurai, Tamil Nadu. It is a prospective study of individuals with self harm behavior mostly without the intention to kill, attending the psychiatry outpatient department of the hospital for the period of one year (January to December 2014) a total number of 140 cases are registered. Sociodemographic, clinical profiles with Axis I or Axis II diagnosis or otherwise, and the initiating or precipitating cause or mode of self-injury or self-harm are studied. The results are presented and discussed. PMID:27114626

  18. Psychiatric Hospital Bed Numbers and Prison Population Sizes in 26 European Countries: A Critical Reconsideration of the Penrose Hypothesis

    PubMed Central

    Blüml, Victor; Waldhör, Thomas; Kapusta, Nestor D.; Vyssoki, Benjamin

    2015-01-01

    Background Recently, there has been a revived interest in the validity of the Penrose hypothesis, which was originally postulated over 75 years ago. It suggests an inverse relationship between the numbers of psychiatric hospital beds and the sizes of prison population. This study aims to investigate the association between psychiatric hospital beds and prison populations in a large sample of 26 European countries between 1993 and 2011. Methods The association between prison population sizes and numbers of psychiatric hospital beds was assessed by means of Spearman correlations and modeled by a mixed random coefficient regression model. Socioeconomic variables were considered as covariates. Data were retrieved from Eurostat, the statistical office of the European Union. Outcomes Mean Spearman correlation coefficients between psychiatric beds and prison population showed a significant negative association (-0.35; p = <0.01). However, in the mixed regression model including socioeconomic covariates there were no significant fixed parameter estimates. Meanwhile, the covariance estimates for the random coefficients psychiatric beds (σ2 = 0.75, p = <0.01) and year (σ2 = 0.0007, p = 0.03) yielded significant results. Interpretation These findings do not support the general validity of the Penrose hypothesis. Notably, the results of the mixed-model show a significant variation in the magnitude and direction of the association of psychiatric hospital bed numbers and the prison population sizes between countries. In this sense, our results challenge the prevalent opinion that a reduction of psychiatric beds subsequently leads to increasing incarcerations. These findings also work against the potential stigmatization of individuals suffering from mental disorders as criminals, which could be an unintentional byproduct of the Penrose hypothesis. PMID:26529102

  19. A Geriatric Day Hospital: Who Improves the Most?

    ERIC Educational Resources Information Center

    Desrosiers, Johanne; Hebert, Rejean; Payette, Helene; Roy, Pierre-Michel; Tousignant, Michel; Cote, Sylvie; Trottier, Lise

    2004-01-01

    This study compared the changes in some bio-psychosocial variables (functional independence, nutritional risk, pain, balance and walking, grip strength, general well-being, psychiatric profile, perception of social support, leisure satisfaction, and caregivers' feeling of burden) in four categories of clients during their program at a geriatric…

  20. A 5-year retrospective study of demographic, anamnestic, and clinical factors related to psychiatric hospitalizations of adolescent patients

    PubMed Central

    Di Lorenzo, Rosaria; Cimino, Nina; Di Pietro, Elena; Pollutri, Gabriella; Neviani, Vittoria; Ferri, Paola

    2016-01-01

    Background Psychiatric emergencies of children and adolescents have greatly increased during the last years, but this phenomenon has not been studied in detail. The aim of this study was to analyze the correlation between acute psychiatric hospitalizations of adolescents and selected variables to highlight risk factors for psychiatric emergencies. Methods This retrospective research was conducted in the acute psychiatric public ward, Service of Psychiatric Diagnosis and Treatment (SPDT), and in the residential facility for adolescents, “The Medlar”, located in Modena. The sample was constituted by all adolescent patients (n=101, age range 14–18) who had acute hospitalizations (n=140) in SPDT and had been successively transferred to “The Medlar” (n=83), from February 2, 2010 to January 31, 2015. From clinical charts, we extracted demographic and anamnestic characteristics of patients and clinical variables related to hospitalizations. Data were statistically analyzed. Results Sixty-one percent of our patients lived with one divorced parent, with adoptive or immigrant family, or in institutions; 51% had experienced stressful events during childhood; 81% had a normal intellective level, but only 6% presented regular school performance. Parental psychiatric illness was negatively related, in a statistically significantly way, with onset age of adolescent mental disorders (coefficient −2.28, 95% confidence interval [CI]: −3.53 to 1.01, P<0.001, single linear regression; odds ratio: 4.39, 95% CI: 1.43–13.47, P<0.010, single logistic regression). The most frequent reasons for admission were aggressive behavior in males and suicide risk in females (P=0.002). The most frequent psychiatric diagnosis at SPDT discharge was “conduct disorder”, more frequent in males, followed by “adjustment disorder”, more frequent in females (P=0.001). In SPDT, the adolescent hospitalizations progressively increased fivefold at the end of the observation period

  1. Pharmacist-initiated prior authorization process to improve patient care in a psychiatric acute care hospital.

    PubMed

    Allen, Shari N; Ojong-Salako, Mebanga

    2015-02-01

    A prior authorization (PA) is a requirement implemented by managed care organizations to help provide medications to consumers in a cost-effective manner. The PA process may be seen as a barrier by prescribers, pharmacists, pharmaceutical companies, and consumers. The lack of a standardized PA process, implemented prior to a patient's discharge from a health care facility, may increase nonadherence to inpatient prescribed medications. Pharmacists and other health care professionals can implement a PA process specific to their institution. This article describes a pharmacist-initiated PA process implemented at an acute care psychiatric hospital. This process was initiated secondary to a need for a standardized process at the facility. To date, the process has been seen as a valuable aspect to patient care. Plans to expand this process include collecting data with regards to adherence and readmissions as well as applying for a grant to help develop a program to automate the PA program at this facility.

  2. Clinico-Epidemiological Profile of Psychiatric Disorders Among Children in a Tertiary Care Hospital of Southern India

    PubMed Central

    Subba, Sonu Hangma; Guha, Arunav

    2016-01-01

    Introduction According to the World Health Organization (WHO), mental health disorders are one of the leading causes of disability worldwide and it is as common in children. Anywhere between one to three children may be suffering from psychiatric disorders at any point in time. Aim This study intended to find the pattern of psychiatric disorders and associated sociodemographic factors among children attending the psychiatric department in a tertiary care hospital in Southern India. Materials and Methods An analysis was conducted of patients who attended the psychiatric clinic from April 2012 to March 2013. Disorders were classified according to International Classification of Diseases, 10th edition (ICD-10) criteria. Data obtained was analysed by SPSS 11.5 version. Chi-square test was used to see association and p<0.05 was taken as significant. Results The mean age of the children was 10.9 years (SD=4.3). Predominance of males was noticed. It was seen that the male children, mostly suffered from Pervasive and specific developmental disorders (n=105; 31.1%). While in the female children, a prominence of anxiety, dissociative, stress-related, somatoform and other non-psychotic mental disorders was seen (n=52; 27.1%). Co-morbidity of psychiatric disorders was seen with intellectual disability and a seasonal predominance of psychiatric disorders was seen during autumn. Conclusion Children presenting with psychiatric disorders in the hospital showed a wide age range and among them, males outnumbered females. Psychiatric disorders showed seasonal variation and the types of disorder varied significantly with age, gender and religion. PMID:27134978

  3. Brief Report: Understanding Crisis Behaviors in Hospitalized Psychiatric Patients with Autism Spectrum Disorder--Iceberg Assessment Interview

    ERIC Educational Resources Information Center

    Stark, Kate H.; Barnes, Julia C.; Young, Nicholas D.; Gabriels, Robin L.

    2015-01-01

    Children and adolescents with autism spectrum disorder (ASD) are at risk for emotional dysregulation and behavior problems that can escalate to levels requiring psychiatric hospitalization. Evaluating the etiology of such behaviors can be challenging for health care providers, as individuals with ASD can have difficulty self-reporting concerns.…

  4. The Contribution of Children's Temperamental Fear and Effortful Control to Restraint and Seclusion during Inpatient Treatment in a Psychiatric Hospital

    ERIC Educational Resources Information Center

    Bridgett, David J.; Valentino, Kristin; Hayden, Lisa C.

    2012-01-01

    The current study examined temperament characteristics as risk factors for restraint and seclusion (R/S) events in psychiatrically hospitalized youth, extending work that has sought to identify R/S risk factors and research examining temperament-behavior problem associations that has largely relied upon community samples. It was anticipated that…

  5. Screen Time on School Days and Risks for Psychiatric Symptoms and Self-Harm in Mainland Chinese Adolescents

    PubMed Central

    Liu, Mingli; Ming, Qingsen; Yi, Jinyao; Wang, Xiang; Yao, Shuqiao

    2016-01-01

    Objective: To investigate associations of television and of video game or non-educational computer use (VG/CU) exposure volumes in a typical school day with psychiatric symptoms and suicidal ideation/self-injurious behavior (self-harm), in mainland Chinese adolescents. Methods: Secondary school pupils (N = 13,659; mean age: 15.18 ± 1.89) from 10 urban areas sampled from different regions of mainland China were recruited. The subjects were divided into the following four screen exposure volume groups for television and VG/CU respectively based on a self-administered questionnaire: 0 h/day, >0 to ≤1 h/day, >1 to ≤2 h/day, and >2 h/day. Demographic and psychiatric symptoms were recorded for each respondent. Odds ratios (ORs) and 95% confidence intervals (CIs) for several types of psychological problems and self-harm were calculated. Results: More than 2 h per school day television watching was associated with higher risk of depression in both boys (OR = 1.33, 95%CI: 1.02–1.73) and girls (OR = 1.62, 95%CI: 1.19–2.21), of anxiety in boys (OR = 1.43, 95%CI: 1.05–1.95), of general emotional, behavioral, and social problems (GEBSPs; OR = 1.55, 95%CI: 1.01–2.39), and of oppositional defiant problems (OR = 1.65, 95% CI: 1.09–2.50) in girls, compared with no television exposure. Conversely, television exposure of no more than 1 h per school day was associated with lower self-harm risk in boys (OR = 0.81, 95%CI: 0.67–0.99) compared with no television exposure. High school day VG/CU time (>2 h) compared with no VG/CU were associated with higher risks of anxiety (OR = 1.40, 95%CI: 1.06–1.86) and of attention deficit/hyperactivity problems (ADHPs; OR = 1.56, 95%CI: 1.02–2.38) in boys. And any school day VG/CU exposure was associated with higher risks of self-harm and all other psychiatric problems in boys and all psychiatric problems (including anxiety and ADHPs) in girls (ORs, 1.44–3.69), compared to no VG/CU exposure. Conclusion: For secondary school

  6. 42 CFR 409.62 - Lifetime maximum on inpatient psychiatric care.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... benefits for 190 days of care in a psychiatric hospital, no further benefits of that type are available to... HUMAN SERVICES MEDICARE PROGRAM HOSPITAL INSURANCE BENEFITS Scope of Hospital Insurance Benefits § 409.62 Lifetime maximum on inpatient psychiatric care. There is a lifetime maximum of 190 days...

  7. 42 CFR 409.62 - Lifetime maximum on inpatient psychiatric care.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... benefits for 190 days of care in a psychiatric hospital, no further benefits of that type are available to... HUMAN SERVICES MEDICARE PROGRAM HOSPITAL INSURANCE BENEFITS Scope of Hospital Insurance Benefits § 409.62 Lifetime maximum on inpatient psychiatric care. There is a lifetime maximum of 190 days...

  8. Managing aggression in a psychiatric hospital using a behaviour plan: a case study.

    PubMed

    Bisconer, S W; Green, M; Mallon-Czajka, J; Johnson, J S

    2006-10-01

    This paper focuses on the critical role of nursing in implementing a behaviour plan in a psychiatric hospital. The plan was implemented with a 40-year-old man with a long history of aggression towards others and self. The study used a single-subject research design with baseline and intervention phases (AB Design). Data were collected on (1) frequency of incidents of aggression towards others and self; (2) use of restrictive interventions to manage aggression (i.e. restraints, pro re nata medication, 1:1 special observation); and (3) frequency of staff injury. The data show a decrease in frequency of aggression towards others and self, a concurrent reduction in the use of restrictive interventions to manage aggression, and a decrease in incidents of staff injury. The behaviour plan helped staff maintain a safe and therapeutic milieu. The behaviour plan has given the patient an opportunity to learn positive replacement behaviours and skills, and the opportunity eventually to leave the hospital to live in a less restrictive community home. PMID:16965469

  9. Patient outcomes following discharge from secure psychiatric hospitals: systematic review and meta-analysis

    PubMed Central

    Fazel, Seena; Fimińska, Zuzanna; Cocks, Christopher; Coid, Jeremy

    2016-01-01

    Background Secure hospitals are a high-cost, low-volume service consuming around a fifth of the overall mental health budget in England and Wales. Aims A systematic review and meta-analysis of adverse outcomes after discharge along with a comparison with rates in other clinical and forensic groups in order to inform public health and policy. Method We searched for primary studies that followed patients discharged from a secure hospital, and reported mortality, readmissions or reconvictions. We determined crude rates for all adverse outcomes. Results In total, 35 studies from 10 countries were included, involving 12 056 patients out of which 53% were violent offenders. The crude death rate for all-cause mortality was 1538 per 100 000 person-years (95% CI 1175–1901). For suicide, the crude death rate was 325 per 100 000 person-years (95% CI 235–415). The readmission rate was 7208 per 100 000 person-years (95% CI 5916–8500). Crude reoffending rates were 4484 per 100 000 person-years (95% CI 3679–5287), with lower rates in more recent studies. Conclusions There is some evidence that patients discharged from forensic psychiatric services have lower offending outcomes than many comparative groups. Services could consider improving interventions aimed at reducing premature mortality, particularly suicide, in discharged patients. PMID:26729842

  10. Trends, victims, and injuries in injurious patient assaults on adult, geriatric, and child/adolescent psychiatric units in US hospitals, 2007-2013.

    PubMed

    Staggs, Vincent S

    2015-04-01

    While rates of other nurse-sensitive adverse outcomes have declined in recent years, little is known about trends in rates of assault by psychiatric inpatients. The primary purpose of this study was to examine recent trends in injurious assault rates against patients and staff on adult, geriatric, and child/adolescent psychiatric units, using data from a nationwide sample of hospitals. A secondary aim was to assess the frequency with which patients and various types of hospital staff were reported as the most severely injured victim. National Database of Nursing Quality Indicators® data from 2007 to 2013 were extracted. The sample comprised 345 hospitals (324 general, 5 pediatric, 16 psychiatric), 438 adult, 75 geriatric, and 105 child/adolescent units, each with assault rate data from at least three of the seven study years. All but four states in the United States were represented. Spearman's rank coefficients were used to test for time trends. In 16.3 million patient days, nearly three-quarters of the 14,877 injurious assaults by patients involved injury only to hospital staff, whereas one-fifth resulted in injury only to patients. A registered nurse was named most frequently as the most severely injured victim (32.1% of assaults), and nursing staff of all types accounted for 64.9% of the most severely injured. Assault rates did not change significantly over time. Unlike several other nursing-sensitive adverse outcomes that have been the focus of policymakers, assault rates have not declined in recent years and remain a problem in need of more focused attention.

  11. A critical black feminist ethnography of treatment for women with co-occurring disorders in the psychiatric hospital.

    PubMed

    Creswell, Laryssa M

    2014-04-01

    The purpose of this study was to explore the perspectives of women diagnosed with co-occurring disorders on the treatments provided by a state psychiatric hospital so that appropriate recommendations for changes in treatment may be made. Critical ethnography was used and the data was viewed through the lens of intersectionality from the black feminist perspective. Seven women hospitalized in one psychiatric hospital in the Mid-Atlantic region participated in the study. Data was collected via semistructured interviews, Consumer Perceptions of Care survey, researcher's observations, and archival data. Three major findings emerged: (1) Dialectical Behavioral Therapy (DBT) was identified as a beneficial treatment, (2) a lack of trust in the system and people in the system, and (3) housing or homelessness was perceived as a barrier. Based on the results of this study, it is recommended clinicians, administrators, and policy makers listen closely to individuals receiving treatment to make decisions regarding treatment accordingly.

  12. Intervention to reduce inpatient psychiatric admission in a metropolitan city.

    PubMed

    Amirsadri, Alireza; Mischel, Edward; Haddad, Luay; Tancer, Manuel; Arfken, Cynthia L

    2015-02-01

    When psychiatric hospitalization is over-used, it represents a financial drain and failure of care. We evaluated implementation and cessation of transporting people medically certified for psychiatric hospitalization to a central psychiatric emergency service for management and re-evaluation of hospitalization need. After implementation, the hospitalization rate declined 89% for 346 transported patients; only four of the nonhospitalized patients presented in crisis again in the next 30 days. Following cessation, the hospitalization rate jumped 59% compared to the preceding year. Costs declined 78.7% per diverted patient. The findings indicate that it is possible to reduce hospitalization and costs, and maintain quality care.

  13. Thyroid dysfunction in major psychiatric disorders in a hospital based sample

    PubMed Central

    Radhakrishnan, Rajiv; Calvin, Sam; Singh, Jyotin Kshitiz; Thomas, Binston; Srinivasan, Krishnamachari

    2013-01-01

    Background & objectives: Abnormalities in thyroid hormonal status is common in major psychiatric disorders. Although the relevance of thyroid dysfunction to bipolar disorder is well-recognized, yet the association between thyroid dysfunction and schizophrenia-spectrum disorders is under-emphasized. The aim of this study was to examine and compare the rates of abnormal thyroid hormonal status in patients with schizophrenia-spectrum disorders and mood disorders in an inpatient tertiary care general hospital psychiatry unit. Methods: This was a retrospective hospital-based study on 468 inpatient samples. Data on serum thyroid stimulating hormone (TSH), T3 (triiodothyroxine), T4 (L-thyroxine), free unbound fractions of T3 and T4 (FT3 and FT4) were obtained from records of 343 patients, 18 patients were anti-TPO (anti thyroid peroxidase antibody) positive. The rates of abnormal thyroid hormonal status were compared using the chi square test. Results: Abnormal thyroid hormonal status in general, and presence of hypothyroidism and hyperthyroidism, in particular were seen in 29.3, 25.17 and 4.08 per cent patients with schizophrenia spectrum disorders, respectively. These were comparable to the rates in patients with mood disorders (23.24, 21.62 and 1.62%, respectively). Eleven of the 18 patients with antiTPO positivity had a schizophrenia-spectrum disorder. There were no gender differences. Interpretation & conclusions: Thyroid dysfunction was present in patients with schizophrenia-spectrum disorder as well as mood disorders. Autoimmune thyroid disease was more commonly seen in patients with schizophrenia-spectrum disorders compared to mood disorders. The findings reiterate the relevance of screening patients with schizophrenia-spectrum disorders for abnormal thyroid hormonal status. PMID:24521631

  14. [Religion and psychiatric disorders in patients admitted to a university general hospital].

    PubMed

    Soeiro, Rachel Esteves; Colombo, Elisabetta S; Ferreira, Marianne H F; Guimarães, Paula S A; Botega, Neury J; Dalgalarrondo, Paulo

    2008-04-01

    In order to evaluate the prevalence of psychiatric disorders in a Brazilian general hospital and their association with religious denomination and religiosity, 253 inpatients were interviewed. A socio-demographic questionnaire and an instrument for diagnosis of mental disorders (MINI-Plus) were applied. Distribution of religious denominations was: Catholic 63.2% (n=177), Evangelical Protestant 20.4% (n=57), Spiritist 4.3% (n=12), traditional Protestant 2.3% (n=8), and "no religion" 7.5% (n=21). Degree of religiosity was: very religious 43.2% (n=116), religious 46.9% (n=129), hardly religious 9.8% (n=27), and not at all religious 1.1% (n=3). Evangelical (Pentecostal) religious affiliation and frequent attendance at worship services were associated with fewer alcohol problems. Membership in an Evangelical (Pentecostal) church may thus have an inhibitory effect on alcohol dependence or abuse. Intensity of religiosity was moderately associated with overall prevalence of disorders, especially bipolar disorder. It is reasonable to conclude that extreme situations (very intense versus very limited religious participation) are related to this finding, associating both an exacerbated pursuit of religion and alienation from it with altered mental states.

  15. Self-evaluation by adolescents in a psychiatric hospital school token program.

    PubMed

    Santogrossi, D A; O'leary, K D; Romanczyk, R G; Kaufman, K F

    1973-01-01

    Nine adolescent boys with a history of high rates of disruptive classroom behavior were selected from a psychiatric hospital school and placed in a remedial reading class after school in which various factors in a token reinforcement program involving self-evaluation were investigated. The effects of self-evaluation, in the form of a rating the students gave themselves about the appropriateness of their classroom behavior, were first assessed. While the students' ratings of their own behavior correlated highly with the teacher's ratings and evaluations made by independent observers, the self-evaluations did not lead to a reduction in disruptive behavior. A token reinforcement program, in which the teacher rated the students' level of appropriate behavior and in which the students traded earned rating points for prizes, clearly led to a reduction of disruptive behavior. When the students were given the opportunity to evaluate their own behavior and to receive rewards in exchange for the evaluation, they returned to their former rates of disruptive behavior. PMID:16795409

  16. Excess non-psychiatric hospitalizations among employees with mental disorders: a 10-year prospective study of the GAZEL cohort

    PubMed Central

    Azevedo Da Silva, M; Lemogne, C; Melchior, M; Zins, M; Van Der Waerden, J; Consoli, S M; Goldberg, M; Elbaz, A; Singh-Manoux, A; Nabi, H

    2015-01-01

    Objective To examine whether non-psychiatric hospitalizations rates were higher in those with mental disorders. Method In a cohort of 15 811 employees, aged 35–50 years in 1989, mental disorder status was defined from 1989 to 2000. Hospitalizations for all-causes, myocardial infarction (MI), stroke, and cancer, were recorded yearly from 2001 to 2011. Negative binomial regression models were used to estimate hospitalization rates over the follow-up. Results After controlling for baseline sociodemographic factors, health-related behaviors, self-rated health, and self-reported medical conditions, participants with a mental disorder had significantly higher rates of all-cause hospitalization [incidence rate ratio, IRR = 1.20 (95%, 1.14–1.26)], as well as hospitalization due to MI [IRR = 1.44 (95%, 1.12–1.85)]. For stroke, the IRR did not reach statistical significance [IRR = 1.37 (95%, 0.95–1.99)] and there was no association with cancer [IRR = 1.01 (95%, 0.86–1.19)]. A similar trend was observed when mental disorders groups were considered (no mental disorder, depressive disorder, mental disorders due to psychoactive substance use, other mental disorders, mixed mental disorders, and severe mental disorder). Conclusion In this prospective cohort of employees with stable employment as well as universal access to healthcare, we found participants with mental disorders to have higher rates of non-psychiatric hospitalizations. PMID:25289581

  17. Spaces for smoking in a psychiatric hospital: social capital, resistance to control, and significance for 'therapeutic landscapes'.

    PubMed

    Wood, Victoria J; Curtis, Sarah E; Gesler, Wil; Spencer, Ian H; Close, Helen J; Mason, James M; Reilly, Joe G

    2013-11-01

    This paper reports on research framed by theories of therapeutic landscapes and the ways that the social, physical and symbolic dimensions of landscapes relate to wellbeing and healing. We focus especially on the question of how attributes of therapeutic landscapes are constructed in different ways according to the variable perspectives of individuals and groups. Through an ethnographic case study in a psychiatric hospital in the North of England we explore the perceived significance for wellbeing of 'smoking spaces' (where tobacco smoking is practiced in ways that may, or may not be officially sanctioned). We interpret our findings in light of literature on how smoking spaces are linked to the socio-geographical power relations that determine how smoking is organised within the hospital and how this is understood by different groups using the hospital building. We draw on qualitative research findings from discussion groups, observations, and interviews with patients, carers and staff. These focused on their views about the building design and setting of the new psychiatric hospital in relation to their wellbeing, and issues relating to smoking spaces emerged as important for many participants. Creating and managing smoking spaces as a public health measure in psychiatric hospitals is shown to be a controversial issue involving conflicting aims for health and wellbeing of patients and staff. Our findings indicate that although from a physical health perspective, smoking is detrimental, the spaces in which patients and staff smoke have social and psychological significance, providing a forum for the creation of social capital and resistance to institutional control. While the findings relate to one case study setting, the paper illustrates issues of wider relevance and contributes to an international literature concerning the tensions between perceived psychological and psychosocial benefits of smoking vs. physical harm that smoking is likely to cause. We consider

  18. Spaces for smoking in a psychiatric hospital: social capital, resistance to control, and significance for 'therapeutic landscapes'.

    PubMed

    Wood, Victoria J; Curtis, Sarah E; Gesler, Wil; Spencer, Ian H; Close, Helen J; Mason, James M; Reilly, Joe G

    2013-11-01

    This paper reports on research framed by theories of therapeutic landscapes and the ways that the social, physical and symbolic dimensions of landscapes relate to wellbeing and healing. We focus especially on the question of how attributes of therapeutic landscapes are constructed in different ways according to the variable perspectives of individuals and groups. Through an ethnographic case study in a psychiatric hospital in the North of England we explore the perceived significance for wellbeing of 'smoking spaces' (where tobacco smoking is practiced in ways that may, or may not be officially sanctioned). We interpret our findings in light of literature on how smoking spaces are linked to the socio-geographical power relations that determine how smoking is organised within the hospital and how this is understood by different groups using the hospital building. We draw on qualitative research findings from discussion groups, observations, and interviews with patients, carers and staff. These focused on their views about the building design and setting of the new psychiatric hospital in relation to their wellbeing, and issues relating to smoking spaces emerged as important for many participants. Creating and managing smoking spaces as a public health measure in psychiatric hospitals is shown to be a controversial issue involving conflicting aims for health and wellbeing of patients and staff. Our findings indicate that although from a physical health perspective, smoking is detrimental, the spaces in which patients and staff smoke have social and psychological significance, providing a forum for the creation of social capital and resistance to institutional control. While the findings relate to one case study setting, the paper illustrates issues of wider relevance and contributes to an international literature concerning the tensions between perceived psychological and psychosocial benefits of smoking vs. physical harm that smoking is likely to cause. We consider

  19. The HOSPITAL score as a predictor of 30 day readmission in a retrospective study at a university affiliated community hospital

    PubMed Central

    2016-01-01

    Introduction Hospital readmissions are common, expensive, and a key target of the Medicare Value Based Purchasing (VBP) program. Risk assessment tools have been developed to identify patients at high risk of hospital readmission so they can be targeted for interventions aimed at reducing the rate of readmission. One such tool is the HOSPITAL score that uses seven readily available clinical variables to predict the risk of readmission within 30 days of discharge. The HOSPITAL score has been internationally validated in large academic medical centers. This study aims to determine if the HOSPITAL score is similarly useful in a moderate sized university affiliated hospital in the midwestern United States. Materials and Methods All adult medical patients discharged from the SIU-SOM Hospitalist service from Memorial Medical Center (MMC) from October 15, 2015 to March 16, 2016, were studied retrospectively to determine if the HOSPITAL score was a significant predictor of hospital readmission within 30 days. Results During the study period, 998 discharges were recorded for the hospitalist service. The analysis includes data for the 931 discharges. Patients who died during the hospital stay, were transferred to another hospital, or left against medical advice were excluded. Of these patients, 109 (12%) were readmitted to the same hospital within 30 days. The patients who were readmitted were more likely to have a length of stay greater than or equal to 5 days (55% vs. 41%, p = 0.005) and were more likely to have been admitted more than once to the hospital within the last year (100% vs. 49%, p < 0.001). A receiver operating characteristic evaluation of the HOSPITAL score for this patient population shows a C statistic of 0.77 (95% CI [0.73–0.81]), indicating good discrimination for hospital readmission. The Brier score for the HOSPITAL score in this setting was 0.10, indicating good overall performance. The Hosmer–Lemeshow goodness of fit test shows a χ2 value of 1

  20. The HOSPITAL score as a predictor of 30 day readmission in a retrospective study at a university affiliated community hospital

    PubMed Central

    2016-01-01

    Introduction Hospital readmissions are common, expensive, and a key target of the Medicare Value Based Purchasing (VBP) program. Risk assessment tools have been developed to identify patients at high risk of hospital readmission so they can be targeted for interventions aimed at reducing the rate of readmission. One such tool is the HOSPITAL score that uses seven readily available clinical variables to predict the risk of readmission within 30 days of discharge. The HOSPITAL score has been internationally validated in large academic medical centers. This study aims to determine if the HOSPITAL score is similarly useful in a moderate sized university affiliated hospital in the midwestern United States. Materials and Methods All adult medical patients discharged from the SIU-SOM Hospitalist service from Memorial Medical Center (MMC) from October 15, 2015 to March 16, 2016, were studied retrospectively to determine if the HOSPITAL score was a significant predictor of hospital readmission within 30 days. Results During the study period, 998 discharges were recorded for the hospitalist service. The analysis includes data for the 931 discharges. Patients who died during the hospital stay, were transferred to another hospital, or left against medical advice were excluded. Of these patients, 109 (12%) were readmitted to the same hospital within 30 days. The patients who were readmitted were more likely to have a length of stay greater than or equal to 5 days (55% vs. 41%, p = 0.005) and were more likely to have been admitted more than once to the hospital within the last year (100% vs. 49%, p < 0.001). A receiver operating characteristic evaluation of the HOSPITAL score for this patient population shows a C statistic of 0.77 (95% CI [0.73–0.81]), indicating good discrimination for hospital readmission. The Brier score for the HOSPITAL score in this setting was 0.10, indicating good overall performance. The Hosmer–Lemeshow goodness of fit test shows a χ2 value of 1

  1. Day Hospital and Residential Addiction Treatment: Randomized and Nonrandomized Managed Care Clients

    ERIC Educational Resources Information Center

    Witbrodt, Jane; Bond, Jason; Kaskutas, Lee Ann; Weisner, Constance; Jaeger, Gary; Pating, David; Moore, Charles

    2007-01-01

    Male and female managed care clients randomized to day hospital (n=154) or community residential treatment (n=139) were compared on substance use outcomes at 6 and 12 months. To address possible bias in naturalistic studies, outcomes were also examined for clients who self-selected day hospital (n=321) and for clients excluded from randomization…

  2. Determinants of mental illness stigma for adolescents discharged from psychiatric hospitalization.

    PubMed

    Moses, Tally

    2014-05-01

    Little is known about the factors that increase the risk for enacted mental illness stigma (i.e. rejection, devaluation and exclusion) as perceived by the stigmatized person. This is particularly true for the population of adolescents diagnosed with a mental illness. The aim of this study was to address this question and examine select social and clinical factors that predict enacted stigma (self-reported) with research that follows eighty American adolescents for 6 months following a first psychiatric hospitalization. Drawing on social identity theory, and research on stigma-threatening environments, social group identification and social support, this study tested four hypotheses: affiliation or identification with higher status and lower status peers predicts more and less stigma respectively (H1); a greater and more supportive social network, and more perceived family support predict less stigma (H2); greater severity of internalizing and externalizing symptoms predicts more stigma (H3); and poorer school functioning predicts more stigma (H4). Results indicated that about 70% of adolescents reported experiencing enacted stigma (at 6 months); disrespect or devaluation was more common than outright social rejection. Using OLS regression analyses, the results provided partial support for H1, H3 and H4, while H2 was not supported. The baseline factors found to be most predictive of enacted stigma ratings at 6-months were: affiliating with more friends with mental health problems, identifying with the 'populars' peer group, higher internalizing symptom ratings, and self-reported disciplinary problems at school. These four factors remained significant when controlling for initial enacted stigma ratings, pointing to their importance in determining changes in social stigma experiences in the follow-up period. They also remained significant when controlling for perceived public stigma ratings at follow-up, indicating that the findings were not due to generalized

  3. A worldwide assessment of the frequency of suicide, suicide attempts, or psychiatric hospitalization after predictive testing for Huntington disease.

    PubMed Central

    Almqvist, E W; Bloch, M; Brinkman, R; Craufurd, D; Hayden, M R

    1999-01-01

    Prior to the implementation of predictive-testing programs for Huntington disease (HD), significant concern was raised concerning the likelihood of catastrophic events (CEs), particularly in those persons receiving an increased-risk result. We have investigated the frequency of CEs-that is, suicide, suicide attempt, and psychiatric hospitalization-after an HD predictive-testing result, through questionnaires sent to predictive-testing centers worldwide. A total of 44 persons (0.97%) in a cohort of 4,527 test participants had a CE: 5 successful suicides, 21 suicide attempts, and 18 hospitalizations for psychiatric reasons. All persons committing suicide had signs of HD, whereas 11 (52.4%) of 21 persons attempting suicide and 8 (44.4%) of 18 who had a psychiatric hospitalization were symptomatic. A total of 11 (84.6%) of 13 asymptomatic persons who experienced a CE during the first year after HD predictive testing received an increased-risk result. Factors associated with an increased risk of a CE included (a) a psychiatric history

  4. Hospital Value-Based Purchasing And 30-Day Readmissions: Are Hospitals Ready?

    PubMed

    Haley, D Rob; Zhao, Mei; Spaulding, Aaron

    2016-01-01

    To better understand the relationship between a hospital's Total Performance Score (TPS) and unplanned readmissions, a multivariate linear regression analysis was used to examine the relationship between hospital TPS and readmission rates for acute myocardial infarction (AMI), heart failure (HF), and pneumonia (PN). Hospital TPS was significantly and inversely related to AMI, HF, and PN readmission rates. The higher the hospital TPS, the lower the readmission rates for patients with AMI, HF, and PN. Hospitals with higher Medicare and Medicaid patients had higher readmission rates for all three conditions. The TPS methodology will likely evolve to include additional measures or dimensions to assess hospital quality and payment. Policymakers and hospital administrators should consider other structure elements and process measures to assess and improve patient safety and quality.

  5. Hospital Value-Based Purchasing And 30-Day Readmissions: Are Hospitals Ready?

    PubMed

    Haley, D Rob; Zhao, Mei; Spaulding, Aaron

    2016-01-01

    To better understand the relationship between a hospital's Total Performance Score (TPS) and unplanned readmissions, a multivariate linear regression analysis was used to examine the relationship between hospital TPS and readmission rates for acute myocardial infarction (AMI), heart failure (HF), and pneumonia (PN). Hospital TPS was significantly and inversely related to AMI, HF, and PN readmission rates. The higher the hospital TPS, the lower the readmission rates for patients with AMI, HF, and PN. Hospitals with higher Medicare and Medicaid patients had higher readmission rates for all three conditions. The TPS methodology will likely evolve to include additional measures or dimensions to assess hospital quality and payment. Policymakers and hospital administrators should consider other structure elements and process measures to assess and improve patient safety and quality. PMID:27439247

  6. The implementation and the cultural adjustment of functional family therapy in a Dutch psychiatric day-treatment center.

    PubMed

    Breuk, Rene E; Sexton, Thomas L; van Dam, Astrid; Disse, Claudia; Doreleijers, Theo A H; Slot, Wim N; Rowland, Marcy K

    2006-10-01

    Because of the increasing severity of adolescent problem behavior, evidence-based practices are becoming of interest as an alternative to traditional treatment with the behavior problems of adolescents in juvenile justice settings. Despite interest in evidence-based practices, questions exist regarding whether or not evidence-based intervention models can be successfully transported to cultures other than those in which they were developed. This article describes the transportation process of an American evidence-based family therapy (Functional Family Therapy [FFT]) into the service delivery system of a psychiatric day treatment center for juvenile delinquents in Amsterdam. The characteristics of FFT that make it cross-culturally sensitive are discussed. Results from the changes in service delivery suggest FFT can be successfully implemented in international settings with adjustments to make the model fit the culture(s) of The Netherlands without changing the model of FFT itself. PMID:17120523

  7. Identity formation in adolescence: case study of gender identity disorder and treatment through an intermediate-care day hospital.

    PubMed

    Babinski, S; Reyes, A

    1994-01-01

    A review of the literature on gender identity disorders is integrated with a case study presentation of a psychiatrically disturbed nineteen-year-old transvestite youth. Accommodations and interventions made both with this patient and in the day care program for psychiatrically disturbed youths that allowed him to live at home and be maintained despite severe pathology are discussed.

  8. Effectiveness of Day Hospital Mentalization-Based Treatment for Patients with Severe Borderline Personality Disorder: A Matched Control Study.

    PubMed

    Bales, Dawn L; Timman, Reinier; Andrea, Helene; Busschbach, Jan J V; Verheul, Roel; Kamphuis, Jan H

    2015-01-01

    The present study extends the body of evidence regarding the effectiveness of day hospital Mentalization-Based Treatment (MBT) by documenting the treatment outcome of a highly inclusive group of severe borderline personality disorder (BPD) patients, benchmarked by a carefully matched group who received other specialized psychotherapeutic treatments (OPT). Structured diagnostic interviews were conducted to assess diagnostic status at baseline. Baseline, 18-month treatment outcome and 36-month treatment outcome (after the maintenance phase) on psychiatric symptoms (Brief Symptom Inventory) and personality functioning (118-item Severity Indices of Personality Problems) were available for 29 BPD patients assigned to MBT, and an initial set of 175 BPD patients assigned to OPT. Propensity scores were used to determine the best matches for the MBT patients within the larger OPT group, yielding 29 MBT and 29 OPT patients for direct comparison. Treatment outcome was analysed using multilevel modelling. Pre to post effect sizes were consistently (very) large for MBT, with a Cohen's d of -1.06 and -1.42 for 18 and 36 months, respectively, for the reduction in psychiatric symptoms, and ds ranging from 0.81 to 2.08 for improvement in domains of personality functioning. OPT also yielded improvement across domains but generally of moderate magnitude. In conclusion, the present matched control study, executed by an independent research institute outside the UK, demonstrated the effectiveness of day hospital MBT in a highly inclusive and severe group of BPD patients, beyond the benchmark provided by a mix of specialized psychotherapy programmes. Interpretation of the (large) between condition effects warrants cautionary caveats given the non-randomized design, as well as variation in treatment dosages.

  9. Prevalence and Predictors of Domestic-Violence towards Wives by their Psychiatric Hospitalized Husbands

    PubMed Central

    Sahraian, Ali; Ghanizadeh, Ahmad; Hashemi, Seyed Hamzeh; Mohammadi, Mohammad Reza; Ahmadzadeh, Laaya

    2015-01-01

    Objective: Violence imposed on wives by their inpatient psychiatric husbands has not been studied yet. The current study surveyed the rates and predictors of violence committed by inpatient psychiatric husbands towards their wives. Methods: A convenient sample of wives of 209 married male psychiatric inpatients completed a self-reported questionnaire. They were asked about physical, emotional, social and economic abuse. Results: More than 80% of the husbands socially abused their wives; 73.0% of the wives had been regularly beaten by their husbands; the rate for humiliation was 77.2%; and only 14.1% of the wives reported that their sexual relationship with their husbands is with desire. Conclusion There is a dramatic high rate of different types of abuse toward wives by their inpatient psychiatric husbands. They are commonly victimized by their husbands. Moreover, different types of violence always co-occur. Future studies should consider this important issue which is unfortunately an ignored research area. PMID:27006668

  10. 42 CFR 482.61 - Condition of participation: Special medical record requirements for psychiatric hospitals.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    .... Medical records must stress the psychiatric components of the record, including history of findings and... record of mental status; (4) Note the onset of illness and the circumstances leading to admission;...

  11. 42 CFR 482.61 - Condition of participation: Special medical record requirements for psychiatric hospitals.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    .... Medical records must stress the psychiatric components of the record, including history of findings and... record of mental status; (4) Note the onset of illness and the circumstances leading to admission;...

  12. 42 CFR 482.61 - Condition of participation: Special medical record requirements for psychiatric hospitals.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    .... Medical records must stress the psychiatric components of the record, including history of findings and... record of mental status; (4) Note the onset of illness and the circumstances leading to admission;...

  13. 42 CFR 482.61 - Condition of participation: Special medical record requirements for psychiatric hospitals.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    .... Medical records must stress the psychiatric components of the record, including history of findings and... record of mental status; (4) Note the onset of illness and the circumstances leading to admission;...

  14. Person-environment interaction in a new secure forensic state psychiatric hospital.

    PubMed

    Eggert, Jon E; Kelly, Sean P; Margiotta, David T; Hegvik, Donna K; Vaher, Kairi A; Kaya, Rachel Tamiko

    2014-01-01

    This study examined the person-environment interaction effects of environmental design on ward climate, safety, job satisfaction, and treatment outcomes within a new high security forensic psychiatric facility. Participants included male and female adult psychiatric inpatients and staff members at different security stages. Data were collected once before and twice after the experimental group moved into the new building. The control group remained in the same facilities. Contrary to expectations, the new building had limited effects on the measured variables.

  15. The views of psychiatric patients and their treating physicians of court-ordered compulsory hospitalization for criminal acts.

    PubMed

    Melamed, Y; Kimhi, R; Stawski, M; Elizur, A

    1997-01-01

    The legal responsibility for the mentally ill has long been a dilemma. Public opinion regarding the law which states that the mentally ill, in a psychotic state, are not responsible for their actions, is divided. The study assessed 30 psychiatric patients, committed by court order, following a criminal act on their part. No relationship was found between the nature of their offense and a psychiatric disorder. Patients who committed more serious crimes, such as murder, tended to have committed fewer criminal acts in the past. Sixty-nine percent of the patients think that the mentally ill are not responsible for their actions and 59% agreed with the judge's decision to hospitalize them. On a concrete level, over two-thirds of the patients were able to distinguish right from wrong. The treating physicians related mainly to the patients' illnesses rather than to the crimes for which they were committed.

  16. [Patients with schizophrenia in forensic-psychiatric hospitals (section 63 German Penal Code) in North Rhine-Westphalia].

    PubMed

    Kutscher, S; Schiffer, B; Seifert, D

    2009-02-01

    The aim of our study was to determine the development of the number of patients with schizophrenia in detention (section 63 German Penal Code) in North Rhine-Westphalia and the characterization of these patients. Patients with schizophrenia are examined, by using a standardized questionnaire answered by the attending psychiatrist or psychologist (n = 531). During the last 12 years the number of patients with schizophrenia in forensic-psychiatric hospitals has increased three times, whereas the number of patients with other diagnoses heightened only twofold. The patients with schizophrenia showed high rates of psychiatric comorbidities (substance disorders 73.9 %, personality disorders 17.2 %), previous inpatient treatments (78.3 % with a mean of 7.5 stays) and previous convictions (63.4 %). Almost half of these convictions (46.6 %) were violent offences (e. g. assault, homicide). Possible explanations for this development are discussed.

  17. Prevalence of Psychiatric Morbidity in Females amongst Infertile Couples- A Hospital Based Report

    PubMed Central

    Sethi, Pragati; Goyal, Lajya Devi; Kaur, Gurmeet

    2016-01-01

    Introduction Infertility leads to significant stress among couple and the reaction to infertility differs among males and females. Aim To know the prevalence of psychiatric morbidity in infertile couples and compare the prevalence of various psychiatric disorders among husband and wife. Materials and Methods A cross-sectional study was conducted on 50 couples diagnosed with infertility from outdoor clinics. Both male and female partner of couple were interviewed for detailed history and clinical examination was done. General Health Questionnaire (GHQ-12) was applied to detect any psychological strain in couples and in those with illness, final diagnosis were made on the basis of DSM -IV (TR). The data thus generated was subjected to appropriate Statistical Analysis. Results Out of the 50 couples, 54% of females had psychiatric morbidity. The most common diagnosis amongst the female participants was MDD (Major Depressive Disorder) (18%), whereas the second most common diagnosis was GAD (Generalized Anxiety Disorder) (16%). Psychiatric morbidity was found in only 26% of males suffering with Adjustment Disorder being most common diagnosis (8%) and Dysthymia and MDD as the second most common diagnosis (6% each). Majority of patients having psychiatric morbidity were from age group 20-29 years. The difference between females and male counterparts was statistically significant. Conclusion Psychiatric morbidity was higher among female partners than male partners. The difference was statistically significant and the situation needs further workup. PMID:27630933

  18. Prevalence of Psychiatric Morbidity in Females amongst Infertile Couples- A Hospital Based Report

    PubMed Central

    Sethi, Pragati; Goyal, Lajya Devi; Kaur, Gurmeet

    2016-01-01

    Introduction Infertility leads to significant stress among couple and the reaction to infertility differs among males and females. Aim To know the prevalence of psychiatric morbidity in infertile couples and compare the prevalence of various psychiatric disorders among husband and wife. Materials and Methods A cross-sectional study was conducted on 50 couples diagnosed with infertility from outdoor clinics. Both male and female partner of couple were interviewed for detailed history and clinical examination was done. General Health Questionnaire (GHQ-12) was applied to detect any psychological strain in couples and in those with illness, final diagnosis were made on the basis of DSM -IV (TR). The data thus generated was subjected to appropriate Statistical Analysis. Results Out of the 50 couples, 54% of females had psychiatric morbidity. The most common diagnosis amongst the female participants was MDD (Major Depressive Disorder) (18%), whereas the second most common diagnosis was GAD (Generalized Anxiety Disorder) (16%). Psychiatric morbidity was found in only 26% of males suffering with Adjustment Disorder being most common diagnosis (8%) and Dysthymia and MDD as the second most common diagnosis (6% each). Majority of patients having psychiatric morbidity were from age group 20-29 years. The difference between females and male counterparts was statistically significant. Conclusion Psychiatric morbidity was higher among female partners than male partners. The difference was statistically significant and the situation needs further workup.

  19. The potential consequences of informal interpreting practices for assessment of patients in a South African psychiatric hospital.

    PubMed

    Kilian, Sanja; Swartz, Leslie; Dowling, Tessa; Dlali, Mawande; Chiliza, Bonginkosi

    2014-04-01

    In South Africa health care practitioners are commonly professionals who speak only one, or at most two, of the languages spoken by their patients. This provides for language provision challenges, since many patients are not proficient in English or Afrikaans and ad hoc and haphazard arrangements are made for interpreting by untrained personnel. As part of a larger study (conducted in 2010) in a public psychiatric hospital, we report here on the potential consequences for diagnostic assessments of 13 psychiatric evaluations mediated by ad hoc interpreters who were employed as health care workers and household aides. The psychiatric evaluations were recorded and transcribed verbatim. The first author checked for accuracy of transcription and translations, and the two members of the author team who are both senior African language academics rechecked transcription and translation. We used the typology developed by Vasquez and Javier (1991) to study interpreter errors (i.e. omissions, additions and substitutions). All errors were independently rated by a senior psychiatrist and a senior clinical psychologist to determine whether the errors were likely to have a bearing on clinical decisions concerning the patient and to rate whether errors deemed clinically significant contributed to making the patient appear more ill psychiatrically, or less ill. Of the 57 errors recorded, 46% were rated as likely to have an impact on the goal of the clinical session. Raters concurred that the clinically significant errors contributed towards potentially making the patient look more psychiatrically ill. Detailed analyses of evaluations demonstrate the complexity of informal interpreter positioning regarding issues of diagnosis and cultural factors in illness. Evaluations conducted where clinicians and interpreters are not trained in language and interpreting issues may create a distorted picture of the patients' mental health conditions.

  20. Associations between Depressive Symptoms and 30-day Hospital Readmission among Older Adults

    PubMed Central

    Berges, Ivonne M.; Amr, Sania; Abraham, Danielle S.; Cannon, Dawn L.; Ostir, Glenn V.

    2015-01-01

    Background Hospital readmissions are common and costly. Our goal was to determine the association between depressive symptoms and readmission within 30 days following hospital discharge in older adults. Methods We analyzed data from a study of 789 persons aged 65 years or older admitted to a 20-bed acute care for elders (ACE) hospital unit from May 2009 to July 2011. Depressive symptoms were recorded within 24-hours of admission to the hospital unit, using the Center for Epidemiologic Studies -Depression (CES-D) Scale. The primary outcome was readmission to hospital within 30 days of discharge. Results The mean age was 77 years; 66% were female, 72% were White, and 59% were unmarried. On average, older patients reported 2.6 comorbid conditions. Sixteen percent were classified with high depressive symptoms (CES-D ≥ 16). The readmission rate within 30 days was 15%. Older patients with high depressive symptoms had more than 1.6 times the odds (OR 1.66; 95% CI: 1.01-2.74) of being readmitted within 30-days, as compared to those with low depressive symptoms (CES-D < 16), after adjustment for age, race/ethnicity, sex, marital status and comorbid conditions. Conclusion High depressive symptoms increased the risk of hospital readmission within 30 days of discharge after adjusting for relevant covariates. In-hospital screening for depressive symptoms may identify older persons at risk for recurrent hospital admissions. PMID:27134802

  1. Inpatient Readmissions and Emergency Department Visits within 30 Days of a Hospital Admission

    PubMed Central

    Brennan, Jesse J.; Chan, Theodore C.; Killeen, James P.; Castillo, Edward M.

    2015-01-01

    Introduction Inpatient hospital readmissions have become a focus for healthcare reform and cost-containment efforts. Initiatives targeting unanticipated readmissions have included care coordination for specific high readmission diseases and patients and health coaching during the post-discharge transition period. However, little research has focused on emergency department (ED) visits following an inpatient admission. The objective of this study was to assess 30-day ED utilization and all-cause readmissions following a hospital admission. Methods This was a retrospective study using inpatient and ED utilization data from two hospitals with a shared patient population in 2011. We assessed the 30-day ED visit rate and 30-day readmission rate and compared patient characteristics among individuals with 30-day inpatient readmissions, 30-day ED discharges, and no 30-day visits. Results There were 13,449 patients who met the criteria of an index visit. Overall, 2,453 (18.2%) patients had an ED visit within 30 days of an inpatient stay. However, only 55.6% (n=1,363) of these patients were admitted at one of these 30-day visits, resulting in a 30-day all-cause readmission rate of 10.1%. Conclusion Approximately one in five patients presented to the ED within 30 days of an inpatient hospitalization and over half of these patients were readmitted. Readmission measures that incorporate ED visits following an inpatient stay might better inform interventions to reduce avoidable readmissions. PMID:26759647

  2. 'Therapeutic landscapes' and the importance of nostalgia, solastalgia, salvage and abandonment for psychiatric hospital design.

    PubMed

    Wood, Victoria J; Gesler, Wil; Curtis, Sarah E; Spencer, Ian H; Close, Helen J; Mason, James; Reilly, Joe G

    2015-05-01

    We examine emotional reactions to changes to medical spaces of care, linked with past experiences. In this paper we draw on findings from a qualitative study of the transfer of psychiatric inpatient care from an old to a newly built facility. We show how the meanings attributed to 'therapeutic landscapes' from one׳s past can evoke emotions and memories, manifesting in ideas about nostalgia, solastalgia, salvage and abandonment, which can impinge on one׳s present therapeutic experience. We reflect on how consideration of these ideas might contribute to better future design of psychiatric inpatient facilities and the wellbeing of those using them.

  3. The current state of physical activity and exercise programs in German-speaking, Swiss psychiatric hospitals: results from a brief online survey

    PubMed Central

    Brand, Serge; Colledge, Flora; Beeler, Nadja; Pühse, Uwe; Kalak, Nadeem; Sadeghi Bahmani, Dena; Mikoteit, Thorsten; Holsboer-Trachsler, Edith; Gerber, Markus

    2016-01-01

    Background Physical activity and exercise programs (PAEPs) are an important factor in increasing and maintaining physical and mental health. This holds particularly true for patients with psychiatric disorders undergoing treatment in a psychiatric hospital. To understand whether the benefits reported in the literature are mirrored in current treatment modalities, the aim of the present study was to assess the current state of PAEPs in psychiatric hospitals in the German-speaking part of Switzerland. Methods All psychiatric hospitals (N=55) in the German-speaking part of Switzerland were contacted in spring 2014. Staff responsible for PAEPs were asked to complete an online questionnaire covering questions related to PAEPs such as type, frequency, staff training, treatment rationale, importance of PAEPs within the treatment strategy, and possible avenues to increase PAEPs. Results Staff members of 48 different psychiatric hospitals completed the survey. Hospitals provided the following therapeutic treatments: relaxation techniques (100%), sports therapy (97%), activity-related psychotherapeutic interventions (95%), physiotherapy (85%), body therapies (59%), far-east techniques (57%), and hippotherapy (22%). Frequencies ranged from once/week to five times/week. Approximately 25% of patients participated in the PAEPs. Interventions were offered irrespective of psychiatric disorders. PAEP providers wanted and needed more vocational training. Conclusion All participating psychiatric hospitals offer a broad variety of PAEPs in their treatment curricula. However, the majority of inpatients do not participate in PAEPs. Furthermore, those who do participate cannot continue to do so following discharge. PAEP providers need specific extended vocational trainings and believe that the potential of PA should be improved. PMID:27350748

  4. Suicidal Ideation of Psychiatrically Hospitalized Adolescents has One-Year Predictive Validity for Suicide Attempts in Girls Only

    PubMed Central

    Jiang, Qingmei; Czyz, Ewa K.; Kerr, David C. R.

    2016-01-01

    Clinicians commonly incorporate adolescents’ self-reported suicidal ideation into formulations regarding adolescents’ risk for suicide. Data are limited, however, regarding the extent to which adolescent boys’ and girls’ reports of suicidal ideation have clinically significant predictive validity in terms of subsequent suicidal behavior. This study examined psychiatrically hospitalized adolescent boys’ and girls’ self-reported suicidal ideation as a predictor of suicide attempts during the first year following hospitalization. A total of 354 adolescents (97 boys; 257 girls; ages 13–17 years) hospitalized for acute suicide risk were evaluated at the time of hospitalization as well as 3, 6, and 12 months later. Study measures included the Suicidal Ideation Questionnaire-Junior, Multidimensional Anxiety Scale for Children, Children’s Depression Rating Scale-Revised, Beck Hopelessness Scale, Youth Self-Report, and Personal Experiences Screen Questionnaire. The main study outcome was presence and number of suicide attempt(s) in the year after hospitalization, measured by the Diagnostic Interview Schedule for Children. Results indicated a significant interaction between suicidal ideation, assessed during first week of hospitalization, and gender for the prediction of subsequent suicide attempts. Suicidal ideation was a significant predictor of subsequent suicide attempts for girls, but not boys. Baseline history of multiple suicide attempts was a significant predictor of subsequent suicide attempts across genders. Results support the importance of empirically validating suicide risk assessment strategies separately for adolescent boys and girls. Among adolescent boys who have been hospitalized due to acute suicide risk, low levels of self-reported suicidal ideation may not be indicative of low risk for suicidal behavior following hospitalization. PMID:23996157

  5. PCL-R Psychopathy Predicts Disruptive Behavior Among Male Offenders in a Dutch Forensic Psychiatric Hospital

    ERIC Educational Resources Information Center

    Hildebrand, Martin; De Ruiter, Corine; Nijman, Henk

    2004-01-01

    In this study, the relationship between psychopathy, according to the Dutch language version of Hare's Psychopathy Checklist-Revised (PCL-R), and various types of disruptive behavior during inpatient forensic psychiatric treatment is investigated. Ninety-two male participants were administered the PCL-R following admission to an inpatient forensic…

  6. Opinions about Treatment Modalities among Patients Involuntarily Committed to a Forensic Psychiatric Hospital in Finland

    ERIC Educational Resources Information Center

    Repo-Tiihonen, Eila; Vuorio, Osmo; Koivisto, Hanna; Paavola, Paula; Hakola, Panu

    2004-01-01

    Patient satisfaction studies concerning various treatment modalities are few among involuntary forensic psychiatric treatment. They indicate general satisfaction with medication, interactive treatment and occupational therapy but dissatisfaction with lack of privacy, insufficiently explained rules and inadequately explained reasons of seclusion.…

  7. Leisure Activity and Hospital Readmission of Short-Term Psychiatric Patients.

    ERIC Educational Resources Information Center

    McMinn, Sheri B.; Lay, C. Marvin

    William Menninger (1948) reported research results indicating a significant relationship in a former patient's ability to stay well and his participation in recreation. J. Bates (1963) indicated one reason patients return to psychiatric facilities was the lack of skills that center around recreation. This study was conducted to investigate the…

  8. Adults with Autism Spectrum Disorders Using Psychiatric Hospitals in Ontario: Clinical Profile and Service Needs

    ERIC Educational Resources Information Center

    Lunsky, Yona; Gracey, Carolyn; Bradley, Elspeth

    2009-01-01

    Background: Adults with Autism Spectrum Disorders (ASD) represent a small, but challenging sub-group of patients within Ontario's mental health care system. However, few studies have documented the clinical characteristics of this population and examined how such individuals differ from other psychiatric patients, with or without intellectual…

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

    ERIC Educational Resources Information Center

    Hanes, Michael J.

    1995-01-01

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

  10. Utility of Socioeconomic Status in Predicting 30-Day Outcomes After Heart Failure Hospitalization

    PubMed Central

    Eapen, Zubin J.; McCoy, Lisa A.; Fonarow, Gregg C.; Yancy, Clyde W.; Miranda, Marie Lynn; Peterson, Eric D.; Califf, Robert M.; Hernandez, Adrian F.

    2015-01-01

    Background An individual's socioeconomic status (SES) is associated with health outcomes and mortality, yet it is unknown whether accounting for SES can improve risk-adjustment models for 30-day outcomes among Centers for Medicare & Medicaid Services (CMS) beneficiaries hospitalized with heart failure (HF). Methods and Results We linked clinical data on hospitalized HF patients in the Get With The Guidelines®-HF™ database (01/2005–12/2011) with CMS claims and county-level SES data from the 2012 Area Health Resources Files. We compared the discriminatory capabilities of multivariable models that adjusted for SES, patient, and/or hospital characteristics to determine whether county-level SES data improved prediction or changed hospital rankings for 30-day all-cause mortality and rehospitalization. After adjusting for patient and hospital characteristics, median household income (per $5,000 increase) was inversely associated with odds of 30-day mortality (OR 0.97, 95% CI 0.95–1.00, p=0.032), and the percentage of persons with at least a high school diploma (per 5 unit increase) was associated with lower odds of 30-day rehospitalization (OR 0.95, 95% CI 0.91–0.99).After adjustment for county-level SES data, relative to whites, Hispanic ethnicity (OR 0.70, 95% CI 0.58, 0.83) and black race (OR 0.57, 95% CI: 0.50–0.65) remained significantly associated with lower 30-day mortality, but had similar 30-day rehospitalization. County-level SES did not improve risk adjustment or change hospital rankings for 30-day mortality or rehospitalization. Conclusions County-level SES data are modestly associated with 30-day outcomes for CMS beneficiaries hospitalized with HF, but do not improve risk adjustment models based on patient characteristics alone. PMID:25747700

  11. XYY males. Some clinical and psychiatric aspects deriving from a survey of 1,811 males in hospitals for the mentally handicapped.

    PubMed

    Hunter, H

    1977-11-01

    A survey of 1,811 mentally handicapped males in eighteen hospitals is described. Males discovered with supernumerary Y chromosomes numbered 15, of whom 12 were 47,XYY. Some of the physical, social, psychological and psychiatric findings are described and compared with groups matched for IQ and height. The main psychiatric findings are diminished intelligence, retardation in development of secondary sexual characteristics, and poor emotional control leading to inadequate social adaptive patters which are described and discussed.

  12. Why are some patients admitted to psychiatric hospital while others are not? A study assessing risk during the admission interview and relationship to outcome.

    PubMed

    Hunt, Glenn E; O'Hara-Aarons, Maureen; O'Connor, Nick; Cleary, Michelle

    2012-04-01

    The aim of this study was to determine what patient characteristics are used to decide whether a patient is or is not admitted to a psychiatric hospital, and what happens to those not admitted. A further aim was to determine if high levels of risk on admission predict seclusions, length of stay, or readmission within 28 days. Data were collected prospectively on consecutive presentations to an admission office via case notes and electronic databases. Eighty percent (100/127) of the adults presenting to the admission office over a typical month were admitted to hospital. Patients were more likely to be admitted if they were experiencing psychosis or exacerbation of schizophrenia, referred by other doctors or mental health teams, had a legal reason for referral, or if they were homeless. There was no association between risk for violence or suicide and seclusion rates, length of stay, or being readmitted within 28 days. It was reassuring to find that 85% of those not admitted were referred to other mental health providers, and none required admission over the following month. This study found high rates of seclusion and readmissions within 1 year, which requires further study to find strategies to reduce these rates. PMID:22039923

  13. Violence in public sector psychiatric hospitals. Benchmarking nursing staff injury rates.

    PubMed

    Love, C C; Hunter, M E

    1996-05-01

    1. Violence toward healthcare workers, particularly psychiatric nursing staff, has only recently been identified as a workplace health hazard. An occupational health perspective underscores the need for proactive monitoring and heightens incentives for prevention through the introduction of external regulation. 2. Nursing staff injury rates from violence alone are higher than injuries seen in industries traditionally considered high risk such as mining, lumber, and heavy construction. Nursing employment categories at particular risk include psychiatric technicians, male staff, and on-unit supervisory personnel. 3. It is exceedingly difficult to accurately measure the extent of violence in a given facility and injury rates are known to underestimate the actual number of violent events that occur. Nursing staff, labor organizations, and managers must work toward more reliable monitoring and risk prevention programs. PMID:8732980

  14. Does Sense of Control Predict Depression Among Individuals After Psychiatric Hospital Discharge?

    PubMed

    Kim, Yoo Jung; Fusco, Rachel A

    2015-11-01

    Sense of control is known to be related to depression. Yet, few studies have examined the role of sense of control as related to depression for discharged psychiatric patients. In this study the longitudinal relationship between sense of control and depressive mood was examined using the MacArthur Violence Risk Assessment Study, a 6-wave, 1-year study of 948 ethnically diverse postdischarge psychiatric patients. Sense of control was decomposed into 2 components (i.e., a time-invariant as well as a time-varying component) and so as to examine which component of sense of control would more accurately explain this relationship. Results demonstrated that time-varying sense of control significantly predicted changes in depressive mood during the transition to community environment. Time-invariant sense of control, however, was not significantly related to changes in depressive mood. Findings of this study hold important implications for intervention practice with people before or after psychiatric discharge, including the need for incorporation of therapeutic and psychoeducational efforts that bolster sense of control.

  15. Extensive antibiotic prescription rate among hospitalized patients in Uganda: but with frequent missed-dose days

    PubMed Central

    Kiguba, Ronald; Karamagi, Charles; Bird, Sheila M.

    2016-01-01

    Objectives To describe the patterns of systemic antibiotic use and missed-dose days and detail the prescription, dispensing and administration of frequently used hospital-initiated antibiotics among Ugandan inpatients. Methods This was a prospective cohort of consented adult inpatients admitted on the medical and gynaecological wards of the 1790 bed Mulago National Referral Hospital. Results Overall, 79% (603/762; 95% CI: 76%–82%) of inpatients received at least one antibiotic during hospitalization while 39% (300/762; 95% CI: 36%–43%) had used at least one antibiotic in the 4 weeks pre-admission; 1985 antibiotic DDDs, half administered parenterally, were consumed in 3741 inpatient-days. Two-fifths of inpatients who received at least one of the five frequently used hospital-initiated antibiotics (ceftriaxone, metronidazole, ciprofloxacin, amoxicillin and azithromycin) missed at least one antibiotic dose-day (44%, 243/558). The per-day risk of missed antibiotic administration was greatest on day 1: ceftriaxone (36%, 143/398), metronidazole (27%, 67/245), ciprofloxacin (34%, 39/114) and all inpatients who missed at least one dose-day of prescribed amoxicillin and azithromycin. Most patients received fewer doses than were prescribed: ceftriaxone (74%, 273/371), ciprofloxacin (90%, 94/105) and metronidazole (97%, 222/230). Of prescribed doses, only 62% of ceftriaxone doses (1178/1895), 35% of ciprofloxacin doses (396/1130) and 27% of metronidazole doses (1043/3862) were administered. Seven percent (13/188) of patients on intravenous metronidazole and 6% (5/87) on intravenous ciprofloxacin switched to oral route. Conclusions High rates of antibiotic use both pre-admission and during hospitalization were observed, with low parenteral/oral switch of hospital-initiated antibiotics. Underadministration of prescribed antibiotics was common, especially on the day of prescription, risking loss of efficacy and antibiotic resistance. PMID:26945712

  16. First-Day Newborn Weight Loss Predicts In-Hospital Weight Nadir for Breastfeeding Infants

    PubMed Central

    Bokser, Seth; Newman, Thomas B.

    2010-01-01

    Abstract Background Exclusive breastfeeding reduces infant infectious disease. Losing ≥10% birth weight may lead to formula use. The predictive value of first-day weight loss for subsequent weight loss has not been studied. The objective of the present study was to evaluate the relationship between weight loss at <24 hours and subsequent in-hospital weight loss ≥10%. Methods For 1,049 infants, we extracted gestational age, gender, delivery method, feeding type, and weights from medical records. Weight nadir was defined as the lowest weight recorded during birth hospitalization. We used multivariate logistic regression to assess the effect of first-day weight loss on subsequent in-hospital weight loss. Results Mean in-hospital weight nadir was 6.0 ± 2.6%, and mean age at in-hospital weight nadir was 38.7 ± 18.5 hours. While in the hospital 6.4% of infants lost ≥10% of birth weight. Infants losing ≥4.5% birth weight at <24 hours had greater risk of eventual in-hospital weight loss ≥10% (adjusted odds ratio 3.57 [1.75, 7.28]). In this cohort, 798 (76.1%) infants did not have documented weight gain while in the hospital. Conclusions Early weight loss predicts higher risk of ≥10% in-hospital weight loss. Infants with high first-day weight loss could be targeted for further research into improved interventions to promote breastfeeding. PMID:20113202

  17. Utility of models to predict 28-day or 30-day unplanned hospital readmissions: an updated systematic review

    PubMed Central

    Zhou, Huaqiong; Della, Phillip R; Roberts, Pamela; Goh, Louise; Dhaliwal, Satvinder S

    2016-01-01

    Objective To update previous systematic review of predictive models for 28-day or 30-day unplanned hospital readmissions. Design Systematic review. Setting/data source CINAHL, Embase, MEDLINE from 2011 to 2015. Participants All studies of 28-day and 30-day readmission predictive model. Outcome measures Characteristics of the included studies, performance of the identified predictive models and key predictive variables included in the models. Results Of 7310 records, a total of 60 studies with 73 unique predictive models met the inclusion criteria. The utilisation outcome of the models included all-cause readmissions, cardiovascular disease including pneumonia, medical conditions, surgical conditions and mental health condition-related readmissions. Overall, a wide-range C-statistic was reported in 56/60 studies (0.21–0.88). 11 of 13 predictive models for medical condition-related readmissions were found to have consistent moderate discrimination ability (C-statistic ≥0.7). Only two models were designed for the potentially preventable/avoidable readmissions and had C-statistic >0.8. The variables ‘comorbidities’, ‘length of stay’ and ‘previous admissions’ were frequently cited across 73 models. The variables ‘laboratory tests’ and ‘medication’ had more weight in the models for cardiovascular disease and medical condition-related readmissions. Conclusions The predictive models which focused on general medical condition-related unplanned hospital readmissions reported moderate discriminative ability. Two models for potentially preventable/avoidable readmissions showed high discriminative ability. This updated systematic review, however, found inconsistent performance across the included unique 73 risk predictive models. It is critical to define clearly the utilisation outcomes and the type of accessible data source before the selection of the predictive model. Rigorous validation of the predictive models with moderate-to-high discriminative

  18. SOCIALIZATION OF THE YOUNGER PSYCHIATRIC PATIENT--THE COMMUNITY AND THE HOSPITAL-A DUAL RESPONSIBILITY.

    ERIC Educational Resources Information Center

    GIORDANO, JOSEPH; AND OTHERS

    TO ASSIST YOUNG, MENTAL PATIENTS IN OVERCOMING SOME OF THEIR SOCIAL DEFICITS, TWO RESOCIALIZATION PROJECTS (PRE- AND POST-DISCHARGE) WERE INITIATED TO MOVE THE PATIENT FROM A MENTAL HOSPITAL SETTING INTO THE LARGER COMMUNITY, WITH A COMMUNITY CENTER AS THE LEARNING GROUND. CAREFULLY SELECTED PATIENTS FROM THE HOSPITAL WERE GIVEN THE OPPORTUNITY TO…

  19. Incidence and Predictors of 30-Day Readmission Among Patients Hospitalized for Advanced Liver Disease

    PubMed Central

    BERMAN, KENNETH; TANDRA, SWETA; FORSSELL, KATE; VUPPALANCHI, RAJ; BURTON, JAMES R.; NGUYEN, JAMES; MULLIS, DEVONNE; KWO, PAUL; CHALASANI, NAGA

    2011-01-01

    BACKGROUND & AIMS The rate of readmission to the hospital 30 days after discharge (30-day readmission rate) is used as a quality measure for hospitalized patients, but it has not been studied adequately for patients with advanced liver disease. We investigated the incidence and factors that predict this rate and its relationship with mortality at 90 days. METHODS We analyzed data from patients with advanced liver disease who were hospitalized to an inpatient hepatology service at 2 large academic medical centers in 2008. Patients with elective admission and recipients of liver transplants were not included. During the study period, there were 447 patients and a total of 554 eligible admissions. Multivariate analyses were performed to identify variables associated with 30-day readmission and to examine its relationship with mortality at 90 days. RESULTS The 30-day readmission rate was 20%. After adjusting for multiple covariates, readmission within 30 days was associated independently with model for end-stage liver disease scores at discharge (odds ratio [OR], 1.06; 95% confidence interval [CI], 1.02–1.09; P = .002), the presence of diabetes (OR, 1.78; 95% CI, 1.07–2.95; P = .027), and male sex (OR, 1.73; 95% CI, 1.03–2.89; P = .038). After adjusting for age, sex, and model for end-stage liver disease score at discharge, the 90-day mortality rate was significantly higher among patients who were readmitted to the hospital within 30 days than those who were not (26.8% vs 9.8%; OR, 2.6; 95% CI, 1.36 –5.02; P = .004). CONCLUSIONS Patients with advanced liver disease frequently are readmitted to the hospital within 30 days after discharge; these patients have a higher 90-day mortality rate than those who are not readmitted in 30 days. These data might be used to develop strategies to reduce early readmission of hospitalized patients with cirrhosis. PMID:21092762

  20. 28 CFR 549.44 - Voluntary hospitalization in a suitable facility for psychiatric care or treatment, and voluntary...

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... facility for psychiatric care or treatment, and voluntary administration of psychiatric medication. 549.44 Section 549.44 Judicial Administration BUREAU OF PRISONS, DEPARTMENT OF JUSTICE INSTITUTIONAL MANAGEMENT... facility for psychiatric care or treatment, and voluntary administration of psychiatric medication....

  1. 28 CFR 549.44 - Voluntary hospitalization in a suitable facility for psychiatric care or treatment, and voluntary...

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... facility for psychiatric care or treatment, and voluntary administration of psychiatric medication. 549.44 Section 549.44 Judicial Administration BUREAU OF PRISONS, DEPARTMENT OF JUSTICE INSTITUTIONAL MANAGEMENT... facility for psychiatric care or treatment, and voluntary administration of psychiatric medication....

  2. 28 CFR 549.44 - Voluntary hospitalization in a suitable facility for psychiatric care or treatment, and voluntary...

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... facility for psychiatric care or treatment, and voluntary administration of psychiatric medication. 549.44 Section 549.44 Judicial Administration BUREAU OF PRISONS, DEPARTMENT OF JUSTICE INSTITUTIONAL MANAGEMENT... facility for psychiatric care or treatment, and voluntary administration of psychiatric medication....

  3. Relationship between mean daily ambient temperature range and hospital admissions for schizophrenia: Results from a national cohort of psychiatric inpatients.

    PubMed

    Sung, Tzu-I; Chen, Mu-Jean; Lin, Chuan-Yao; Lung, Shih-Chun; Su, Huey-Jen

    2011-12-01

    Environmental temperature is known to correlate with schizophrenia, but little is known about the association with changes in temperature. This 12-year study aimed to evaluate the relationship between the mean daily range of ambient temperature and schizophrenia admissions in a national cohort of psychiatric inpatients in Taiwan. Meteorological data provided by the Central Weather Bureau of Taiwan were interpolated to create representative estimates. Psychiatric inpatient admissions in all hospitals with medical services enrolled in the current health care insurance system were retrieved from the 1996-2007 Psychiatric Inpatient Medical Claim dataset of the National Health Insurance Research Database. Generalized linear models with Poisson distributions were used to analyze the impact of mean diurnal change of temperature on schizophrenia admissions, controlling for internal correlations and demographic covariates. The daily temperature range varied between 1.7°C and 12.1°C (1st to 99th percentile). The relative risk of schizophrenia admission was significantly increased at a temperature range of 3.2°C (10th percentile), and the maximum was at 12.1°C (99th percentile); however, no such association was found with schizoaffective disorder. When restricted to the capital and largest city, the effects of temperature range were prominent and may correlate with temperature itself. The joint effect of temperature and temperature range was associated with elevated risk, particularly at cooler temperatures. A positive correlation was found between increasing temperature range and schizophrenia admissions. The increase in morbidity at high percentiles suggests that the increasing dynamics of temperature range are a valid reflection of risk, highlighting the need for precautionary action. PMID:22018962

  4. Predicting U.S. Army suicides after hospitalizations with psychiatric diagnoses in the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS)

    PubMed Central

    Kessler, Ronald C.; Warner, LTC Christopher H.; Ivany, LTC Christopher; Petukhova, Maria V.; Rose, Sherri; Bromet, Evelyn J.; Brown, LTC Millard; Cai, Tianxi; Colpe, Lisa J.; Cox, Kenneth L.; Fullerton, Carol S.; Gilman, Stephen E.; Gruber, Michael J.; Heeringa, Steven G.; Lewandowski-Romps, Lisa; Li, Junlong; Millikan-Bell, Amy M.; Naifeh, James A.; Nock, Matthew K.; Rosellini, Anthony J.; Sampson, Nancy A.; Schoenbaum, Michael; Stein, Murray B.; Wessely, Simon; Zaslavsky, Alan M.; Ursano, Robert J.

    2014-01-01

    IMPORTANCE The U.S. Army experienced a sharp rise in suicides beginning in 2004. Administrative data show that among those at highest risk are soldiers in the 12 months after inpatient treatment of a psychiatric disorder. OBJECTIVE To develop an actuarial risk algorithm predicting suicide in the 12 months after US Army soldier inpatient treatment of a psychiatric disorder to target expanded post-hospital care. DESIGN, SETTING, AND PARTICIPANTS There were 53,769 hospitalizations of active duty soldiers in 2004–2009 with ICD-9-CM psychiatric admission diagnoses. Administrative data available prior to hospital discharge abstracted from a wide range of data systems (socio81 demographic, Army career, criminal justice, medical/pharmacy) were used to predict suicides in the subsequent 12 months using machine learning methods (regression trees, penalized regressions) designed to evaluate cross-validated linear, nonlinear, and interactive predictive associations. MAIN OUTCOME Suicides of soldiers hospitalized with psychiatric disorders in the 12 months after hospital discharge. RESULTS 68 soldiers died by suicide within 12 months of hospital discharge (12.0% of all Army suicides), equivalent to 263.9 suicides/100,000 person-years compared to 18.5 suicides/100,000 person-years in the total Army. Strongest predictors included socio-demographics (male, late age of enlistment), criminal offenses (verbal violence, weapons possession), prior suicidality, aspects of prior psychiatric inpatient and outpatient treatment, and disorders diagnosed during the focal hospitalizations. 52.9% of post-hospital suicides occurred after the 5% of hospitalizations with highest predicted suicide risk (3,824.1 suicides/100,000 person years). These highest-risk hospitalizations also accounted for significantly elevated proportions of several other adverse post-hospital outcomes (unintentional injury deaths, suicide attempts, re-hospitalizations). CONCLUSIONS AND RELEVANCE The high concentration

  5. Clinical assessment and management of psychiatric patients' violent and aggressive behaviors in general hospital.

    PubMed

    Bernstein, Kunsook Song; Saladino, Joseph P

    2007-10-01

    Patients with co-morbid psychiatric disorders exhibiting violent and aggressive behaviors can be a challenge for nurses in medical-surgical units. They can deliver effective, safe care by assessing risk and building a rapport with the patient during the admission process; utilizing crisis prevention strategies, including appropriate medication administration, environmental, psychobiological, counseling, and health teaching interventions; and employing conflict resolution technique. Utilizing the nursing process, the nurse can provide effective therapeutic interventions to promote safety for both the patient and the nurse. PMID:18072668

  6. Work engagement supports nurse workforce stability and quality of care: nursing team-level analysis in psychiatric hospitals.

    PubMed

    Van Bogaert, P; Wouters, K; Willems, R; Mondelaers, M; Clarke, S

    2013-10-01

    Research in healthcare settings reveals important links between work environment factors, burnout and organizational outcomes. Recently, research focuses on work engagement, the opposite (positive) pole from burnout. The current study investigated the relationship of nurse practice environment aspects and work engagement (vigour, dedication and absorption) to job outcomes and nurse-reported quality of care variables within teams using a multilevel design in psychiatric inpatient settings. Validated survey instruments were used in a cross-sectional design. Team-level analyses were performed with staff members (n = 357) from 32 clinical units in two psychiatric hospitals in Belgium. Favourable nurse practice environment aspects were associated with work engagement dimensions, and in turn work engagement was associated with job satisfaction, intention to stay in the profession and favourable nurse-reported quality of care variables. The strongest multivariate models suggested that dedication predicted positive job outcomes whereas nurse management predicted perceptions of quality of care. In addition, reports of quality of care by the interdisciplinary team were predicted by dedication, absorption, nurse-physician relations and nurse management. The study findings suggest that differences in vigour, dedication and absorption across teams associated with practice environment characteristics impact nurse job satisfaction, intention to stay and perceptions of quality of care. PMID:22962847

  7. Work engagement supports nurse workforce stability and quality of care: nursing team-level analysis in psychiatric hospitals.

    PubMed

    Van Bogaert, P; Wouters, K; Willems, R; Mondelaers, M; Clarke, S

    2013-10-01

    Research in healthcare settings reveals important links between work environment factors, burnout and organizational outcomes. Recently, research focuses on work engagement, the opposite (positive) pole from burnout. The current study investigated the relationship of nurse practice environment aspects and work engagement (vigour, dedication and absorption) to job outcomes and nurse-reported quality of care variables within teams using a multilevel design in psychiatric inpatient settings. Validated survey instruments were used in a cross-sectional design. Team-level analyses were performed with staff members (n = 357) from 32 clinical units in two psychiatric hospitals in Belgium. Favourable nurse practice environment aspects were associated with work engagement dimensions, and in turn work engagement was associated with job satisfaction, intention to stay in the profession and favourable nurse-reported quality of care variables. The strongest multivariate models suggested that dedication predicted positive job outcomes whereas nurse management predicted perceptions of quality of care. In addition, reports of quality of care by the interdisciplinary team were predicted by dedication, absorption, nurse-physician relations and nurse management. The study findings suggest that differences in vigour, dedication and absorption across teams associated with practice environment characteristics impact nurse job satisfaction, intention to stay and perceptions of quality of care.

  8. Patient safety culture in two Finnish state-run forensic psychiatric hospitals.

    PubMed

    Kuosmanen, Anssi; Tiihonen, Jari; Repo-Tiihonen, Eila; Eronen, Markku; Turunen, Hannele

    2013-01-01

    Safety culture refers to the way patient safety is regarded and implemented within an organization and the structures and procedures in place to support this. The aim of this study was to evaluate patient safety culture, identify areas for improvement, and establish a baseline for improving state hospitals in Finland. Cross-sectional design data were collected from two state-run forensic hospitals in Finland using an anonymous, Web-based survey targeted to hospital staff based on the Hospital Survey on Patient Safety Culture questionnaire. The response rate was 43% (n = 283). The overall patient safety level was rated as excellent or very good by 58% of respondents. The highest positive grade was for "teamwork within units" (72%). The lowest rating was for "nonpunitive response to errors" (26% positive). Good opportunities for supplementary education had a statistically significant (p ≤ 0.05) effect on 9 of 12 Hospital Survey on Patient Safety Culture dimensions. Statistically significant (p ≤ 0.05) differences in patient safety culture were also found in the staff's educational background, manager status, and between the two hospitals. These findings suggest there are a number of patient safety problems related to cultural dimensions. Supplementary education was shown to be a highly significant factor in transforming patient safety culture and should therefore be taken into account alongside sufficient resources. PMID:24256983

  9. Half of 30-Day Hospital Readmissions Among HIV-Infected Patients Are Potentially Preventable

    PubMed Central

    Kitchell, Ellen; Etherton, Sarah Shelby; Duarte, Piper; Halm, Ethan A.; Jain, Mamta K.

    2015-01-01

    Abstract Thirty-day readmission rates, a widely utilized quality metric, are high among HIV-infected individuals. However, it is unknown how many 30-day readmissions are preventable, especially in HIV patients, who have been excluded from prior potentially preventable readmission analyses. We used electronic medical records to identify all readmissions within 30 days of discharge among HIV patients hospitalized at a large urban safety net hospital in 2011. Two independent reviewers assessed whether readmissions were potentially preventable using both published criteria and detailed chart review, how readmissions might have been prevented, and the phase of care deemed suboptimal (inpatient care, discharge planning, post-discharge). Of 1137 index admissions, 213 (19%) resulted in 30-day readmissions. These admissions occurred among 930 unique HIV patients, with 130 individuals (14%) experiencing 30-day readmissions. Of these 130, about half were determined to be potentially preventable using published criteria (53%) or implicit chart review (48%). Not taking antiretroviral therapy (ART) greatly increased the odds of a preventable readmission (OR 5.9, CI:2.4–14.8). Most of the preventable causes of readmission were attributed to suboptimal care during the index hospitalization. Half of 30-day readmission in HIV patients are potentially preventable. Increased focus on early ART initiation, adherence counseling, management of chronic conditions, and appropriate timing of discharge may help reduce readmissions in this vulnerable population. PMID:26154066

  10. Half of 30-Day Hospital Readmissions Among HIV-Infected Patients Are Potentially Preventable.

    PubMed

    Nijhawan, Ank E; Kitchell, Ellen; Etherton, Sarah Shelby; Duarte, Piper; Halm, Ethan A; Jain, Mamta K

    2015-09-01

    Thirty-day readmission rates, a widely utilized quality metric, are high among HIV-infected individuals. However, it is unknown how many 30-day readmissions are preventable, especially in HIV patients, who have been excluded from prior potentially preventable readmission analyses. We used electronic medical records to identify all readmissions within 30 days of discharge among HIV patients hospitalized at a large urban safety net hospital in 2011. Two independent reviewers assessed whether readmissions were potentially preventable using both published criteria and detailed chart review, how readmissions might have been prevented, and the phase of care deemed suboptimal (inpatient care, discharge planning, post-discharge). Of 1137 index admissions, 213 (19%) resulted in 30-day readmissions. These admissions occurred among 930 unique HIV patients, with 130 individuals (14%) experiencing 30-day readmissions. Of these 130, about half were determined to be potentially preventable using published criteria (53%) or implicit chart review (48%). Not taking antiretroviral therapy (ART) greatly increased the odds of a preventable readmission (OR 5.9, CI:2.4-14.8). Most of the preventable causes of readmission were attributed to suboptimal care during the index hospitalization. Half of 30-day readmission in HIV patients are potentially preventable. Increased focus on early ART initiation, adherence counseling, management of chronic conditions, and appropriate timing of discharge may help reduce readmissions in this vulnerable population.

  11. The effects of daily weather variables on psychosis admissions to psychiatric hospitals

    NASA Astrophysics Data System (ADS)

    McWilliams, Stephen; Kinsella, Anthony; O'Callaghan, Eadbhard

    2013-07-01

    Several studies have noted seasonal variations in admission rates of patients with psychotic illnesses. However, the changeable daily meteorological patterns within seasons have never been examined in any great depth in the context of admission rates. A handful of small studies have posed interesting questions regarding a potential link between psychiatric admission rates and meteorological variables such as environmental temperature (especially heat waves) and sunshine. In this study, we used simple non-parametric testing and more complex ARIMA and time-series regression analysis to examine whether daily meteorological patterns (wind speed and direction, barometric pressure, rainfall, sunshine, sunlight and temperature) exert an influence on admission rates for psychotic disorders across 12 regions in Ireland. Although there were some weak but interesting trends for temperature, barometric pressure and sunshine, the meteorological patterns ultimately did not exert a clinically significant influence over admissions for psychosis. Further analysis is needed.

  12. Tensions between policy and practice: A qualitative analysis of decisions regarding compulsory admission to psychiatric hospital.

    PubMed

    Fistein, Elizabeth C; Clare, Isabel C H; Redley, Marcus; Holland, Anthony J

    2016-01-01

    The use of detention for psychiatric treatment is widespread and sometimes necessary. International human rights law requires a legal framework to safeguard the rights to liberty and personal integrity by preventing arbitrary detention. However, research suggests that extra-legal factors may influence decisions to detain. This article presents observational and interview data to describe how decisions to detain are made in practice in one jurisdiction (England and Wales) where a tension between policy and practice has been described. The analysis shows that practitioners mould the law into 'practical criteria' that appear to form a set of operational criteria for identifying cases to which the principle of soft paternalism may be applied. Most practitioners also appear willing, albeit often reluctantly, to depart from their usual reliance on the principle of soft paternalism and authorise detention of people with the capacity to refuse treatment, in order to prevent serious harm. We propose a potential resolution for the tension between policy and practice: two separate legal frameworks to authorise detention, one with a suitable test of capacity, used to enact soft paternalism, and the other to provide legal justification for detention for psychiatric treatment of the small number of people who retain decision-making capacity but nonetheless choose to place others at risk by refusing treatment. This separation of detention powers into two systems, according to the principle that justifies the use of detention would be intellectually coherent, consistent with human rights instruments and, being consistent with the apparent moral sentiments of practitioners, less prone to idiosyncratic interpretations in practice. PMID:27062108

  13. Day care surgery in a metropolitan government hospital setting--Indian scenario.

    PubMed

    Dorairajan, Natarajan; Andappan, Anandi; Arun, B; Siddharth, Dorairajan; Meena, M

    2010-01-01

    Day care surgery has generated a lot of interest, among both surgeons and the common people. This study aims to explore the management and advantages, including the cost benefits and cost effectiveness, of day care surgery in a government hospital setting. A prospective, single-center, single-unit study was carried out over 1 year from August 2006 to January 2008. The total number of patients studied was 327. Surgeries for hernia, hydrocele, fibroadenoma, fissure in ano, and phimosis were included. Patients were admitted on the day of surgery and were discharged the same day or evening. Patients were analyzed with respect to failure to discharge, wound infection, duration of stay in the ward, cost benefits, cost effectiveness, and postoperative pain. A total of 157 patients were treated for hernia, 61 for hydrocele, 52 for fibroadenoma, 34 for fissure in ano, and 23 for phimosis. Day care surgery is a fast growing and well accepted way of providing care to patients. Most of the patients studied had a favorable impression of the day care surgical procedure compared with inpatient care. In a country like India, in spite of problems of financial constraints and insufficient grants for health care, we are able to enjoy all the advantages of day care surgery, even in a government hospital setting.

  14. 42 CFR 424.13 - Requirements for inpatient services of hospitals other than inpatient psychiatric facilities.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ...) Certification of need for hospitalization when a SNF bed is not available. (1) The physician may certify or... treatment in a SNF but no bed is available in a participating SNF. (2) If this is the basis for the... physician is expected to continue efforts to place the patient in a participating SNF as soon as a...

  15. Evaluating Psychiatric Hospital Admission Decisions for Children in Foster Care: An Optimal Classification Tree Analysis

    ERIC Educational Resources Information Center

    Snowden, Jessica A.; Leon, Scott C.; Bryant, Fred B.; Lyons, John S.

    2007-01-01

    This study explored clinical and nonclinical predictors of inpatient hospital admission decisions across a sample of children in foster care over 4 years (N = 13,245). Forty-eight percent of participants were female and the mean age was 13.4 (SD = 3.5 years). Optimal data analysis (Yarnold & Soltysik, 2005) was used to construct a nonlinear…

  16. The end of the mental hospital. A review of the psychiatric experience in Trieste.

    PubMed

    Dell'Acqua, G; Cogliati Dezza, M G

    1985-01-01

    This paper describes the closing of the mental hospital in Trieste and the establishing of a comprehensive community mental health service, over a period of 13 years from 1971. In 1971 the hospital had 1058 patients. By 1975 there were 656 patients, 403 of whom were guests, in effect ordinary citizens who had nowhere else to live. The paper describes this dramatic and innovative transformation, the rearrangement of wards, the abolition of shock therapies, the establishment of many flats and group homes, the starting of a cleaning cooperative employing ex-patients to do the work they previously did as "ergotherapy", the first mass exodus of the patients into the city. The paper goes on to describe the opening of 7 mental health centres between 1975 and 1977 and the present existing network of services. At this time the hospital buildings were converted into a variety of uses for the benefit of the local people. It describes in greater detail the philosophy and practice of one of these centres at Barcola and how the dialectical relationship between staff and client works to create a flexible and responsive service. It ends by repeating the assertion that the closure of the mental hospital is a first necessary step towards an improved mental health service for everyone.

  17. The assessment of risk management systems for patients on Warrants of the Lieutenant Governor in Ontario psychiatric hospitals.

    PubMed

    McKerrow, W

    1989-01-01

    An assessment of risk management systems for patients on Warrants of the Lieutenant Governor in the provincial psychiatric hospitals was conducted. The assessment revealed that, to date, with some exceptions, the system has coped reasonably well. However, with a present count of over 400, and the ever increasing number of patients on warrants, there is a pressing need to improve the overall coordination of the system. The numbers, types and location of beds required to serve the system must be reviewed. Staff needs and training must be addressed. Increased numbers of coordinated research studies and improved information systems are required. System-wide policies and procedures for releasing information to policy, employers and home operators are necessary. As well, there must be a consistent approach in dealing with potential abuse of alcohol and non-prescribed drugs. Systems for authorizing and documenting patient privileges can be improved in some hospitals. A set of guidelines for interpreting terms and conditions of warrants is necessary. Lastly, information for staff treating patients on warrants should be developed and distributed.

  18. SUICIDAL IDEATORS IN THE PSYCHIATRIC FACILITY OF A GENERAL HOSPITAL - A PSYCHODEMOGRAPHIC PROFILE

    PubMed Central

    Unni, Sadanandan K.E.; Mani, Annie J.

    1996-01-01

    As a part of the basis for planning of prevention of suicide and suicide attempt, 154 suicidal ideators registered between 1988 and 1991, were recruited for an analysis of their psychiatric morbidity pattern. 59.74% had depression. The representation of substance abuse disorder and psychoses were 9.74% each 7.14% had neurotic disorders. 9.09% had bipolar affective disorder and 0.65% had normal mental status. 40% of the sample were housewives. Majority of them were between the age group of 16 and45years, having an educational status below 10th Standard The four year follow up findings showed that 8 of the sample completed suicide, of which four were suffering from psychosis. Repeaters suffered from disociation disorder. 15 of the depressives had resistant depression with nonremittent suicidal ideas. Psychotic patients and patients with somatic complaints were not free communicators of their suicidal idea. Implication of the results in the cunicalmanagement and further research on these patients are discussed. PMID:21584150

  19. Cognitive and Social Factors Associated with NSSI and Suicide Attempts in Psychiatrically Hospitalized Adolescents

    PubMed Central

    Wolff, Jennifer; Frazier, Elisabeth A.; Esposito-Smythers, Christianne; Burke, Taylor; Sloan, Emma; Spirito, Anthony

    2013-01-01

    Although non-suicidal self-injury (NSSI) and suicide attempts (SA) frequently co-occur among youth, there is increasing evidence that both the risk factors and the phenomenology of the behaviors are distinct. This study examined how individuals who engage in NSSI only, individuals who attempt suicide only, and those who have histories of both NSSI and at least one suicide attempt may differ in terms of cognitions and perceived social support. Participants were 185 adolescents (78.1% female) between the ages of 13 and 18 recruited from a psychiatric inpatient facility in the northeastern United States. One hundred forty-eight teens were identified with a history of self-injurious behavior and divided into three groups: NSSI only (n=45), SA only (n=24) or both NSSI and SA (NSSI+SA; n=79). Analyses showed that the NSSI+SA group exhibited more cognitive errors, negative self-statements, and negative views of self, world, and future, as well as less perceived familial support than either the NSSI or SA only groups. There were no differences between groups on perceived support from teachers or peers. No significant demographic or diagnostic differences were found between the NSSI and SA groups. Limitations and clinical implications of the current research are discussed. PMID:23588400

  20. Psychosocial functioning of individuals with schizophrenia in community housing facilities and the psychiatric hospital in Zurich.

    PubMed

    Jaeger, Matthias; Briner, David; Kawohl, Wolfram; Seifritz, Erich; Baumgartner-Nietlisbach, Gabriela

    2015-12-15

    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.

  1. Psychosocial functioning of individuals with schizophrenia in community housing facilities and the psychiatric hospital in Zurich.

    PubMed

    Jaeger, Matthias; Briner, David; Kawohl, Wolfram; Seifritz, Erich; Baumgartner-Nietlisbach, Gabriela

    2015-12-15

    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

  2. Prevalence of a history of sexual abuse among female psychiatric patients in a state hospital system.

    PubMed

    Craine, L S; Henson, C E; Colliver, J A; MacLean, D G

    1988-03-01

    Fifty-one percent of a sample of 105 female state hospital patients were found to have been sexually abused as children or adolescents. In the majority of cases, hospital staff were unaware that the patients had histories of sexual abuse, and only 20 percent of the abused patients believed they had been adequately treated for sexual abuse. Sixty-six percent of the abused patients met the diagnostic criteria for posttraumatic stress disorder, although none had received that diagnosis. Compared with patients who had not been sexually abused, abused patients were significantly more likely to have 17 of 32 symptoms commonly linked with sexual abuse. Every patient who was positive for six symptoms--compulsive sexual behavior, chemical dependency, sadomasochistic sexual fantasy, sexual identity issues, chronic fatigue, and loss of interest in sex--had been sexually abused.

  3. [Treatment of eating disorders in adolescents--the view of a child and adolescence psychiatric hospital].

    PubMed

    Pfeiffer, Ernst; Hansen, Berit; Korte, Alexander; Lehmkuhl, Ulrike

    2005-04-01

    The paper presents--in the sense of clinical guidelines--reality of clinical care in a child and adolescence university hospital specialised on eating disorders. Need of a multimodal therapeutic approach is emphasized, including normalisation of weight and eating behaviour, nursing and pedagogical measures, individual, group and family therapy, completed by body therapy, art and music therapy and in case psychopharmacotherapy. Recommendations for overcoming weak spots are made.

  4. Psychiatric hospitalizations for affective disorders in Warsaw, Poland: Effect of season and intensity of sunlight.

    PubMed

    Dominiak, Monika; Swiecicki, Lukasz; Rybakowski, Janusz

    2015-09-30

    The purpose of this study was to assess any associations between the number of hospitalizations for affective disorders, seasons of the year and the intensity of sunlight in Poland, a country with a very changeable climate and significant seasonal fluctuations. We analyzed 2837 admissions with affective disorders hospitalized in the Institute of Psychiatry and Neurology in Warsaw, between 2002 and 2010 (mania, n=380, mixed episode, n=131, bipolar depression, n=736, recurrent depression, n=681, single depressive episode, n=909). For each diagnostic group admission time series were created and categorized into subgroups according to sex and age, and these were analyzed by means of the Autoregressive Integrated Moving Average (ARIMA) method. Regression models and correlations were used to assess the influence of the intensity of sunlight on the number of hospitalizations. Most mania admissions were noted in spring/summer months and in midwinter, mixed episode-late spring and winter, and depression (bipolar, recurrent and single depressive episode)-spring and autumn months. The association between frequency of admissions and monthly hours of sunshine was observed in some age and sex subgroups of patients with bipolar disorder and single depressive episode. The results support the seasonality of admissions of patients with affective disorders.

  5. Co-morbidities and 90-day outcomes in hospitalized COPD exacerbations.

    PubMed

    Roberts, Christopher M; Stone, Robert A; Lowe, Derek; Pursey, Nancy A; Buckingham, Rhona J

    2011-10-01

    COPD exacerbations resulting in hospitalization are accompanied by high mortality and morbidity. The contribution of specific co-morbidities to acute outcomes is not known in detail: existing studies have used either administrative data or small clinical cohorts and have provided conflicting results. Identification of co-existent diseases that affect outcomes provides opportunities to address these conditions proactively and improve overall COPD care. Cases were identified prospectively on admission then underwent retrospective case note audit to collect data including co-morbidities on up to 60 unselected consecutive acute COPD admissions between March and May in each hospital participating in the 2008 UK National COPD audit. Outcomes recorded were death in hospital, length of stay, and death and readmission at 90 days after index admission. 232 hospitals collected data on 9716 patients, mean age 73, 50% male, mean FEV1 42% predicted. Prevalence of co-morbidities were associated with increased age but better FEV1 and ex-smoker status and with worse outcomes for all four measures. Hospital mortality risk was increased with cor pulmonale, left ventricular failure, neurological conditions and non-respiratory malignancies whilst 90 day death was also increased by lung cancer and arrhythmias. Ischaemic and other heart diseases were important factors in readmission. This study demonstrates that co-morbidities adversely affect a range of short-term patient outcomes related to acute admission to hospital with exacerbations of COPD. Recognition of relevant accompanying diseases at admission provides an opportunity for specific interventions that may improve short-term prognosis. PMID:21864116

  6. The Day-Hospital of the University Hospital, Bobo Dioulasso: An Example of Optimized HIV Management in Southern Burkina Faso

    PubMed Central

    Chas, Julie; Hema, Arsène; Slama, Laurence; Kabore, Nongondo Firmin; Lescure, François-Xavier; Fontaine, Camille; Pialoux, Gilles; Sawadogo, Adrien

    2015-01-01

    Objectives To evaluate the epidemiological evolution of patients with HIV (PtHIV), between 2002 and 2012, in a day-hospital that became an HIV reference centre for south-west Burkina Faso. Materials and Methods This was a retrospective study of PtHIV followed in the Bobo Dioulasso university hospital since 2002. The study was based on clinical data recorded using ESOPE software and analysed using Excel and SAS. Results A total of 7320 patients have been treated at the centre since 2002; the active file of patients increased from 147 in 2002 to 3684 patients in 2012. Mean age was stable at 38.4 years and the majority were female (71%). The delay to initiation of antiretroviral (ARV) treatment after HIV diagnosis decreased from 12.9 months in 2002 to 7.2 months in 2012. The percentage of PtHIV lost to follow-up, untreated for HIV and deaths all decreased after 2005. Voluntary anonymous screening and/or an evocative clinical picture were the main reasons for HIV diagnosis, usually at a late stage (41.1% at WHO stage 3). Virological success increased due to a decrease in time to initiation of ARV treatment and an increase in percentage of patients treated (90.5% in 2012, mainly with 1st line drugs). However, there was also a slight increase in the rate of therapeutic failures and the percentage of patients who progressed to 2nd or 3rd line-ARVs. Conclusion Our day-hospital is a good example of the implementation of a specialist centre for the management of PtHIV in a resource-limited country (Burkina Faso). PMID:25970181

  7. [Physical activities, psychiatric care and mental health].

    PubMed

    Davanture, Olivier

    2014-02-01

    At Ville-Evrard psychiatric hospital, sports activities are used as one of several therapeutic tools. The day-long multi-sport sessions, led notably by a nurse, form part of the care programme. Sport not only enables the patients to exert themselves, it is above all a form of therapeutic mediation which encourages verbal and non-verbal communication.

  8. Schizophrenia and tobacco smoking: a replication study in another US psychiatric hospital.

    PubMed

    de Leon, Jose; Tracy, Joseph; McCann, Eileen; McGrory, Amy; Diaz, Francisco J

    2002-07-01

    A prior study in a US state hospital suggested that schizophrenia is more closely associated with tobacco smoking when compared with other severe mental illnesses. This second study, in a neighborhood hospital, tries to (1) replicate that schizophrenia is associated with smoking and heavy smoking, and (2) rule out that this relationship is explained by substance use. The methodology was very similar to the first study. The sample included 588 inpatients. Logistic regression was used to develop models of variables associated with smoking or heavy smoking. The frequency of current smoking for the total, schizophrenic and non-schizophrenic samples were respectively 71, 75, and 55%. The sequence of frequencies from the highest to lowest was the same as in the first study: male schizophrenic patients, male non-schizophrenic patients, female schizophrenic patients and female non-schizophrenic patients. This second study consistently replicated the relationship between schizophrenia and smoking (after correcting for other variables) including history of alcohol and drug abuse or dependence. Only one of two definitions of heavy smoking showed a significant association with schizophrenia. In summary, these two studies suggest that schizophrenia is strongly associated with smoking. Neither substance use, antipsychotics, nor institutionalism can explain this relationship.

  9. Comprehensive Geriatric Care in a Day Hospital: A Demonstration of the British Model in the United States.

    ERIC Educational Resources Information Center

    Morishita, Lynne; And Others

    1989-01-01

    Reviewed 273 medical records and interviewed 42 referring physicians to examine effectiveness of geriatric day hospital (GDH). Found that GDH provided intensive outpatient care, geriatric assessment, rehabilitation, and alternative to hospitalization: 21 percent of physician-referred patients would have been hospitalized without GDH, 7 percent…

  10. Ear, Nose and Throat Day-Case Surgery at a District General Hospital

    PubMed Central

    Pézier, T; Stimpson, P; Kanegaonkar, RG; Bowdler, DA

    2009-01-01

    INTRODUCTION In 2000, The NHS Plan in the UK set a target of 75% for all surgical activity to be performed as day-cases. We aim to assess day-case turnover for ENT procedures and, in particular, day-case rates for adult and paediatric otological procedures together with re-admissions within 72 h as a proxy measure of safety. PATIENTS AND METHODS Retrospective collection of data (procedure and length of stay) from the computerised theatre system (Galaxy) and Patient Information Management System (PIMS) of all elective patients operated over one calendar year. The setting was a district general hospital ENT department in South East England. All ENT operations are performed with the exception of oncological head and neck procedures and complex skull-base surgery. RESULTS Overall, 2538 elective operations were performed during the study period. A total of 1535 elective adult procedures were performed with 74% (1137 of 1535) performed as day-cases. Of 1003 paediatric operations, 73% (730 of 1003) were day-cases. Concerning otological procedures, 93.4% (311 of 333) of paediatric procedures were day-cases. For adults, we divided the procedures into major and minor, achieving day-case rates of 88% (93 of 101) and 91% (85 of 93), respectively. The overall day-case rate for otological procedures was 91% (528 of 580). Re-admission rates overall were 0.7% (11 of 1535) for adults and 0.9% (9 of 1003) for paediatric procedures. The most common procedure for re-admission was tonsillectomy accounting for 56% of all adult re-admissions and 78% of paediatric re-admissions. The were no deaths following day-case procedures. DISCUSSION ENT surgery is well-suited to a day-case approach. UK Government targets are attainable when considering routine ENT surgery. Day-case rates for otology in excess of targets are possible even when considering major ear surgery. PMID:19102826

  11. [Staff-patient meetings at the psychiatric unit of a university hospital center].

    PubMed

    Gelin, E; Havet, J M; Wargny-Citti, E; Lesage, V; Pascalis, G

    1987-10-01

    Staff/patients meetings have been held for 10 years within a mental teaching hospital for adults. The meeting was initiated by a clinical psychologist still in charge of it. The patients have developed the following themes: (i) entrance conditions, (ii) everyday life information, (iii) inconveniences, (iv) mental illness, (v) the exclusion process. The least severely affected patients will exclude the other ones on ground of insanity. Yet all patients consider themselves banned from society, and even feel rejected by the stall at times. The meeting is meant as a regular talk scène. Individual or collective conflicts arising between the patients can be settled there. Patient passivity may also be counteracted. Staff seminar should work up clearly the data provided by the meeting.

  12. The impact of the Great East Japan earthquake on mandatory psychiatric emergency hospitalizations in Tokyo: a retrospective observational study.

    PubMed

    Aoki, A; Aoki, Y; Harima, H

    2012-10-09

    On 11 March 2011, the eastern part of Japan was struck by a magnitude 9.0 quake. About 20 000 people were killed or were missing, and a nuclear crisis followed. In Tokyo, people were indirectly exposed to the earthquake and nuclear crisis by TV broadcast. The aim of our study was to evaluate the potential effect of the series of catastrophes on psychiatric emergency hospitalizations in Tokyo. Clinical records of patients who were mandatorily admitted to Tokyo Metropolitan Matsuzawa Hospital by law because of urgent risk to self or others were reviewed. Records regarding the 2 years of investigation, which include the 6 months after the earthquake, were reviewed. The six months after the earthquake were compared with the eighteen months before the earthquake in clinical and demographic data using independent t-tests or χ(2) tests. During the 6 months before and after the earthquake, 97 and 127 people were mandatorily admitted. χ(2) Tests demonstrated a significant increase in the number of patients after the earthquake (P = 0.045), attributable to the significant increase in the number of patients with schizophrenia after the earthquake (P = 0.011, 32 vs 56), whereas there were no significant differences in the number of patients with other diagnoses between those two periods. Independent t-tests revealed that patients admitted after the earthquake had marginally significantly shorter periods of education compared with those admitted before the earthquake (13.78 vs 12.82 years, P = 0.084). This work suggests that patients with schizophrenia were more sensitive to indirect exposure to the earthquake and that a shorter period of education was a potential risk factor.

  13. The impact of the Great East Japan earthquake on mandatory psychiatric emergency hospitalizations in Tokyo: a retrospective observational study

    PubMed Central

    Aoki, A; Aoki, Y; Harima, H

    2012-01-01

    On 11 March 2011, the eastern part of Japan was struck by a magnitude 9.0 quake. About 20 000 people were killed or weremissing, and a nuclear crisis followed. In Tokyo, people were indirectly exposed to the earthquake and nuclear crisis by TV broadcast. The aim of our study was to evaluate the potential effect of the series of catastrophes on psychiatric emergency hospitalizations in Tokyo. Clinical records of patients who were mandatorily admitted to Tokyo Metropolitan Matsuzawa Hospital by law because of urgent risk to self or others were reviewed. Records regarding the 2 years of investigation, which include the 6 months after the earthquake, were reviewed. The six months after the earthquake were compared with the eighteen months before the earthquake in clinical and demographic data using independent t-tests or χ2 tests. During the 6 months before and after the earthquake, 97 and 127 people were mandatorily admitted. χ2 Tests demonstrated a significant increase in the number of patients after the earthquake (P=0.045), attributable to the significant increase in the number of patients with schizophrenia after the earthquake (P=0.011, 32 vs 56), whereas there were no significant differences in the number of patients with other diagnoses between those two periods. Independent t-tests revealed that patients admitted after the earthquake had marginally significantly shorter periods of education compared with those admitted before the earthquake (13.78 vs 12.82 years, P=0.084). This work suggests that patients with schizophrenia were more sensitive to indirect exposure to the earthquake and that a shorter period of education was a potential risk factor. PMID:23032944

  14. Pediatric Day Case Surgical Practice at a Tertiary Hospital in Lagos: How Have We Faired?

    PubMed Central

    Elebute, OA; Ademuyiwa, AO; Bode, CO; Idiodi-Thomas, HOI

    2014-01-01

    Background: There has been a gradual increase in the number of patients treated as a day case surgery in our center. This study has been conducted to audit pediatric day case surgery practice at the Lagos University Teaching Hospital. Aims: The aim of the following study is to determine the morbidity and mortality from day case surgery in our center. Subjects and Methods: The type of study was a prospective study over a 2½ year period at the Lagos University Teaching Hospital. The patients scheduled for surgeries were assessed in the pediatric outpatient clinic and information obtained for each of the patients included age, sex, diagnosis and operation planned. Additional information collected included the (1) type of anesthesia (2) post-operative complications and the cadre of the surgeon. The data was analyzed using SPSS version 19 (IBM Corp. Released 2010. IBM SPSS Statistics for Windows, Version 19.0. Armonk, NY: IBM Corp, USA). Result: A total of 381 patients were operated during the study period. The age range of patients was 2 weeks to 15 years and the mean age was 2.9 years (3.0). There were 338 male patients (88.7%;338/381) and 43 females (11.3%;43/381). Inguinal hernias and hydroceles constituted almost half of the cases treated while 16.0% of cases were undescended testis. There were four morbidities and no mortality. Conclusion: Day case surgery is associated with a low morbidity and no mortality in our center. PMID:25221704

  15. [Recruitment and selection of human resources in a psychiatric hospital at a municipality of São Paulo].

    PubMed

    Mazon, L; Trevizan, M A

    2000-08-01

    This paper aims at disseminating the experience of recruiting and selecting human resources in a psychiatric hospital in the city of Ribeirão Preto, a philanthropic institution with one hundred and four beds that assists pharmaco-dependent patients with mental problems. It presently has eighty-four employees and a high staff turnover in different sectors. As trainees, we realized that the high turnover impaieds the development of activities at the organization as well as prevented a better care delivery to clients. Therefore, we were invited to integrate a team that was made responsible for the recruitment and selection of human resources for this institution. After these procedures and the respective follow-up by those in charge of different sectors, our purpose is to reduce the turnover, implement larger institutional engagement and more synchrony among employees, reduce expenses and bureaucratic activities related to hiring and laying off personnel, reduce operational work and implementing more assisting activities in terms of planning, orientation, execution and evaluation. PMID:11235244

  16. The politics of black patients' identity: ward-rounds on the 'black side' of a South African psychiatric hospital.

    PubMed

    Swartz, L

    1991-06-01

    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.

  17. The politics of black patients' identity: ward-rounds on the 'black side' of a South African psychiatric hospital.

    PubMed

    Swartz, L

    1991-06-01

    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

  18. Open-label treatment with risperidone of 26 psychiatrically-hospitalized children and adolescents with mixed diagnoses and aggressive behavior.

    PubMed

    Buitelaar, J K

    2000-01-01

    Open-label risperidone was administered to 26 subjects (24 boys: 19 with borderline IQ and 5 with mild mental retardation), 10-18 years old, who were hospitalized for treatment of psychiatric disorders associated with aggressive behavior. Risperidone was given in daily doses ranging from 0.5 to 4 mg for periods of 2-12 months. Treatment response was monitored by means of the improvement scale of the CGI and the modified OAS. Extrapyramidal side effects were measured on the ESRS. Fourteen (54%) of 26 subjects had a marked reduction in aggression; 10 subjects had a moderate reduction; two subjects had mild changes; and none worsened. Two subjects had a marked weight gain in the first 8 weeks of treatment. In seven of the 22 children who continued taking risperidone after week 8, tiredness and sedation that necessitated dose reduction emerged between weeks 8 and 16. These results suggest that risperidone may be useful when treating severe aggressive behavior in children and adolescents. Weight gain and sedation can be troublesome side effects.

  19. What happens when 55% of acute psychiatric beds are closed in six days: an unexpected naturalistic observational study

    PubMed Central

    Branch, Matt; Mitchell, Anji; Parkin, Lindsay; Confue, Phil; Shankar, Rohit; Wilson-James, Diane; Marshall, Mike; Edgecombe, Maria; Keaney, Bernie; Gill, Kiran; Harrison, Juliet

    2016-01-01

    Objective The sudden closure of 30 out of 54 acute psychiatric beds in Cornwall presented a stressful challenge to staff but also a natural experiment on how a service dealt with this situation. We aimed to evaluate the outcomes of patients needing to leave the closed ward, how bed occupancy rates were affected and the impact on admission rates. Design A service evaluation of the impact of the ward closure. Setting A comprehensive secondary NHS mental health service in Cornwall serving 550,000 population. Main outcome measures The destination of the patients needing to leave the acute unit, the effect of the closure on bed occupancy, admission rates and serious untoward incidents. Results Of 26 patients needing to be moved from the acute ward, only 10 needed an acute psychiatric bed. None of the seven patients who had been on the ward longer than nine weeks needed an acute unit. Admission rates fell over the subsequent three months. There was no increase in serious incidents due to the closure. Conclusions This naturalistic event suggests that many patients on acute units could be cared for elsewhere, especially recovery/rehabilitation care environments, if political and financial urgency is present. Admission rates are responsive to the pressure on beds. PMID:27757241

  20. Identifying reasons for delays in acute hospitals using the Day-of-Care Survey method.

    PubMed

    Reid, Erica; King, Andrew; Mathieson, Alex; Woodcock, Thomas; Watkin, Simon W

    2015-04-01

    This paper describes a new tool called 'Day-of-Care Survey', developed to assess inpatient delays in acute hospitals. Using literature review, iterative testing and feedback from professional groups, a national multidisciplinary team developed the survey criteria and methodology. Review teams working in pairs visited wards and used case records and bedside charts to assess the patient's status against severity of illness and service intensity criteria. Patients who did not meet the survey criteria for acute care were identified and delays were categorised. From March 2012 to December 2013, nine acute hospitals across Scotland, Australia and England were surveyed. A total of 3,846 adult general inpatient beds (excluding intensive care and maternity) were reviewed. There were 145 empty beds at the time of surveys across the nine sites, with 270 definite discharges planned on the day of the survey. The total number of patients not meeting criteria for acute care was 798/3,431 (23%, range 18-28%). Six factors accounted for 61% (490/798) of the reasons why patients not meeting acute care criteria remained in hospital. This survey gives important insights into the challenges of managing inpatient flow using system level information as a method to target interventions designed to address delay. PMID:25824060

  1. Identifying reasons for delays in acute hospitals using the Day-of-Care Survey method.

    PubMed

    Reid, Erica; King, Andrew; Mathieson, Alex; Woodcock, Thomas; Watkin, Simon W

    2015-04-01

    This paper describes a new tool called 'Day-of-Care Survey', developed to assess inpatient delays in acute hospitals. Using literature review, iterative testing and feedback from professional groups, a national multidisciplinary team developed the survey criteria and methodology. Review teams working in pairs visited wards and used case records and bedside charts to assess the patient's status against severity of illness and service intensity criteria. Patients who did not meet the survey criteria for acute care were identified and delays were categorised. From March 2012 to December 2013, nine acute hospitals across Scotland, Australia and England were surveyed. A total of 3,846 adult general inpatient beds (excluding intensive care and maternity) were reviewed. There were 145 empty beds at the time of surveys across the nine sites, with 270 definite discharges planned on the day of the survey. The total number of patients not meeting criteria for acute care was 798/3,431 (23%, range 18-28%). Six factors accounted for 61% (490/798) of the reasons why patients not meeting acute care criteria remained in hospital. This survey gives important insights into the challenges of managing inpatient flow using system level information as a method to target interventions designed to address delay.

  2. Factors Affecting the Agreement Between Emergency Psychiatrists and General Practitioners Regarding Involuntary Psychiatric Hospitalizations.

    PubMed

    Geoffroy, Pierre Alexis; Duhamel, Alain; Behal, Hélène; Zouitina-Lietaert, Nadia; Duthilleul, Julie; Marquette, Louise; Ducrocq, François; Vaiva, Guillaume; Rolland, Benjamin

    2016-06-21

    Important discrepancies exist between physicians in deciding when to perform involuntary hospitalization measures (IHMs). The factors underlying these differences are poorly known.We conducted a two-year single-center retrospective study in France on patients who were referred to the emergency department (ED) with an IHM certificate written by a private-practice General Practitioner (GP). For each consultation, the official IHM motive was categorized into four groups: Suicide; Psychosis, Mania, or Melancholia (PMM); Agitation; and Other. The alcohol status of the patient was also noted. The factors underlying the ED psychiatrists' confirmation of the use of IHMs were determined using a logistic regression model. One hundred eighty-nine cases were found (165 patients; 44.2 ± 16 years, 41.3% women). The ED psychiatrists confirmed the use of IHMs in 123 instances (65.1% agreement rate). Multivariate analyses found that IHM disagreement was significantly associated with patient alcohol status and the reason for referral. Specifically, there was an increased risk of IHM disagreement when the patient had an alcohol-positive status (OR = 15.80; 95% CI [6.45-38.67]; p < 0.0001) and when the motive for IHM was "agitation" compared with "suicide" (OR = 11.44; 95% CI[3.38-38.78]; p < 0.0001). These findings reflect significant disparities between GPs and ED psychiatrists regarding the decision to proceed to an IHM.

  3. Factors Affecting the Agreement Between Emergency Psychiatrists and General Practitioners Regarding Involuntary Psychiatric Hospitalizations

    PubMed Central

    Geoffroy, Pierre Alexis; Duhamel, Alain; Behal, Hélène; Zouitina-Lietaert, Nadia; Duthilleul, Julie; Marquette, Louise; Ducrocq, François; Vaiva, Guillaume; Rolland, Benjamin

    2016-01-01

    Important discrepancies exist between physicians in deciding when to perform involuntary hospitalization measures (IHMs). The factors underlying these differences are poorly known. We conducted a two-year single-center retrospective study in France on patients who were referred to the emergency department (ED) with an IHM certificate written by a private-practice General Practitioner (GP). For each consultation, the official IHM motive was categorized into four groups: Suicide; Psychosis, Mania, or Melancholia (PMM); Agitation; and Other. The alcohol status of the patient was also noted. The factors underlying the ED psychiatrists’ confirmation of the use of IHMs were determined using a logistic regression model. One hundred eighty-nine cases were found (165 patients; 44.2 ± 16 years, 41.3% women). The ED psychiatrists confirmed the use of IHMs in 123 instances (65.1% agreement rate). Multivariate analyses found that IHM disagreement was significantly associated with patient alcohol status and the reason for referral. Specifically, there was an increased risk of IHM disagreement when the patient had an alcohol-positive status (OR = 15.80; 95% CI [6.45–38.67]; p < 0.0001) and when the motive for IHM was “agitation” compared with “suicide” (OR = 11.44; 95% CI[3.38–38.78]; p < 0.0001). These findings reflect significant disparities between GPs and ED psychiatrists regarding the decision to proceed to an IHM. PMID:27324574

  4. Neopositivism and the DSM psychiatric classification. An epistemological history. Part 2: Historical pathways, epistemological developments and present-day needs.

    PubMed

    Aragona, Massimiliano

    2013-12-01

    Little is known about the concrete historical sources for the use of neopositivist operational criteria by the DSM-III. This paper suggests that distinct sources operated implicitly. The current usefulness of the operational approach is questioned. It is shown that: (a) in epistemology, neopositivism has been replaced by more adequate accounts; (b) psychologists rejected operational definitions because these were unable to define the majority of mental phenomena; (c) mental symptoms cannot be directly described as such, because they already make part of the psychiatric diagnosis to which they belong. In conclusion, diagnosing is based on the hermeneutical co-construction of mental symptoms. The failure of the neopositivist programme suggests that it is time to reconcile scientific formalization and semiotic activity. PMID:24573752

  5. Analyzing health insurance claims on different timescales to predict days in hospital.

    PubMed

    Xie, Yang; Schreier, Günter; Hoy, Michael; Liu, Ying; Neubauer, Sandra; Chang, David C W; Redmond, Stephen J; Lovell, Nigel H

    2016-04-01

    Health insurers maintain large databases containing information on medical services utilized by claimants, often spanning several healthcare services and providers. Proper use of these databases could facilitate better clinical and administrative decisions. In these data sets, there exists many unequally spaced events, such as hospital visits. However, data mining of temporal data and point processes is still a developing research area and extracting useful information from such data series is a challenging task. In this paper, we developed a time series data mining approach to predict the number of days in hospital in the coming year for individuals from a general insured population based on their insurance claim data. In the proposed method, the data were windowed at four different timescales (bi-monthly, quarterly, half-yearly and yearly) to construct regularly spaced time series features extracted from such events, resulting in four associated prediction models. A comparison of these models indicates models using a half-yearly windowing scheme delivers the best performance on all three populations (the whole population, a senior sub-population and a non-senior sub-population). The superiority of the half-yearly model was found to be particularly pronounced in the senior sub-population. A bagged decision tree approach was able to predict 'no hospitalization' versus 'at least one day in hospital' with a Matthews correlation coefficient (MCC) of 0.426. This was significantly better than the corresponding yearly model, which achieved 0.375 for this group of customers. Further reducing the length of the analysis windows to three or two months did not produce further improvements.

  6. Analyzing health insurance claims on different timescales to predict days in hospital.

    PubMed

    Xie, Yang; Schreier, Günter; Hoy, Michael; Liu, Ying; Neubauer, Sandra; Chang, David C W; Redmond, Stephen J; Lovell, Nigel H

    2016-04-01

    Health insurers maintain large databases containing information on medical services utilized by claimants, often spanning several healthcare services and providers. Proper use of these databases could facilitate better clinical and administrative decisions. In these data sets, there exists many unequally spaced events, such as hospital visits. However, data mining of temporal data and point processes is still a developing research area and extracting useful information from such data series is a challenging task. In this paper, we developed a time series data mining approach to predict the number of days in hospital in the coming year for individuals from a general insured population based on their insurance claim data. In the proposed method, the data were windowed at four different timescales (bi-monthly, quarterly, half-yearly and yearly) to construct regularly spaced time series features extracted from such events, resulting in four associated prediction models. A comparison of these models indicates models using a half-yearly windowing scheme delivers the best performance on all three populations (the whole population, a senior sub-population and a non-senior sub-population). The superiority of the half-yearly model was found to be particularly pronounced in the senior sub-population. A bagged decision tree approach was able to predict 'no hospitalization' versus 'at least one day in hospital' with a Matthews correlation coefficient (MCC) of 0.426. This was significantly better than the corresponding yearly model, which achieved 0.375 for this group of customers. Further reducing the length of the analysis windows to three or two months did not produce further improvements. PMID:26827621

  7. Risk Factors for 30-Day Hospital Readmission among General Surgery Patients

    PubMed Central

    Kassin, Michael T; Owen, Rachel M; Perez, Sebastian; Leeds, Ira; Cox, James C; Schnier, Kurt; Sadiraj, Vjollca; Sweeney, John F

    2012-01-01

    Background Hospital readmission within 30-days of an index hospitalization is receiving increased scrutiny as a marker of poor quality patient care. This study identifies factors associated with 30-day readmission following General Surgery procedures. Study Design Using standard National Surgical Quality Improvement Project (NSQIP) protocol, preoperative, intraoperative, and postoperative outcomes were collected on patients undergoing inpatient General Surgery procedures at a single academic center between 2009 and 2011. Data were merged with our institutional clinical data warehouse to identify unplanned 30-day readmissions. Demographics, comorbidities, type of procedure, postoperative complications, and ICD-9 coding data were reviewed for patients who were readmitted. Univariate and multivariate analysis was utilized to identify risk factors associated with 30-day readmission. Results 1442 General Surgery patients were reviewed. 163 (11.3%) were readmitted within 30 days of discharge. The most common reasons for readmission were gastrointestinal complaint/complication (27.6%), surgical infection (22.1%), and failure to thrive/malnutrition (10.4%). Comorbidities associated with risk of readmission included disseminated cancer, dyspnea, and preoperative open wound (p<0.05 for all variables). Surgical procedures associated with higher rates of readmission included pancreatectomy, colectomy, and liver resection. Postoperative occurrences leading to increased risk of readmission were blood transfusion, postoperative pulmonary complication, wound complication, sepsis/shock, urinary tract infection, and vascular complications. Multivariable analysis demonstrates that the most significant independent risk factor for readmission is the occurrence of any postoperative complication (OR 4.20, 95% CI 2.89–6.13). Conclusions Risk factors for readmission after General Surgery procedures are multi-factorial; however, postoperative complications appear to drive readmissions in

  8. Use of mortality within 30 days of a COPD hospitalisation as a measure of COPD care in UK hospitals.

    PubMed

    Walker, P P; Thompson, E; Crone, H; Flatt, G; Holton, K; Hill, S L; Pearson, M G

    2013-10-01

    Mortality rate has been proposed as a metric of hospital chronic obstructive pulmonary disease (COPD) care in light of variation seen in national COPD audits. Using Hospital Episode Statistics (hospital 'coding') we examined 30-day mortality after COPD hospitalisation in 150 UK hospitals during 2006-2007 and 2007-2008. Mean and median 30-day mortalities were similar each year but the coefficient of variation was >20% and hospitals could change from a low or high quartile to the median by chance. We could not detect any reasons for hospitals being at the extremes. 30-day mortality after COPD hospitalisation is a complex variable and unlikely to be useful as a primary annual COPD metric.

  9. Days of heroin use predict poor self-reported health in hospitalized heroin users.

    PubMed

    Meshesha, Lidia Z; Tsui, Judith I; Liebschutz, Jane M; Crooks, Denise; Anderson, Bradley J; Herman, Debra S; Stein, Michael D

    2013-12-01

    This study examined associations between substance use behaviors and self-reported health among hospitalized heroin users. Of the 112 participants, 53 (47%) reported good or better health. In multivariable logistic regression models, each day of heroin use in the last month was associated with an 8% lower odds of reporting health as good or better (OR=.92; 95% CI 0.87, 0.97, p<.05). Cocaine, cannabis, cigarettes, alcohol use, unintentional overdose, nor injection drug use was associated with health status. PMID:24045030

  10. Examination of hospital characteristics and patient quality outcomes using four inpatient quality indicators and 30-day all-cause mortality.

    PubMed

    Carretta, Henry J; Chukmaitov, Askar; Tang, Anqi; Shin, Jihyung

    2013-01-01

    The study objective was to examine hospital mortality outcomes and structure using 2008 patient-level discharges from general community hospitals. Discharges from Florida administrative files were merged to the state mortality registry. A cross-sectional analysis of inpatient mortality was conducted using Inpatient Quality Indicators (IQIs) for acute myocardial infarction (AMI), congestive heart failure (CHF), stroke, pneumonia, and all-payer 30-day postdischarge mortality. Structural characteristics included bed size, volume, ownership, teaching status, and system affiliation. Outcomes were risk adjusted using 3M APR-DRG. Volume was inversely correlated with AMI, CHF, stroke, and 30-day mortality. Similarities and differences in the direction and magnitude of the relationship of structural characteristics to 30-day postdischarge and IQI mortality measures were observed. Hospital volume was inversely correlated with inpatient mortality outcomes. Other hospital characteristics were associated with some mortality outcomes. Further study is needed to understand the relationship between 30-day postdischarge mortality and hospital quality.

  11. [The day-to-day routine in hospitals--standards and conflicts, based on the example of the Rothschild spital in Vienna around the year 1900].

    PubMed

    Malleier, Elisabeth

    2014-01-01

    The juxtaposition of official regulations and letters of complaint from Vienna's Rothschild Hospital shows, beyond the rhetoric and euphemisms of hospital reports, how lively and diverse day-to-day life was in a Jewish hospital around the year 1900. The letters of complaint query the official hospital rules and show that ideal and reality did not always coincide. Often, religious questions were at the root of the critique--such as doubts as to whether kosher dietary laws were adhered to--or conflicts between the agents involved, be they individuals or groups, patients, nurses, physicians or administrative staff. As part of this process, power structures, social hierarchies, patient rights and gender issues were called into question and renegotiated. PMID:25134251

  12. An Approach to the Teaching of Psychiatric Nursing in Diploma and Associate Degree Programs: Workshop Report.

    ERIC Educational Resources Information Center

    National League for Nursing, New York, NY. Mental Health and Psychiatric Nursing Advisory Service.

    This workshop was the third and final phase of a project to determine what goals, methods, content, and learning experiences in psychiatric-mental health nursing should be included in diploma and associate degree education for nursing in light of present day trends in psychiatric care. The project indicates that the hospital is no longer the focal…

  13. [Prospective assessment of children with pervasive developmental disorder after 2 years of day-hospital treatment].

    PubMed

    Poinso, F; Dubois, B; Chatel, C; Viellard, M; Bastard-Rosset, D; Girardot, A-M; Grandgeorge, P; De Martino, S; Sokolowsky, M; Salle-Collemiche, X; Da Fonseca, D

    2013-01-01

    The treatment of children with pervasive developmental disorders (PDD) has not been systematically assessed in French day-care units. In this prospective study, 11 children with a diagnosis of PDD were followed up for 2years in a day-care unit in the Marseille university hospital. The treatment they received is based on an initial assessment by the "Centre Ressources Autisme" (CRA PACA) and further included a continued observation of the child and an assessment of the child's abilities and needs. This treatment used various therapeutic approaches 10h weekly and also included parental counseling and coordinated work with schools. Treatment in our day-care unit can be categorized as eclectic, non-intensive therapy. It is based on methods such as TEACCH (Treatment and Education of Autistic and related Communication handicapped Children), Floor Time Play, speech and language therapy, developmental therapy, and psychotherapy. International studies on intensive behavioral therapies suggest that this treatment is superior to non-behavioral and/or non-intensive treatment. They suggest its efficiency is due both to the nature of the treatment (behavioral) and to its intensity (more than 25h a week). In this study, the CRA diagnosed children using the ADI and ADOS. The 11 children (mean age, 3years 5months) were tested twice, with the Vineland and CARS scales. The first assessment was on admission to the day hospital and the second was 2years later. The results showed developmental progress with a mean increase of 13.5 months at the Vineland Scale, and a decrease of the autism severity score on the CARS. The treatment presented here proves to be efficient; if compared to similar results in international studies, we obtained better results than their eclectic intensive or non-intensive treatment comparison group.

  14. Peritoneal Dialysis Reduces the Number of Hospitalization Days in Heart Failure Patients Refractory to Diuretics

    PubMed Central

    Courivaud, Cécile; Kazory, Amir; Crépin, Thomas; Azar, Raymond; Bresson-Vautrin, Catherine; Chalopin, Jean-Marc; Ducloux, Didier

    2014-01-01

    ♦ Background: Previous small studies have reported favorable results of peritoneal dialysis (PD) in the setting of chronic refractory heart failure (CRHF). We evaluated the impact of PD in a larger cohort of patients with CHRF where end-stage renal disease was excluded. ♦ Methods: All patients who received PD therapy for CRHF between January 1995 and December 2010 in two medical centers in France were included in this retrospective study. Baseline characteristics were compared with clinical parameters during the first year after initiation of PD. Mortality, safety, and sustainability of PD were also analyzed. ♦ Results: The 126 patients included had a mean age of 72 ± 11 years and an estimated glomerular filtration rate of 33.5 ± 15.1 mL/min/1.73 m2. Mean time on PD was 16 ± 16.6 months. During the first year, patients with a left ventricular ejection fraction (LVEF) of 30% or less experienced improvement in cardiac function (30% ± 10% vs 20% ± 6%, p < 0.0001). We observed a significant reduction in the number of days of hospitalization for acute decompensated heart failure after PD initiation (3.3 ± 2.6 days/patient-month vs 0.3 ± 0.5 days/patient-month, p < 0.0001). One-year mortality was 42%. ♦ Conclusions: In CRHF, PD significantly reduces the number of days of hospitalization for acute heart failure. Improved LVEF may have led to the comparatively good 1-year survival in this cohort. PMID:23994842

  15. The ecological relationship between deprivation, social isolation and rates of hospital admission for acute psychiatric care: a comparison of London and New York City.

    PubMed

    Curtis, Sarah; Copeland, Alison; Fagg, James; Congdon, Peter; Almog, Michael; Fitzpatrick, Justine

    2006-03-01

    We report on comparative analyses of small area variation in rates of acute hospital admissions for psychiatric conditions in Greater London around the year 1998 and in New York City (NYC) in 2000. Based on a theoretical model of the factors likely to influence psychiatric admission rates, and using data from the most recent population censuses and other sources, we examine the association with area indicators designed to measure access to hospital beds, socio-economic deprivation, social fragmentation and ethnic/racial composition. We report results on admissions for men and women aged 15-64 for all psychiatric conditions (excluding self-harm), drug-related substance abuse/addiction, schizophrenia and affective disorders. The units of analysis in NYC were 165 five-digit Zip Code Areas and, in London, 760 electoral wards as defined in 1998. The analysis controls for age and sex composition and, as a proxy for access to care, spatial proximity to hospitals with psychiatric beds. Poisson regression modeling incorporating random effects was used to control for both overdispersion in the counts of admissions and for the effects of spatial autocorrelation. The results for NYC and London showed that local admission rates for all types of condition were positively and significantly associated with deprivation and the association is independent of demographic composition or 'access' to beds. In NYC, social fragmentation showed a significant association with admissions due to affective disorders and schizophrenia, and for drug dependency among females. Racial minority concentration was significantly and positively associated with admissions for schizophrenia. In London, social fragmentation was associated positively with admissions for men and women due to schizophrenia and affective disorders. The variable measuring racial/ethnic minority concentration for London wards showed a negative association with admission rates for drug dependency and for affective disorders. We

  16. The ecological relationship between deprivation, social isolation and rates of hospital admission for acute psychiatric care: a comparison of London and New York City.

    PubMed

    Curtis, Sarah; Copeland, Alison; Fagg, James; Congdon, Peter; Almog, Michael; Fitzpatrick, Justine

    2006-03-01

    We report on comparative analyses of small area variation in rates of acute hospital admissions for psychiatric conditions in Greater London around the year 1998 and in New York City (NYC) in 2000. Based on a theoretical model of the factors likely to influence psychiatric admission rates, and using data from the most recent population censuses and other sources, we examine the association with area indicators designed to measure access to hospital beds, socio-economic deprivation, social fragmentation and ethnic/racial composition. We report results on admissions for men and women aged 15-64 for all psychiatric conditions (excluding self-harm), drug-related substance abuse/addiction, schizophrenia and affective disorders. The units of analysis in NYC were 165 five-digit Zip Code Areas and, in London, 760 electoral wards as defined in 1998. The analysis controls for age and sex composition and, as a proxy for access to care, spatial proximity to hospitals with psychiatric beds. Poisson regression modeling incorporating random effects was used to control for both overdispersion in the counts of admissions and for the effects of spatial autocorrelation. The results for NYC and London showed that local admission rates for all types of condition were positively and significantly associated with deprivation and the association is independent of demographic composition or 'access' to beds. In NYC, social fragmentation showed a significant association with admissions due to affective disorders and schizophrenia, and for drug dependency among females. Racial minority concentration was significantly and positively associated with admissions for schizophrenia. In London, social fragmentation was associated positively with admissions for men and women due to schizophrenia and affective disorders. The variable measuring racial/ethnic minority concentration for London wards showed a negative association with admission rates for drug dependency and for affective disorders. We

  17. Efficacy of treatment for hyperglycemic crisis in elderly diabetic patients in a day hospital

    PubMed Central

    Benaiges, D; Chillarón, JJ; Carrera, MJ; Cots, F; Puig de Dou, J; Corominas, E; Pedro-Botet, J; Flores-Le Roux, JA; Claret, C; Goday, A; Cano, JF

    2014-01-01

    Background The purpose of this prospective cohort study was to compare the costs of day hospital (DH) care for hyperglycemic crisis in elderly diabetic patients with those of conventional hospitalization (CH). Secondary objectives were to compare these two clinical scenarios in terms of glycemic control, number of emergency and outpatient visits, readmissions, hypoglycemic episodes, and nosocomial morbidity. Methods The study population comprised diabetic patients aged >74 years consecutively admitted to a tertiary teaching hospital in Spain for hyperglycemic crisis (sustained hyperglycemia [>300 mg/dL] for at least 3 days with or without ketosis). The patients were assigned to DH or CH care according to time of admission and were followed for 6 months after discharge. Exclusion criteria were ketoacidosis, hyperosmolar crisis, hemodynamic instability, severe intercurrent illness, social deprivation, or Katz index >D. Results Sixty-four diabetic patients on DH care and 36 on CH care were included, with no differences in baseline characteristics. The average cost per patient was 1,345.1±793.6 € in the DH group and 2,212.4±982.5 € in the CH group (P<0.001). There were no differences in number of subjects with mild hypoglycemia during follow-up (45.3% DH versus 33.3% CH, P=0.24), nor in the percentage of patients achieving a glycated hemoglobin (HbA1c) <8% (67.2% DH versus 58.3% CH, P=0.375). Readmissions for hyperglycemic crisis and pressure ulcer rates were significantly higher in the CH group. Conclusion DH care for hyperglycemic crises is more cost-effective than CH care, with a net saving of 1,418.4 € per case, lower number of readmissions and pressure ulcer rates, and similar short-term glycemic control and hypoglycemia rates. PMID:24868152

  18. A nurse-physician co-leadership model in psychiatric hospitals: results of a survey among leading staff members in three sites.

    PubMed

    Steinert, Tilman; Goebel, Rita; Rieger, Wolfgang

    2006-12-01

    In three psychiatric hospitals in Baden-Wuerttemberg, Germany, a physician-nurse shared leadership model was implemented in 1997 by the hospital management. The whole hospital, departments, and single wards are led each by a leadership team consisting of a physician, psychologist or social worker and a nurse, being responsible for organization, staff, and budgets. The consequences for staff opinion in leadership positions were evaluated. All 165 leading staff members of all professional groups were anonymously interviewed with a questionnaire containing 45 items regarding their satisfaction with this new leadership model. The response rate was 79.4%. Overall, the leading staff members were satisfied with the shared leadership model both in their own clinical practice and in general. Non-medical staff members were significantly more in favour of several aspects of shared leadership than physicians, but even the latter reported to be generally satisfied. However, both professional groups estimated leading positions to be only modestly attractive. The results yield some evidence that the change from traditional leadership models to the physician-nurse shared leadership model may have advantages in the management of psychiatric hospitals. PMID:17064321

  19. A nurse-physician co-leadership model in psychiatric hospitals: results of a survey among leading staff members in three sites.

    PubMed

    Steinert, Tilman; Goebel, Rita; Rieger, Wolfgang

    2006-12-01

    In three psychiatric hospitals in Baden-Wuerttemberg, Germany, a physician-nurse shared leadership model was implemented in 1997 by the hospital management. The whole hospital, departments, and single wards are led each by a leadership team consisting of a physician, psychologist or social worker and a nurse, being responsible for organization, staff, and budgets. The consequences for staff opinion in leadership positions were evaluated. All 165 leading staff members of all professional groups were anonymously interviewed with a questionnaire containing 45 items regarding their satisfaction with this new leadership model. The response rate was 79.4%. Overall, the leading staff members were satisfied with the shared leadership model both in their own clinical practice and in general. Non-medical staff members were significantly more in favour of several aspects of shared leadership than physicians, but even the latter reported to be generally satisfied. However, both professional groups estimated leading positions to be only modestly attractive. The results yield some evidence that the change from traditional leadership models to the physician-nurse shared leadership model may have advantages in the management of psychiatric hospitals.

  20. Diagnostic delays and dilemmas. Management of affected patients in the psychiatric inpatient unit of a general children's hospital.

    PubMed

    Fennig, S; Fennig, S

    1999-01-01

    We present the role of the medical-psychiatric unit in the management of children and adolescents with somatic symptoms in whom diagnosis remains uncertain or delayed, which can lead to severe impairment in the child's normal development and functioning and cause anger and hostility in the families. We describe two patients, one with cyclic vomiting syndrome, considered a medical disorder, and the other with conversion disorder, considered a psychiatric disorder. Both patients had had multiple ER admissions and outpatient visits with elaborate and expensive diagnostic workups. On admission to our unit, a coherent and integrated treatment plan was finally formulated and successfully implemented. We discuss the advantage of the medical-psychiatric unit for simultaneous medical and psychosocial intervention early in the development of symptoms and signs. The units need to be ready and able to cope with a wide range of medical and psychiatric disorders with different levels of gravity. PMID:10228893

  1. [Adverse perinatal and infant outcomes among children born to mothers with major mental disorders in a psychiatric hospital in Rio de Janeiro, Brazil].

    PubMed

    Pereira, Priscila Krauss; Vieira, Cláudia Lima; Santos, Jacqueline Fernandes de Cintra; Lima, Lúcia Abelha; Legay, Letícia Fortes; Lovisi, Giovanni Marcos

    2014-08-01

    Adverse perinatal and infant outcomes are the leading causes of infant morbidity and mortality in developing countries like Brazil. Among the risk factors are maternal mental disorders. A retrospective longitudinal study was conducted based on passive follow-up using probabilistic record linkage to estimate the prevalence of adverse perinatal and infant outcomes in children of women admitted to a public psychiatric hospital in Rio de Janeiro, Brazil, and who gave birth from 1999 to 2009. Prevalence rates were: low birth weight (27.6%), prematurity (17.4%), malformations (2.5%), stillbirths (4.8%), and neonatal deaths (3.7%). Associated factors were deficient prenatal care, schizophrenia, and low income. The results corroborate the high prevalence of adverse perinatal and infant outcomes in mothers with major mental disorders, and that screening of psychiatric symptoms and specialized care by mental health professionals are essential throughout prenatal and postpartum care.

  2. Application of Barcoding to Reduce Error of Patient Identification and to Increase Patient's Information Confidentiality of Test Tube Labelling in a Psychiatric Teaching Hospital.

    PubMed

    Liu, Hsiu-Chu; Li, Hsing; Chang, Hsin-Fei; Lu, Mei-Rou; Chen, Feng-Chuan

    2015-01-01

    Learning from the experience of another medical center in Taiwan, Kaohsiung Municipal Kai-Suan Psychiatric Hospital has changed the nursing informatics system step by step in the past year and a half . We considered ethics in the original idea of implementing barcodes on the test tube labels to process the identification of the psychiatric patients. The main aims of this project are to maintain the confidential information and to transport the sample effectively. The primary nurses had been using different work sheets for this project to ensure the acceptance of the new barcode system. In the past two years the errors in the blood testing process were as high as 11,000 in 14,000 events per year, resulting in wastage of resources. The actions taken by the nurses and the new barcode system implementation can improve the clinical nursing care quality, safety of the patients, and efficiency, while decreasing the cost due to the human error. PMID:26262221

  3. Improving acute psychiatric hospital services according to inpatient experiences. A user-led piece of research as a means to empowerment.

    PubMed

    Walsh, Jim; Boyle, Joan

    2009-01-01

    This paper has been undertaken by people with experience with mental health issues and mental health care systems. The aim of the research was to explore psychiatric inpatients' strategies for coping with mental ill health and in what ways acute inpatient psychiatric hospital services are facilitative to the individual attempting recovery. Ten focus groups were facilitated and data were analysed through systematic content analysis. Findings revealed that the main areas of concern for inpatients were: information, communication, relationships, activities, self-help, patient involvement in care treatment plans, and the physical environment. The authors also make a case to improve the status of user-led research as a means to understand the needs of mental health service users. PMID:19148819

  4. Occupational exposure to blood-borne pathogens in a tertiary hospital: benchmarking using patient days.

    PubMed

    Mazi, Waleed; Senok, Abiola C; Assiri, Abdullah M; Kazem, Najla; Abato, Avigail Tan

    2015-03-01

    Incidence and risk factors for occupational exposure to blood-borne pathogens (OEBBPs) in a tertiary hospital in Saudi Arabia was assessed. Reported sharps injuries from 2009 to 2010 were analyzed and benchmarked using patient days. OEBBPs caused by sharps injuries increased from 41 in 2009 to 65 in 2010, with an incidence rate of 4.09/10 000 patient days in 2009 and 5.9/10 000 patient days in 2010. Most episodes (41%) occurred during recapping of hollow bore needles after obtaining blood specimens. The highest incidence was among nursing staff(n/N = 87/106; 82%), and injuries also occurred in housekeeping staff (3.7%). A correlationbetween morning shift and OEBBPs was observed, and the highest number of episodes occurred in the emergency room (21.5%) and renal dialysis unit (16.9%). There was exposure to HCV (n = 13) and HBV (n = 4) but not to HIV (n = 0), and no seroconversions were documented. Education on adherence to universal precaution measures and use of safety engineered devices as well as the introduction of an OEBBP notification hotline are recommended.

  5. The characteristics of advanced cancer patients followed at home, but admitted to the hospital for the last days of life.

    PubMed

    Mercadante, Sebastiano; Masedu, Francesco; Valenti, Marco; Mercadante, Alessandro; Aielli, Federica

    2016-08-01

    Information regarding advanced cancer patients followed at home who are admitted to the hospital in the last days of life are lacking. The aim of this study was to assess the characteristics of patients who were hospitalized in the last days of life after being assisted by a home palliative care team. The secondary outcome was to identify possible risk factors for hospitalization. The charts were analyzed of a consecutive sample of advanced cancer patients admitted to hospital wards in the last days of life after being followed at home by a palliative care team. Of 550 consecutive patients followed at home, 138 (25.1 %) were admitted to the hospital. Younger patients were more likely to die in the hospital. In a logistic risk analysis adjusted for age, patients with lung and head-neck cancer were more likely to die in the hospital. Patients having a female relative or a female consort as a caregiver were more likely to die at home. CAGE-positive patients (7.25 %), and patients with a shorter period of home assistance were more likely transported to hospital before dying (p = 0.00 and p < 0.024, respectively). The most frequent reason for hospital admission was dyspnea. Admission was more frequent to the oncology ward. Patients who were admitted to the hospital died after a mean of 10.2 days (SD 8.2, range 0-40). This study provides preliminary data on the risk factors of hospitalization at the end of life for advanced cancer patients followed at home.

  6. [Mental health care: listening to patients discharged from a day hospital].

    PubMed

    Ferreira, Maria Solange de Castro; Pereira, Maria Alice Ornellas

    2012-01-01

    This is a qualitative study aiming at understanding how patients discharged from a Mental Health Day Hospital view the service, at learning whether such service contributed to changes in their lives and at whether those individuals continued treatment. Semi-structured interviews and documental research were used for nine patients who had completed treatment at the service in 2008. Thematic analysis was adopted for organization of the data obtained, which were analyzed according to the Psychosocial Rehabilitation framework. It emphasizes the importance of looking for the various subjective aspects of human existence, requiring from services and professionals the establishment of a caring relationship that enables the reconstruction of trajectories interrupted by the onset of the disease, through actions that consider the integrality and intersectionality.

  7. [Patients' experiences and picture processes during the art therapy in a psychosomatic day hospital].

    PubMed

    Oster, Jörg; Poetsch, Stephanie; Danner-Weinberger, Alexandra; von Wietersheim, Jörn

    2014-02-01

    The aim of this study was the examination of the experiences of patients participating in an art therapy during a psychosomatic day hospital. The data basis were 15 transliterated interviews from the end of the treatment, conducted with a presentation of the pictures painted in the art therapy sessions, as well as the digitised pictures. The evaluation was done with a qualitative analysis of the interviews and an analysis of the pictures, using a specially-developed category system. In the art therapy, most part of the pa-tients dealt with own conflicts. Nearly all pa-tients benefitted from the art therapy and indicated an improvement of their feeling. The picture processes are different; at the beginning, wishes and familiar techniques dominated. Pictures of turning points differed in their dimensions. The art therapy was seen as a part of the complete treatment in which several therapies assembled. The final interviews were experienced as helpful for further reflections.

  8. Analysis of Time-of-Day Energy Demand and Supply in University and Hospital

    NASA Astrophysics Data System (ADS)

    Shimazaki, Yoichi

    The aim of this study was to estimate the time-of-day energy demand in University of Yamanashi. Our University consisted of Kofu campus (Faculty of Education & Human Sciences and Faculty of Engineering) and Faculty of Medicine campus (Faculty of Medicine and University Hospital). The energy data of 4 facilities were classified into hot water, heating, cooling and electric power demands based on electric power consumptions, city gas and heavy oil from 1996 to 2005. For 10 years, primary energy increased 1.2 times in the whole of the university. The amount of electric power consumption was 63% in the fuel classification. The amount of electric power consumption of faculty reacted to the change in temperature greatly. In 2005, it was found that thermoelectric-ratios for 4 facilities, i.e. Education, Engineering, Medicine and Hospital were 2.3, 1.5, 2.0 and 2.7 respectively. These data are very useful for the energy saving and energy management of university.

  9. [Place of psychoanalysis in a day hospital for psychotic little children].

    PubMed

    Klein, F; Boucharlat, R; Cartier-Bresson, M; Graveleau, M T; Ribas, D

    1983-12-15

    The authors try to draw conclusions from Winnicot's articles on the discontinous nature of emotional development. They try to understand how autism may originate in disruptions of self-non-self" attachments. However, they admit that the child's personality may develop even within such disruptions. In an experiment of intensive care in a day-hospital for autistic or psychotic children they have tried to restore these attachments in the hospital itself, through continuous care by each member of the staff, regardless of qualification or training. This continuity provides a basis for relationships which may be voiced and interpreted during the children's therapy as they share this reference experience. Its continuity makes life in the institution therapeutic in itself, even without psychoanalytic interpretations. The lack of spoken language gives rise to communication difficulties and use of an educated self is a current project. Two clinical observations exemplify the parallel work of parents and children and their reciprocal interactions. As the origin and future of these psychoses are still open questions, the possible responsibility of predisposing or initial fragilizing factors which facilitate this lasting personality organization is to be considered.

  10. Effect of Hospital Use of Oral Nutritional Supplementation on Length of Stay, Hospital Cost, and 30-Day Readmissions Among Medicare Patients With COPD

    PubMed Central

    Snider, Julia Thornton; Linthicum, Mark T.; Hegazi, Refaat A.; Partridge, Jamie S.; LaVallee, Chris; Lakdawalla, Darius N.; Wischmeyer, Paul E.

    2015-01-01

    BACKGROUND: COPD is a leading cause of death and disability in the United States. Patients with COPD are at a high risk of nutritional deficiency, which is associated with declines in respiratory function, lean body mass and strength, and immune function. Although oral nutritional supplementation (ONS) has been associated with improvements in some of these domains, the impact of hospital ONS on readmission risk, length of stay (LOS), and cost among hospitalized patients is unknown. METHODS: Using the Premier Research Database, we first identified Medicare patients aged ≥ 65 years hospitalized with a primary diagnosis of COPD. We then identified hospitalizations in which ONS was provided, and used propensity-score matching to compare LOS, hospitalization cost, and 30-day readmission rates in a one-to-one matched sample of ONS and non-ONS hospitalizations. To further address selection bias among patients prescribed ONS, we also used instrumental variables analysis to study the association of ONS with study outcomes. Model covariates included patient and provider characteristics and a time trend. RESULTS: Out of 10,322 ONS hospitalizations and 368,097 non-ONS hospitalizations, a one-to-one matched sample was created (N = 14,326). In unadjusted comparisons in the matched sample, ONS use was associated with longer LOS (8.7 days vs 6.9 days, P < .0001), higher hospitalization cost ($14,223 vs $9,340, P < .0001), and lower readmission rates (24.8% vs 26.6%, P = .0116). However, in instrumental variables analysis, ONS use was associated with a 1.9-day (21.5%) decrease in LOS, from 8.8 to 6.9 days (P < .01); a hospitalization cost reduction of $1,570 (12.5%), from $12,523 to $10,953 (P < .01); and a 13.1% decrease in probability of 30-day readmission, from 0.34 to 0.29 (P < .01). CONCLUSIONS: ONS may be associated with reduced LOS, hospitalization cost, and readmission risk in hospitalized Medicare patients with COPD. PMID:25357165

  11. Prediction of Hospital Acute Myocardial Infarction and Heart Failure 30-Day Mortality Rates Using Publicly Reported Performance Measures

    PubMed Central

    Aaronson, David S.; Bardach, Naomi S.; Lin, Grace A.; Chattopadhyay, Arpita; Goldman, L. Elizabeth; Dudley, R. Adams

    2014-01-01

    Objective To identify an approach to summarizing publicly reported hospital performance data for acute myocardial infarction (AMI) or heart failure (HF) that best predicts current year hospital mortality rates. Setting A total of 1,868 U.S. hospitals reporting process and outcome measures for AMI and HF to the Centers for Medicare and Medicaid Services (CMS) from July 2005 to June 2006 (Year 0) and July 2006 to June 2007 (Year 1). Design Observational cohort study measuring the percentage variation in Year 1 hospital 30-day risk-adjusted mortality rate explained by denominator-based weighted composite scores summarizing hospital Year 0 performance. Data Collection Data were prospectively collected from hospitalcompare.gov. Results Percentage variation in Year 1 mortality was best explained by mortality rate alone in Year 0 over other composites including process performance. If only Year 0 mortality rates were reported, and consumers using hospitals in the highest decile of mortality instead chose hospitals in the lowest decile of mortality rate, the number of deaths at 30 days that potentially could have been avoided was 1.31 per 100 patients for AMI and 2.12 for HF (p < .001). Conclusion Public reports focused on 30-day risk-adjusted mortality rate may more directly address policymakers’ goals of facilitating consumer identification of hospitals with better outcomes. PMID:22093186

  12. [History of psychiatric care].

    PubMed

    Häfner, H

    2006-01-01

    The lecture incorporates stages of the Ettelbruck jubilee-hospital into european psychiatric history of the two last centuries. Beginning with social exclusion in the sense of a Michel Foucauld ("Central Hospice"), then turning into a typical large psychiatric hospital the CHNP is nowadays a specialized clinic with national tasks within the network of mental health community care. Milestones of this evolution are: the isolation theory of the 19th and beginning of the 20th centuries; eugenics and euthanasia on patients in Nazi-Germany; the second psychiatric revolution after World War 2 and it's impact in Luxembourg.

  13. The importance of relationships in mental health care: A qualitative study of service users' experiences of psychiatric hospital admission in the UK

    PubMed Central

    Gilburt, Helen; Rose, Diana; Slade, Mike

    2008-01-01

    Background While a number of studies have looked at life on service users' experiences of life on psychiatric wards, no research exists that have approached these experiences from the user perspective since the introduction of community care. Methods This user-led study uses a participatory approach to develop an understanding of the processes and themes which define the user experience of hospitalisation. Nineteen service users who had all had inpatient stays in psychiatric hospitals in London were interviewed in the community. Results Relationships formed the core of service users' experiences. Three further codes, treatment, freedom and environment defined the role of hospital and its physical aspects. Themes of communication, safety, trust, coercion, and cultural competency contributed to the concept of relationships. Conclusion Relationships with an individual which comprised effective communication, cultural sensitivity, and the absence of coercion resulted in that person being attributed with a sense of trust. This resulted in the patient experiencing the hospital as a place of safety in terms of risk from other patients and staff. Barriers to positive relationships included ineffective and negative communication, a lack of trust, a lack of safety in terms of staff as ineffective in preventing violence, and as perpetrators themselves, and the use of coercion by staff. This unique perspective both acts as a source of triangulation with previous studies and highlights the importance of the therapeutic relationship in providing a safe and therapeutic milieu for the treatment of people with acute mental health problems. PMID:18439254

  14. The INDDEP study: inpatient and day hospital treatment for depression – symptom course and predictors of change

    PubMed Central

    2013-01-01

    Background Depression can be treated in an outpatient, inpatient or day hospital setting. In the German health care system, episodes of inpatient or day hospital treatment are common, but there is a lack of studies evaluating effectiveness in routine care and subgroups of patients with a good or insufficient treatment response. Our study aims at identifying prognostic and prescriptive outcome predictors as well as comparative effectiveness in psychosomatic inpatient and day hospital treatment in depression. Methods/Design In a naturalistic study, 300 consecutive inpatient and 300 day hospital treatment episodes in seven psychosomatic hospitals in Germany will be included. Patients are assessed at four time points of measurement (admission, discharge, 3-months follow-up, 12-months follow-up) including a broad range of variables (self-report and expert ratings). First, the whole sample will be analysed to identify prognostic and prescriptive predictors of outcome (primary outcome criterion: Quick Inventory of Depressive Symptoms QIDS-total score, expert rating). Secondly, for a comparison of inpatient and day hospital treatment, samples will be matched according to known predictors of outcome. Discussion Naturalistic studies with good external validity are needed to assess treatment outcome in depression in routine care and to identify subgroups of patients with different therapeutic needs. Trial registration Current Controlled Trials ISRCTN20317064 PMID:23531019

  15. The leisure time and the third age: the experience of a geriatric day hospital.

    PubMed

    Di Mauro, S; Scalia, G; Di Mauro, A; Di Fazio, I; Giuffrida, F; Leotta, C; Grasso, M G; Distefano, A

    2001-01-01

    Leisure time represents an important part of the so-called 'successful aging' and contributes to overcome the problems related to the reduction of the social roles, favoring a better subjective adaptation to old age. In this work we observed the elderly population frequenting our Day Hospital, by estimating the affective sphere (geriatric depression scale, GDS), the autosufficiency (activity of daily living, ADL; and instrumental activity of daily living, IADL) and the schooling years in correlation with the type and length of leisure time activities during the day. These data have been compared with those of the national statistics (ISTAT). The analyses revealed a very wide diffusion of the utilization of mass media and a large interindividual differentiation of the modes of using leisure time. The correlations between the indices of affectivity and autosufficiency show an effect on the types of leisure time activities, while the scholarity of the subjects has no influence on it. These results suggest considering leisure time as an indispensable part of the relational life of elderly subjects, having an important 'valency' for the affective sphere and the individual expectations and needs. PMID:15374030

  16. [Improving the medical treatment of minors who are victims of sexual assault or physical abuse: a receiving center and partnership between a psychiatric hospital and university hospital].

    PubMed

    Fremy, D

    2003-04-01

    The aim of the partnership is the establishment and operation of a centre open 24 hours a day which receives and treats adults and underage victims of sexual assault and physical abuse coming from the greater metropolitan area of Besançon. The centre also provides the victims and their families with adapted forensic and psychotherapeutic assistance. The mechanisms to carry out the project will be set out in a contract between the two hospitals, including the resources of the two institutions. The centre will fit into the existing network of partners which is already operational in Besançon. The role of the University of Besançon and the Faculty of Medicine will be to promote research in the field of physical abuse, its causes and effects, and to train future physicians who will later be in charge of handling these types of cases in their careers. PMID:12784493

  17. [The Day Service as a tool to reduce inappropriateness of care: the experience of a research hospital in Rome (Italy)].

    PubMed

    Cadeddu, Chiara; Specchia, Maria Lucia; Principi, Francesca; Marchini, Raffaele; Cerimele, Marina; Ricciardi, Walter; Cavuto, Costanza

    2015-01-01

    The Day Service was established in Italy to promote appropriateness of care and consists in the delivery of packages of complex outpatient services. A Working Group for the continuous improvement of pre-hospitalization activities of the Regina Elena Scientific Institute in Rome, Italy, established that the outpatient management of surgical patients in the hospital would occur in a Day Service, through a package of services identified at the regional level or appropriate diagnostic and therapeutic pathways. This article describes the experience of the hospital's Day Service and compares results from the last four months of 2013 with those of the first four months of 2014. The introduction of a Day Service has led to a reduction in the number of inappropriate pre-admission tests (mainly computerized tomography, magnetic resonance and Positron emission scans and scintigraphy) and this has had a positive impact not only in terms of organization, reduction of hospital stay and overall hospitalization-related activities, but also from an economic standpoint. The implementation of a Day Service has also improved the overall patient experience, from an organizational point of view, and this is an important aspect, considering that patients at the Regina Elena Scientific Institute are oncological patients, they are often elderly and most reside in other Italian regions.

  18. Prevalence of Attention Deficit Hyperactivity among Children Attending Outpatient Clinic in Psychiatric Teaching Hospital in Erbil City

    ERIC Educational Resources Information Center

    Shakir, Lana Nabeel; Sulaiman, Karwan Hawez

    2016-01-01

    Background and objectives: Attention deficit hyperactivity disorder is one of the common psychiatric disorder in childhood and it affects on children socially and academically. The aim of this study is to find out the prevalence of Attention deficit hyperactivity disorder among the studied population, describe its association with certain…

  19. Psychiatric In-Patients Away from Home: Accounts by People with Intellectual Disabilities in Specialist Hospitals outside Their Home Localities

    ERIC Educational Resources Information Center

    Chinn, Deborah; Hall, Ian; Ali, Afia; Hassell, Holly; Patkas, Iannis

    2011-01-01

    Background: This study reflects a growing concern with the placement of people with intellectual disabilities and complex mental health problems in out of area placements at a distance from their families and communities. Materials and methods: We interviewed service users (n = 17) living in out of area in-patient psychiatric units using a…

  20. Job Stress and Self-Efficacy among Psychiatric Nursing Working in Mental Health Hospitals at Cairo, Egypt

    ERIC Educational Resources Information Center

    Zaki, Rania. A.

    2016-01-01

    Nursing stress is considered a problem that affects the practice worldwide. Job stress is a harmful response physically and emotionally when the nurses' skills, resources, and needs could not fulfill the requirement of the job. This study was aimed to assess job stress and self-efficacy among psychiatric nursing working in mental health hospitals…

  1. The Twenty-Year Trajectory of Suicidal Activity Among Post-Hospital Psychiatric Men and Women with Mood Disorders and Schizophrenia.

    PubMed

    Kaplan, Kalman J; Harrow, Martin; Clews, Kelsey

    2016-07-01

    The Chicago Follow-up Study has followed the course of severe mental illness among psychiatric patients for more than 20 years after their index hospitalization. Among these patients are 97 schizophrenia patients, 45 patients with schizoaffective disorders, 102 patients with unipolar nonpsychotic depression, and 53 patients with a bipolar disorder. Maximum suicidal activity (suicidal ideation, suicidal attempts and suicide completions) generally declines over the 3 time periods (early, middle, and late follow-ups) following discharge from the acute psychiatric hospitalization for both males and females across diagnostic categories with two exceptions: female schizophrenia patients and female bipolar patients. A weighted mean suicidal activity score tended to decrease across follow-ups for male patients in the schizophrenia, schizoaffective, and depressive diagnostic groups with an uneven trend in this direction for the male bipolars. No such pattern emerges for our female patients except for female depressives. Males' suicidal activity seems more triggered by psychotic symptoms and potential chronic disability while females' suicidal activity seems more triggered by affective symptoms. PMID:26881891

  2. Evaluation of a radio based ADL interaction recognition system in a day hospital for old age psychiatry with healthy probands.

    PubMed

    Neuhaeuser, J; Diehl-Schmid, J; Lueth, T C

    2011-01-01

    In this contribution the evaluation of a system called "Eventlogger" is presented, which is installed in a day hospital for old age psychiatry. The Eventlogger is a radio based module with an adjustable communication range, able to recognize interaction of the user with objects or with other people. It is intended to function as a monitoring tool for the users' activities. Due to the demographic change monitoring systems for elderly people become more important. In this paper the "simple activities of daily living" (sADL) is introduced as well as the evaluation for the recognition of sADL in a day hospital for old age psychiatry with healthy probands is presented. Together with the first approaches of post processing for better results it is shown that the system is now ready to be used with patients of the day hospital for old age psychiatry.

  3. Decreased Length of Stay and Cumulative Hospitalized Days Despite Increased Patient Admissions and Readmissions in an Area of Urban Poverty

    PubMed Central

    Kalra, Amit D.; Fisher, Robert S.

    2010-01-01

    Background Length of stay at US acute care hospitals has been steadily decreasing since 1960, and there is ongoing concern that increasing financial pressures on hospitals with high proportions of Medicaid patients may be causing unduly short lengths of stay. Objective To study temporal trends in hospital utilization on internal medicine services at Temple University Hospital, which has the highest percentage of Medicaid and uninsured patients in the state of Pennsylvania. Design Examination of temporal changes in hospital practice over three time periods spanning 13 years. Measurements Numbers of discharges, 1- and 12-month re-admission rates, and lengths of stay. US census data from 1990 to 2000 were examined for the eight major zip codes in which hospitalized patients live. Main Results The number of internal medicine admissions increased from 1991 (117/month) to 2004 (455/month); p < 0.0001. Mean length of stay for the index admission decreased from 8.7 to 4.9 days; p < 0.001. The percentage of patients readmitted within 12 months of the discharge date of the index admission increased from 42.3% to 49.5%; p = 0.045. Mean cumulative length of stay over 12 months, including readmissions, decreased significantly (15.8 to 12.5 days; p = 0.031). Compared to all US hospitals, our hospital had a greater increase in admissions and a greater decrease in length of stay. During this time period, in surrounding zip codes, there were decreases in total population and total number of persons living in poverty, but also multiple closures of area hospitals that served poor patients. Conclusion During the 13-year study period, despite increased readmission rates, the overall number of hospitalized days per year on the internal medicine inpatient service decreased. As local hospitals serving this inner city low income area have closed, our hospital had atypically high increases in numbers of admissions and decreases in length of stay. This raises questions

  4. Narratives of change and reform processes: global and local transactions in French psychiatric hospital reform after the Second World War.

    PubMed

    Henckes, Nicolas

    2009-02-01

    As with the rest of biomedicine, psychiatry has, since the Second World War, developed under the strong influence of the transnational accumulation of a whole series of practices and knowledge. Anthropology has taught us to pay attention to the transactions between local-level actors and those operating at the global level in the construction of this new world of medicine. This article examines the role played by the recommendations of the WHO Expert Committee of Mental Health in the reform of the French mental health system during the 1950s. Rooted in the experience of practitioners and administrators participating in the process of reforming local psychiatric systems, the recommendations of the WHO Expert Committee developed a new vision of regulating psychiatry, based on professionalism and an idea of a normativity of the doctor-patient relation. This article shows how, by mobilizing the WHO reports' recommendations, French administrators and doctors succeeded in creating a typically French object: "the psychiatric sector", founded on elaborating a new mandate for the psychiatric profession. The article thus questions the deinstitutionalization model as an explanation of transformations of the structure of the French psychiatry system in the post-war period.

  5. Diversion from custody. I: Psychiatric assessment at the magistrates' court.

    PubMed

    Joseph, P L; Potter, M

    1993-03-01

    The homeless mentally disordered defendant facing minor charges poses considerable problems regarding appropriate disposal. Psychiatric assessment may be required in order to facilitate the court's decision, but this is often available only after remand in custody. A psychiatric assessment service based at two inner-London magistrates' courts is described. Over 18 months, 201 defendants were referred. They were predominantly male, single, and of no fixed abode, suffering from serious psychiatric disorder; these defendants had often received previous in-patient treatment, frequently as detained patients. They typically were recidivists charged with minor offences. Following initial assessment, 25% were admitted to hospital, 50% were released, and 25% returned to custody. The Crown Prosecution Service discontinued 29% of cases. For those admitted directly to hospital, the mean (s.d.) time from arrest to hospital admission was 5.8 (6.8) days, significantly quicker than with prison-based assessments.

  6. Understanding psychiatric institutionalization: a conceptual review

    PubMed Central

    2013-01-01

    Background Since Goffman’s seminal work on psychiatric institutions, deinstitutionalization has become a leading term in the psychiatric debate. It described the process of closure or downsizing of large psychiatric hospitals and the establishment of alternative services in the community. Yet, there is a lack of clarity on what exactly the concept of institutionalization means in present-day psychiatry. This review aims to identify the meaning of psychiatric institutionalization since the early 1960s to present-day. Method A conceptual review of institutionalization in psychiatry was conducted. Thematic analysis was used to synthesize the findings. Results Four main themes were identified in conceptualizing institutionalization: bricks and mortar of care institutions; policy and legal frameworks regulating care; clinical responsibility and paternalism in clinician-patient relationships; and patients’ adaptive behavior to institutionalized care. Conclusions The concept of institutionalization in psychiatry reflects four distinct themes. All themes have some relevance for the contemporary debate on how psychiatric care should develop and on the role of institutional care in psychiatry. PMID:23773398

  7. The ambivalent chaplain: negotiating structural and ideological difference on the margins of modern-day hospital medicine.

    PubMed

    Norwood, Frances

    2006-01-01

    The chaplain experience in modern-day hospital medicine is largely one of marginalization. It is not, however, an experience without agency. Working within the constraints of difference, chaplains learn how to negotiate on the margins of medicine. This starts with learning the language of hospital medicine, learning to skillfully see, speak, and move in ways that minimize difference. Successes in socialization and acclimation do not, however, guarantee the chaplain a place in the hospital, where chaplains encounter both structural marginalization (resulting from inequalities in power and hierarchy) and ideological marginalization (resulting from inequalities in accepted forms of knowledge and practice). Using the theories of Michel Foucault (1973) and Byron Good (1994), I examine how chaplains negotiate structural and ideological marginality, at times embracing their connection to medicine (downplaying their connection to the institution of religion) and at other times embracing their connection to religion and religious practices. The result is an ambivalent chaplain who strategically embraces one or the other paradigm in order to survive. Using data gathered during a 12-month ethnography of chaplain interns at a university teaching hospital, this article examines the structural and ideological differences between science and religion through the modern-day practice of hospital chaplains. It both introduces readers to the modern-day chaplain, a healer largely absent in ethnography, and adds a renewed perspective to a long-standing body of literature on the relationship between structure and agency, and science and religion. PMID:16546831

  8. The ambivalent chaplain: negotiating structural and ideological difference on the margins of modern-day hospital medicine.

    PubMed

    Norwood, Frances

    2006-01-01

    The chaplain experience in modern-day hospital medicine is largely one of marginalization. It is not, however, an experience without agency. Working within the constraints of difference, chaplains learn how to negotiate on the margins of medicine. This starts with learning the language of hospital medicine, learning to skillfully see, speak, and move in ways that minimize difference. Successes in socialization and acclimation do not, however, guarantee the chaplain a place in the hospital, where chaplains encounter both structural marginalization (resulting from inequalities in power and hierarchy) and ideological marginalization (resulting from inequalities in accepted forms of knowledge and practice). Using the theories of Michel Foucault (1973) and Byron Good (1994), I examine how chaplains negotiate structural and ideological marginality, at times embracing their connection to medicine (downplaying their connection to the institution of religion) and at other times embracing their connection to religion and religious practices. The result is an ambivalent chaplain who strategically embraces one or the other paradigm in order to survive. Using data gathered during a 12-month ethnography of chaplain interns at a university teaching hospital, this article examines the structural and ideological differences between science and religion through the modern-day practice of hospital chaplains. It both introduces readers to the modern-day chaplain, a healer largely absent in ethnography, and adds a renewed perspective to a long-standing body of literature on the relationship between structure and agency, and science and religion.

  9. [THE DEVELOPMENT OF MEDICAL CARE OF POPULATION IN CONDITIONS OF SPECIALIZED DAY-TIME HOSPITALS OF NEUROLOGICAL PROFILE].

    PubMed

    Grishina, N K; Solovieva, N B; Abdulsalamova, Z A

    2015-01-01

    The article considers issues concerning increasing of quality and accessibility of medical care in Moscow neurological profile included at the expense of wide-spread implementation of specialized day-time hospitals in health care practice. The analysis applied was based on average Moscow indicators of functioning of public health institutions and characteristics of clinical course of diseases of the mentioned profile.

  10. The Validity of Goal Achievement as an Outcome Measure in Physical Rehabilitation Day Hospitals for Older People

    ERIC Educational Resources Information Center

    Kneebone, Ian I.; Hurn, Jane S.; Raisbeck, Elizabeth; Cropley, Mark; Khoshnaw, Hiro; Milton, Jane E.

    2010-01-01

    Physical rehabilitation day hospitals are widely used community-based services designed to meet the medical and rehabilitation needs of older people. While there is evidence for the effectiveness of these services, concerns about the shortcomings of how this is measured have led to the recommendation that the achievement of individually tailored…

  11. Effect of Random versus Nonrandom Assignment in a Comparison of Inpatient and Day Hospital Rehabilitation for Male Alcoholics.

    ERIC Educational Resources Information Center

    McKay, James R.; And Others

    1995-01-01

    To examine differences in substance use and psychosocial outcomes under experimental and nonexperimental designs, compared alcoholic patients randomly assigned to day hospital or inpatient rehabilitation with patients who self-selected these treatment settings. Self-selecting patients experienced outcomes no better than those who were randomly…

  12. Integrated Educational and Mental Health Services within a Day Treatment Setting.

    ERIC Educational Resources Information Center

    Francis, Greta; Radka, Dale F.

    This paper discusses the integration of educational and mental health services for children and adolescents within a psychiatric day treatment setting at the Bradley School housed in a private psychiatric hospital affiliated with Brown University in Rhode Island. A full range of mental health services are used, and therapies are delivered in the…

  13. Alternate Level of Care Patients in Public General Hospital Psychiatry.

    ERIC Educational Resources Information Center

    Marcos, Luis R.; Gil, Rosa M.

    1984-01-01

    Analyzes the interaction between psychiatric services in public general hospitals and in other institutional settings. A one-day census of patients in a New York general hospital showed the hospital was providing care to a large number of patients in need of other, less intensive institutional settings. (BH)

  14. The Day Reagan Was Shot: How a University Hospital PR Staff Handled the Crisis.

    ERIC Educational Resources Information Center

    Turk, Emily R.; And Others

    1981-01-01

    The experiences of George Washington University Hospital's public relations staff when it handled the crisis of the shooting of President Reagan is described. Security, choice of a spokesperson, relations with the news media, dealing with VIPs, etc., are discussed. (MLW)

  15. Predictors of fifty days in-hospital mortality in decompensated cirrhosis patients with spontaneous bacterial peritonitis

    PubMed Central

    Bal, Chinmaya Kumar; Daman, Ripu; Bhatia, Vikram

    2016-01-01

    AIM: To determine the predictors of 50 d in-hospital mortality in decompensated cirrhosis patients with spontaneous bacterial peritonitis (SBP). METHODS: Two hundred and eighteen patients admitted to an intensive care unit in a tertiary care hospital between June 2013 and June 2014 with the diagnosis of SBP (during hospitalization) and cirrhosis were retrospectively analysed. SBP was diagnosed by abdominal paracentesis in the presence of polymorphonuclear cell count ≥ 250 cells/mm3 in the peritoneal fluid. Student’s t test, multivariate logistic regression, cox proportional hazard ratio (HR), receiver operating characteristics (ROC) curves and Kaplan-Meier survival analysis were utilized for statistical analysis. Predictive abilities of several variables identified by multivariate analysis were compared using the area under ROC curve. P < 0.05 were considered statistical significant. RESULTS: The 50 d in-hospital mortality rate attributable to SBP is 43.11% (n = 94). Median survival duration for those who died was 9 d. In univariate analysis acute kidney injury (AKI), hepatic encephalopathy, septic shock, serum bilirubin, international normalized ratio, aspartate transaminase, and model for end-stage liver disease - sodium (MELD-Na) were significantly associated with in - hospital mortality in patients with SBP (P ≤ 0.001). Multivariate cox proportional regression analysis showed AKI (HR = 2.16, 95%CI: 1.36-3.42, P = 0.001) septic shock (HR = 1.73, 95%CI: 1.05-2.83, P = 0.029) MELD-Na (HR = 1.06, 95%CI: 1.02-1.09, P ≤ 0.001) was significantly associated with 50 d in-hospital mortality. The prognostic accuracy for AKI, MELD-Na and septic shock was 77%, 74% and 71% respectively associated with 50 d in-hospital mortality in SBP patients. CONCLUSION: AKI, MELD-Na and septic shock were predictors of 50 d in-hospital mortality in decompensated cirrhosis patients with SBP. PMID:27134704

  16. Family influence and psychiatric care: Physical treatments in Devon mental hospitals, c. 1920 to the 1970s☆

    PubMed Central

    Baur, Nicole

    2013-01-01

    ‘What is it that appears to make the mentally ill so vulnerable to therapeutic experimentation?’1 One commentator wrote in the 1990s, regarding mental hospitals as repressive, coercive and custodial institutions where medical staff subjected patients to orgies of experimentation. A careful study of surviving documents of the Devon County Lunatic Asylum (DCLA), however, paints a different picture. Rather than medical staff, patients’ relatives and the wider community exercised a considerable influence over a patient's hospital admission and discharge, rendering the therapeutic regime in the middle of the 20th century the result of intense negotiations between the hospital and third parties. PMID:23876990

  17. Clinical characteristics of perinatal psychiatric patients: a chart review study.

    PubMed

    Battle, Cynthia L; Zlotnick, Caron; Miller, Ivan W; Pearlstein, Teri; Howard, Margaret

    2006-05-01

    Although postpartum depression and other perinatal disorders have been the subject of increased research attention, important questions remain regarding women who actively seek psychiatric treatment during pregnancy and the postpartum period. In this study, we examined clinical records of 500 perinatal psychiatric patients who received treatment in a psychiatric day hospital (N = 398) or outpatient behavioral health clinic (N = 102). Patients' presenting diagnoses, psychiatric history, treatment course, and depressive symptoms were recorded. The majority of women had major depression as their primary diagnosis, with an average Edinburgh Postnatal Depression Scale score of over 20. Many depressed patients were diagnosed with comorbid anxiety and substance abuse disorders. Although most women were willing to take psychotropic medications, a sizable minority were not, particularly those who were breast-feeding. For more than a third of the sample, the treatment sought while pregnant or postpartum represented their first contact with the mental health system. Treatment implications are discussed. PMID:16699387

  18. Transporting Forensic Psychiatric Patients.

    PubMed

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

    2015-12-01

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

  19. Transporting Forensic Psychiatric Patients.

    PubMed

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

    2015-12-01

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

  20. Evaluation of the safety and efficacy of same-day discharge following outpatient surgery in a US hospital.

    PubMed

    Singletary, De'Ana

    2016-07-01

    In the US, safe and effective same-day discharge of patients, following uncomplicated, ambulatory surgery, also referred to as outpatient surgery, significantly reduces the nursing hours spent caring for patients who do not require hospital admission. Data from the last three decades show that same-day discharge for patients who undergo approved outpatient surgical procedures carries no higher risk of complications than for those who stay for 24-hour observation. This article describes a service development project which evaluated patients' perceived preparedness for same-day discharge. Results suggest that a standardised approach to managing potential complicating factors, such as pain and patients' expectations, can increase the number of successful same-day discharges. The terms outpatient and ambulatory are used interchangeably in the article, and refer to surgical procedures for which inpatient admission is not considered necessary by patients' insurance providers. PMID:27369726

  1. High levels of bed occupancy associated with increased inpatient and thirty-day hospital mortality in Denmark.

    PubMed

    Madsen, Flemming; Ladelund, Steen; Linneberg, Allan

    2014-07-01

    High bed occupancy rates have been considered a matter of reduced patient comfort and privacy and an indicator of high productivity for hospitals. Hospitals with bed occupancy rates of above 85 percent are generally considered to have bed shortages. Little attention has been paid to the impact of these shortages on patients' outcomes. We analyzed all 2.65 million admissions to Danish hospitals' departments of medicine in the period 1995-2012. We found that high bed occupancy rates were associated with a significant 9 percent increase in rates of in-hospital mortality and thirty-day mortality, compared to low bed occupancy rates. Being admitted to a hospital outside of normal working hours or on a weekend or holiday was also significantly associated with increased mortality. The health risks of bed shortages, including mortality, could be better documented as a priority health issue. Resources should be allocated to researching the causes and effects of bed shortages, with the aim of creating greater interest in exploring new methods to avoid or reduce bed shortages. PMID:25006151

  2. High levels of bed occupancy associated with increased inpatient and thirty-day hospital mortality in Denmark.

    PubMed

    Madsen, Flemming; Ladelund, Steen; Linneberg, Allan

    2014-07-01

    High bed occupancy rates have been considered a matter of reduced patient comfort and privacy and an indicator of high productivity for hospitals. Hospitals with bed occupancy rates of above 85 percent are generally considered to have bed shortages. Little attention has been paid to the impact of these shortages on patients' outcomes. We analyzed all 2.65 million admissions to Danish hospitals' departments of medicine in the period 1995-2012. We found that high bed occupancy rates were associated with a significant 9 percent increase in rates of in-hospital mortality and thirty-day mortality, compared to low bed occupancy rates. Being admitted to a hospital outside of normal working hours or on a weekend or holiday was also significantly associated with increased mortality. The health risks of bed shortages, including mortality, could be better documented as a priority health issue. Resources should be allocated to researching the causes and effects of bed shortages, with the aim of creating greater interest in exploring new methods to avoid or reduce bed shortages.

  3. Time to rehospitalization in patients with major depression vs. those with schizophrenia or bipolar I disorder in a public psychiatric hospital.

    PubMed

    Lin, Ching-Hua; Chen, Ming-Chao; Chou, Li-Shiu; Lin, Chieh-Hsin; Chen, Cheng-Chung; Lane, Hsien-Yuan

    2010-12-30

    Compared rehospitalization rates in patients with schizophrenia or bipolar I disorder to patients with major depressive disorder remains unclear. This study aimed to compare the time to rehospitalization of the three groups. Other clinical variables were also examined. Rehospitalization status was monitored for all admitted inpatients with schizophrenia (n=637), bipolar I disorder (n=197), or major depressive disorder (n=191), from January 1, 2006 to December 31, 2006. Time to rehospitalization within 1 year after discharge was measured using the Kaplan-Meier method. Risk factors associated with rehospitalization were examined using the Cox proportional hazards regression model. The three groups were comparable for comorbid alcohol abuse/dependence, family history of severe psychiatric illness, years of education, and number of previous hospitalizations. No significant differences were noted among the three groups for the time to rehospitalization or the time to discontinuation. Age onset and number of previous admission were associated with risks of rehospitalization. This study suggests that the major depressive disorder, schizophrenia, and bipolar I disorder have comparable influences on time to rehospitalization and discontinuation from treatment and that earlier onset of illness and more previous hospitalizations are associated with higher risks of rehospitalization. Further prospective research is warranted. PMID:20494450

  4. Dissection of the prongs of ALI. A retrospective assessment of criminal responsibility by the psychiatric staff of the Clifton T. Perkins Hospital Center.

    PubMed

    Silver, S B; Spodak, M K

    1983-01-01

    The staff of the Clifton T. Perkins Hospital Center has systematically reassessed the impact of the proposed modification of the ALI test removing the second prong. Findings of this retrospective survey reveal few changes in the composite staff opinions reported by the hospital but many variations in the opinions of individual psychiatrists when rating the prongs independently. The effect of these changes in Maryland (while difficult to anticipate) might be an increase in litigation. The resulting fiscal impact, therefore, not only could affect the Division of Corrections but also could increase court costs. The data suggest that rather than limiting psychiatric testimony and ensuring that only the sickest patients are exculpated, the proposed truncation of ALI may have paradoxical consequences. There may be more frequent battles of the experts based on less rigorous science and potential exclusion of affective psychosis from appropriate access to the defense of insanity. While the study methods and sample size prohibit reliable conclusions concerning the likelihood of these consequences in vivo, the issues raised strongly support a need for further investigation before a relatively well-functioning legal framework is changed in favor of the untested rubric of the proposed modifications of ALI.

  5. Development and use of an administrative claims measure for profiling hospital-wide performance on 30-day unplanned readmission

    PubMed Central

    Horwitz, Leora I.; Partovian, Chohreh; Lin, Zhenqiu; Grady, Jacqueline N.; Herrin, Jeph; Conover, Mitchell; Montague, Julia; Dillaway, Chloe; Bartczak, Kathleen; Suter, Lisa G.; Ross, Joseph S.; Bernheim, Susannah M.; Krumholz, Harlan M.; Drye, Elizabeth E.

    2014-01-01

    Background Existing publicly-reported readmission measures are condition-specific, representing < 20% of adult hospitalizations. An all-condition measure may better measure quality and promote innovation. Objective To develop an all-condition, hospital-wide readmission measure. Design Measure development Setting 4,821 US hospitals. Patients Medicare Fee for Service (FFS) beneficiaries ≥ 65 years. Measurements Hospital-level, risk-standardized unplanned readmissions within 30 days of discharge. The measure uses Medicare FFS claims and is a composite of five specialty-based risk-standardized rates for medicine, surgery/gynecology, cardiorespiratory, cardiovascular and neurology cohorts. We randomly split the 2007–2008 admissions for development and validation. Models were adjusted for age, principal diagnosis and comorbidity. We examined calibration in Medicare and all-payer data, and compared hospital rankings in the development and validation samples. Results The development dataset contained 8,018,949 admissions associated with 1,276,165 unplanned readmissions (15.9%). The median hospital risk-standardized unplanned readmission rate was 15.8 (range 11.6–21.9). The five specialty cohort models accurately predicted readmission risk in both Medicare and all-payer datasets for average risk patients but slightly overestimated readmission risk at the extremes. Overall hospital risk-standardized readmission rates did not differ statistically in the split samples (p=0.7 for difference in rank) and 76% of hospitals’ validation set rankings were within two deciles of the development rank (24% >2 deciles). Of hospitals ranking in the top or bottom deciles, 90% remained within two deciles (10% >2 deciles), and 82% remained within one decile (18% > 1 decile). Limitations Risk-adjustment was limited to that available in claims data. Conclusions We developed a claims-based hospital-wide unplanned readmission measure for profiling hospitals that produced reasonably

  6. St. Mary's has a "Sailabration". An Indiana hospital sets aside a day for spiritual renewal.

    PubMed

    Sister Betty Anne Darch; Newsmaster, Pamela

    2005-01-01

    Ascension Health has asked all of its health care ministries to promote spirituality in the workplace. St. Mary's Health System, Evansville, IN, responded to this request with several initiatives, including the development, facilitation, and implementation of a new model for what St. Mary's calls its "Employee Renewal Day." Revamped from a voluntary unpaid day to a paid day on which participation is strongly encouraged, Employee Renewal Day 2004 focused on fellowship, relaxation, and the history and heritage of St. Mary's and its sponsor. Based on an employee's suggestion, the mission team adopted a nautical theme, "Sailabration Cruise: A Day of Renewal," and took employees on "a voyage" complete with mission-themed ports, passenger photos, a ship's log, purser's desk, and an activities director. More than 1,200 St. Mary's employees-or 23 percent of the total workforce-participated. All of St. Mary's 135 leaders were in attendance. The new Employee Renewal Day model will be tried over a three-year period, so as to measure the progress of furthering the integration of spirituality within the organizational culture.

  7. Hospital Nursing and 30-Day Readmissions among Medicare Patients with Heart Failure, Acute Myocardial Infarction, and Pneumonia

    PubMed Central

    McHugh, Matthew D.; Ma, Chenjuan

    2013-01-01

    Background Provisions of the Affordable Care Act that increase hospitals’ financial accountability for preventable readmissions have heightened interest in identifying system-level interventions to reduce readmissions. Objectives To determine the relationship between hospital nursing; i.e. nurse work environment, nurse staffing levels, and nurse education, and 30-day readmissions among Medicare patients with heart failure, acute myocardial infarction, and pneumonia. Method and Design Analysis of linked data from California, New Jersey, and Pennsylvania that included information on the organization of hospital nursing (i.e., work environment, patient-to-nurse ratios, and proportion of nurses holding a BSN degree) from a survey of nurses, as well as patient discharge data, and American Hospital Association Annual Survey data. Robust logistic regression was used to estimate the relationship between nursing factors and 30-day readmission. Results Nearly one-quarter of heart failure index admissions (23.3% [n=39,954]); 19.1% (n=12,131) of myocardial infarction admissions; and 17.8% (n=25,169) of pneumonia admissions were readmitted within 30-days. Each additional patient per nurse in the average nurse’s workload was associated with a 7% higher odds of readmission for heart failure (OR=1.07, [1.05–1.09]), 6% for pneumonia patients (OR=1.06, [1.03–1.09]), and 9% for myocardial infarction patients (OR=1.09, [1.05–1.13]). Care in a hospital with a good versus poor work environment was associated with odds of readmission that were 7% lower for heart failure (OR = 0.93, [0.89–0.97]); 6% lower for myocardial infarction (OR = 0.94, [0.88–0.98]); and 10% lower for pneumonia (OR = 0.90, [0.85–0.96]) patients. Conclusions Improving nurses’ work environments and staffing may be effective interventions for preventing readmissions. PMID:23151591

  8. [150 years of psychiatric therapy].

    PubMed

    von Keyserlingk, H

    1976-06-01

    The treatment of insane persons in the last century is briefly described. A more liberal and unrestrained treatment was introduced at the turn of the century, and chiefly agriculturally oriented insane asylums were established at that time. The question of persons trained to care for subjects afflicted with insanity was increasingly gaining in importance, and the aim was to have available a pool of skilled nursing personnel. Treatment by inducing artificial fever is outlined in addition to a brief description of a more activ treatment of patients by the Simon-Gütersloh method. In 1925, a "neuro-psychiatric dispensary" was established in the Soviet Union. Later, there were introduced such methods as insulin shock treatment and electroconvulsive therapy and, more recently, treatment with psychopharmaceuticals, the latter being drugs used in the treatment of emotional disorders in modern psychiatric hospitals. Inpatient and outpatient treatment is further developed with the establishment of day/night hospitals, and the need is pointed out to develop a system of care for mental patients on the model of that which exists in the Soviet Union.

  9. Psychiatric diagnosis, psychiatric power and psychiatric abuse.

    PubMed Central

    Szasz, T

    1994-01-01

    Psychiatric abuse, such as we usually associate with practices in the former Soviet Union, is related not to the misuse of psychiatric diagnoses, but to the political power intrinsic to the social role of the psychiatrist in totalitarian and democratic societies alike. Some reflections are offered on the modern, therapeutic state's proclivity to treat adults as patients rather than citizens, disjoin rights from responsibilities, and thus corrupt the language of political-philosophical discourse. PMID:7996558

  10. ["Should the staff's attitude towards the patients remain unchanged, I will not guarantee anything." Protest masculinity and coping of "rebellious patients" at the Heidelberg University Psychiatric Hospital on the eve of deinstitutionalization].

    PubMed

    Schwamm, Christoph

    2015-01-01

    This article analyses the illness experiences of male patients from the Heidelberg University Psychiatric Hospital during the protests against Psychiatry in the year 1973. Protest is one of the most important expressions of masculinity in socially disadvantaged men, such as men with mental disorders. The analysis of 100 medical records shows that some patients tried to construct themselves as men in a way that was explicitly motivated by antipsychiatric ideas: They questioned psychiatric authority, behaved "sexually inappropriate", or used drugs. On the eve of psychiatric reform in West Germany those patients were well aware that the alternative--complying with the treatment--would put them at considerable risk. In addition to the usual inference of hegemonic or normative masculinities as risk-factors, the behavior of those ,,rebellious patients" has to be interpreted as individual coping strategies.

  11. ["Should the staff's attitude towards the patients remain unchanged, I will not guarantee anything." Protest masculinity and coping of "rebellious patients" at the Heidelberg University Psychiatric Hospital on the eve of deinstitutionalization].

    PubMed

    Schwamm, Christoph

    2015-01-01

    This article analyses the illness experiences of male patients from the Heidelberg University Psychiatric Hospital during the protests against Psychiatry in the year 1973. Protest is one of the most important expressions of masculinity in socially disadvantaged men, such as men with mental disorders. The analysis of 100 medical records shows that some patients tried to construct themselves as men in a way that was explicitly motivated by antipsychiatric ideas: They questioned psychiatric authority, behaved "sexually inappropriate", or used drugs. On the eve of psychiatric reform in West Germany those patients were well aware that the alternative--complying with the treatment--would put them at considerable risk. In addition to the usual inference of hegemonic or normative masculinities as risk-factors, the behavior of those ,,rebellious patients" has to be interpreted as individual coping strategies. PMID:26219192

  12. Classifying emergency 30-day readmissions in England using routine hospital data 2004–2010: what is the scope for reduction?

    PubMed Central

    Blunt, Ian; Bardsley, Martin; Grove, Amy; Clarke, Aileen

    2015-01-01

    Background Many health systems across the globe have introduced arrangements to deny payment for patients readmitted to hospital as an emergency. The purpose of this study was to develop an exploratory categorisation based on likely causes of readmission, and then to assess the prevalence of these different types. Methods Retrospective analysis of 82 million routinely collected National Health Service hospital records in England (2004–2010) was undertaken using anonymised linkage of records at person-level. Numbers of 30-day readmissions were calculated. Exploratory categorisation of readmissions was applied using simple rules relating to International Classification of Diseases (ICD) diagnostic codes for both admission and readmission. Results There were 5 804 472 emergency 30-day readmissions over a 6-year period, equivalent to 7.0% of hospital discharges. Readmissions were grouped into hierarchically exclusive categories: potentially preventable readmission (1 739 519 (30.0% of readmissions)); anticipated but unpredictable readmission (patients with chronic disease or likely to need long-term care; 1 141 987 (19.7%)); preference-related readmission (53 718 (0.9%)); artefact of data collection (16 062 (0.3%)); readmission as a result of accident, coincidence or related to a different body system (1 101 818 (19.0%)); broadly related readmission (readmission related to the same body system (1 751 368 (30.2%)). Conclusions In this exploratory categorisation, a large minority of emergency readmissions (eg, those that are potentially preventable or due to data artefacts) fell into groups potentially amenable to immediate reduction. For other categories, a hospital's ability to reduce emergency readmission is less clear. Reduction strategies and payment incentives must be carefully tailored to achieve stated aims. PMID:24668396

  13. Wasted hospital days impair the value of length-of-stay variables in the quality assessment of trauma care.

    PubMed

    Jacobs, David G; Sarafin, Jennifer L; Norton, H James; Christmas, A Britt; Huynh, Toan; Sing, Ronald F

    2009-09-01

    Hospital length of stay (LOS) is frequently used to evaluate the quality of trauma care but LOS may be impacted by nonmedical factors as well. We reviewed our experience with delays in patient discharge to determine its financial consequences and its impact on LOS. We performed an analysis of linked trauma registry and "delayed discharge" databases. Actual LOS (A-LOS) values were compared with calculated ideal LOS (I-LOS) values, and the per cent increase in LOS was calculated. Linear regression analysis was used to identify significant predictors of prolonged LOS. One thousand, five hundred and seventeen patients were studied, with an A-LOS of 6.54 days. Seven per cent of patients experienced discharge delays, resulting in 580 excess hospital days. Calculated I-LOS was 6.15 days, 6.34 per cent lower than A-LOS. Other I-LOS estimates were as much as 25 per cent lower than A-LOS. Estimated excess patient charges associated with delayed discharges were $4,000,000 to $15,000,000. Discharge delays are an infrequent, although costly, occurrence that has a significant impact on LOS. LOS therefore may not be an appropriate metric for assessing the quality of trauma care, and should only be used if it has been corrected for discharge delays. Concerted efforts should be directed towards identifying and correcting the factors responsible for delayed discharge in trauma patients.

  14. [What should general hospital psychiatry do in a community?].

    PubMed

    Takehisa, Takahashi

    2003-01-01

    medical care of GHP on same level as a part of general hospital of course. For community psychiatric care and short-term hospitalization it is necessary for GHP to cooperate with various types of social resources. As for users of rehabilitation facilities in Nagano prefecture, GHP outpatients occupy 27.2%, and as for day care users, these occupy 19.6%, thus GHPs are able to cooperate with facilities. Above-mentioned facts indicate there is high necessity as a GHP, not a psychiatric hospital or a clinic. Cooperation between GHP and other social resources including welfare services will enrich community psychiatric services. GHP is a wide entrance for psychiatric care from a viewpoints of whole psychiatric care. When GHP accepted all patients on demands from acute cases to chronic, manpower will be diffused, and safety of medical care will be undermined. Therefore, psychiatric triage mainly functioning to treat early stage in severe cases with combined medical and psychiatric illness above all is necessary for GHP in order to offer proper treatment to a community. Accessibility in early stage of disease, priority of seriously ill patients and rehabilitation programs at a community as daily life space are essential for community mental health. We believe the first role of GHP in a community is to seek for psychiatric treatment on same level as general medicine. The second role is the psychiatric triage in order to function as GHP in a community. The third role is to cooperate with other social resources in a community. In order to promote the above it is necessary to self-evaluate GHP concerning the difference with specialized psychiatric hospitals or clinics. From these viewpoints GHP will become a core of community psychiatry. Currently, however, preparation concerned with GHP is poor compared with other advanced countries, so an aggressive improvement in medical policy is expected. PMID:12875227

  15. Waiving the Three-Day Rule: Admissions and Length-of-Stay at Hospitals and Skilled Nursing Facilities did not Increase

    PubMed Central

    Grebla, Regina C.; Keohane, Laura; Lee, Yoojin; Lipsitz, Lewis A.; Rahman, Momotazur; Trivedl, Amal N.

    2015-01-01

    The traditional Medicare program requires an enrollee to have a hospital stay of at least three consecutive calendar days to qualify for coverage of subsequent postacute care in a skilled nursing facility. This long-standing policy, implemented to discourage premature discharges from hospitals, might now be inappropriately lengthening hospital stays for patients who could be transferred sooner. To assess the implications of eliminating the three-day qualifying stay requirement, we compared hospital and postacute skilled nursing facility utilization among Medicare Advantage enrollees in matched plans that did or did not eliminate that requirement in 2006–10. Among hospitalized enrollees with a skilled nursing facility admission, the mean hospital length-of-stay declined from 6.9 days to 6.7 days for those no longer subject to the qualifying stay but increased from 6.1 to 6.6 days among those still subject to it, for a net decline of 0.7 day when the three-day stay requirement was eliminated. The elimination was not associated with more hospital or skilled nursing facility admissions or with longer lengths-of-stay in a skilled nursing facility. These findings suggest that eliminating the three-day stay requirement conferred savings on Medicare Advantage plans and that study of the requirement in traditional Medicare plans is warranted. PMID:26240246

  16. Waiving the three-day rule: admissions and length-of-stay at hospitals and skilled nursing facilities did not increase.

    PubMed

    Grebla, Regina C; Keohane, Laura; Lee, Yoojin; Lipsitz, Lewis A; Rahman, Momotazur; Trivedi, Amal N

    2015-08-01

    The traditional Medicare program requires an enrollee to have a hospital stay of at least three consecutive calendar days to qualify for coverage of subsequent postacute care in a skilled nursing facility. This long-standing policy, implemented to discourage premature discharges from hospitals, might now be inappropriately lengthening hospital stays for patients who could be transferred sooner. To assess the implications of eliminating the three-day qualifying stay requirement, we compared hospital and postacute skilled nursing facility utilization among Medicare Advantage enrollees in matched plans that did or did not eliminate that requirement in 2006-10. Among hospitalized enrollees with a skilled nursing facility admission, the mean hospital length-of-stay declined from 6.9 days to 6.7 days for those no longer subject to the qualifying stay but increased from 6.1 to 6.6 days among those still subject to it, for a net decline of 0.7 day when the three-day stay requirement was eliminated. The elimination was not associated with more hospital or skilled nursing facility admissions or with longer lengths-of-stay in a skilled nursing facility. These findings suggest that eliminating the three-day stay requirement conferred savings on Medicare Advantage plans and that study of the requirement in traditional Medicare plans is warranted.

  17. [University professors in the Soviet Occupation Zone and the German Democratic Republic up to 1961: Academic alternation of generations at university psychiatric hospitals].

    PubMed

    Kumbier, E; Haack, K

    2015-05-01

    After WWII a politically guided staffing policy foresaw an exchange program for professors from the Soviet Occupation Zone and the German Democratic Republic (GDR). In the field of medicine this initiative was not successful. With respect to university psychiatric/neurological hospitals this experiment failed as a result of a shortage of personnel due to the consequences of war, denazification and people migrating into western occupation zones. Criteria for politically selecting promising young talent which had been propagated by the Socialist Unity Party of Germany (Sozialistische Einheitspartei Deutschlands, SED) were thus not relevant in academic medicine until 1961; however, the communist rulers had great interest in bringing professional and academic resources up to date. Politically implicated representatives in the field were also included in this process. At the forefront was the interest in functioning medical care and education in order to be able to train much needed health professionals. At the end of the 1950s a new generation of professors was established at the university hospitals. This generation rotation demonstrated the politically intended replacement of the "old" professor generation and the transition to a new GDR generation that had been trained after 1945. This second generation of professors inherited vacant professorships and defined and shaped research and academia until the end of the GDR much more than the previous generation had and also more than the one that followed. The generation of professors continued to feel a strong affiliation with their academic teachers and consequently continued their tradition in the sense of a school, for the most part independent of political circumstances.

  18. [Hospital day-surgery: comparative evaluation of 3 general anesthesia techniques].

    PubMed

    Rossi, A E; Lo Sapio, D; Oliva, O; Vitale, O; Ebano, A

    1995-06-01

    For the voluntary interruption of pregnancy, three anaesthetic techniques have been compared being a random assigned to three groups of 40 patients. Induction of anaesthesia was based on fentanyl 0.005 mg/kg+midazolam 0.2 mg/kg or fentanyl 0.005 mg/kg = propofol 2.5 mg/kg or ketamina 0.5 mg/kg+propofol 2.0 mg/kg. Anaesthesia was maintained delivering in spontaneous-assisted ventilation N2O 70% in O2. In addition to the intraoperative conditions, quality and rapidity of some neurofunctional aspects of the recovery have been evaluated using the Steward Score and the Coin Counting Test respectively. Our data suggest fentanyl-propofol association as the safest one as regards the needs of one-day surgery.

  19. A Neurologist's Hard Day's Work: Impact of Inpatient Neurology Consultation in a Tertiary Hospital.

    PubMed

    Rocha, Helena; Monteiro, Ana; Gomes, Tiago; Grilo, Miguel; Carvalho, Marta

    2016-01-01

    Introdução: A consulta de neurologia realizada a doentes hospitalizados sob a responsabilidade de outras especialidades é um trabalho exigente mas muitas vezes sub-valorizado e pouco documentado. Este estudo pretendeu avaliar o impacto das consultas internas de neurologia num hospital português e, consequentemente, a performance do nosso Serviço no que diz respeito a esta matéria. Material e Métodos: Foi conduzido um estudo retrospetivo durante o ano de 2013 através da revisão de dados clínicos e demográficos. Resultados: Ao longo de um ano, os neurologistas no nosso Serviço avaliaram 632 doentes internados. As principais razões para o pedido de consulta foram a alteração do estado mental/comportamental, défice neurológico focal e crises epiléticas. Os pedidos de avaliação provieram principalmente de serviços médicos mas também de Unidades de Cuidados Intensivos e Intermédios. Os neurologistas sugeriram investigação adicional em cerca de 50% dos doentes; alterações terapêuticas foram efetuadas numa proporção semelhante de doentes. No final da consulta foi possível estabelecer um novo diagnóstico em 63% dos casos, sendo os mais frequentes manifestação neurológica de doenças sistémicas, epilepsia e doença vascular cerebral. Tal intervenção teve impacto no cuidado de 68% dos doentes. Discussão e Conclusão: Diferentes estudos na literatura suportam os nossos achados, enfatizando que esta atividade tem benefícios diretos no tratamento dos doentes e que é custo-efetiva. Os nossos resultados sugerem que a atividade de consultadoria interna da Neurologia resulta em intervenções úteis para a gestão clínica dos doentes internados.

  20. A Public-Private Partnership Develops and Externally Validates a 30-Day Hospital Readmission Risk Prediction Model

    PubMed Central

    Choudhry, Shahid A.; Li, Jing; Davis, Darcy; Erdmann, Cole; Sikka, Rishi; Sutariya, Bharat

    2013-01-01

    Introduction: Preventing the occurrence of hospital readmissions is needed to improve quality of care and foster population health across the care continuum. Hospitals are being held accountable for improving transitions of care to avert unnecessary readmissions. Advocate Health Care in Chicago and Cerner (ACC) collaborated to develop all-cause, 30-day hospital readmission risk prediction models to identify patients that need interventional resources. Ideally, prediction models should encompass several qualities: they should have high predictive ability; use reliable and clinically relevant data; use vigorous performance metrics to assess the models; be validated in populations where they are applied; and be scalable in heterogeneous populations. However, a systematic review of prediction models for hospital readmission risk determined that most performed poorly (average C-statistic of 0.66) and efforts to improve their performance are needed for widespread usage. Methods: The ACC team incorporated electronic health record data, utilized a mixed-method approach to evaluate risk factors, and externally validated their prediction models for generalizability. Inclusion and exclusion criteria were applied on the patient cohort and then split for derivation and internal validation. Stepwise logistic regression was performed to develop two predictive models: one for admission and one for discharge. The prediction models were assessed for discrimination ability, calibration, overall performance, and then externally validated. Results: The ACC Admission and Discharge Models demonstrated modest discrimination ability during derivation, internal and external validation post-recalibration (C-statistic of 0.76 and 0.78, respectively), and reasonable model fit during external validation for utility in heterogeneous populations. Conclusions: The ACC Admission and Discharge Models embody the design qualities of ideal prediction models. The ACC plans to continue its partnership to

  1. DAY-CARE REHABILITATION CENTER FOR EMOTIONALLY DISTURBED ADOLESCENTS. FINAL REPORT.

    ERIC Educational Resources Information Center

    CRAWFORD, HUGH A.; VAN DUYNE, WILLIAM V.

    IN THIS FIVE YEAR DEMONSTRATION PROJECT, EMOTIONALLY DISTURBED ADULTS AND ADOLESCENTS RECEIVED TREATMENT AT A DAY CARE REHABILITATION CENTER SPONSORED BY THE RHODE ISLAND DIVISION OF VOCATIONAL REHABILITATION (DVR) LOCATED IN A PRIVATE PSYCHIATRIC HOSPITAL (BUTLER HOSPITAL). THE MAJOR TREATMENT GOALS WERE PRESERVATION AND RESTORATION OF…

  2. Three day crisis resolution unit.

    PubMed

    Dubin, S E; Ananth, J; Bajwa-Goldsmith, B; Stuller, S; Lewis, C; Miller, M; Noel, N; Fernandez, L

    1990-01-01

    This paper describes a three day crisis resolution unit within the confines of the psychiatric emergency service of a general hospital. It utilizes a crisis model of acute intervention, time limited psychotherapeutic approach combined with family therapy, and psychotropic meditation when indicated. One hundred thirty six consecutive admissions were rev ie.wed. 19% were discharged within 72 hours, and 51% required further hospitalization. Seventy seven percent of the patients discharged had involved families (significant others) in the treatment process, in comparison with only 28% family involvement with those patients who needed further hospitalization. This may be even more significant for psychotic patients who were discharged (14/18 family involvement) versus those who needed long hospitalization (13/50 family involvement).

  3. Risk factors associated with psychiatric readmission.

    PubMed

    Lorine, Kim; Goenjian, Haig; Kim, Soeun; Steinberg, Alan M; Schmidt, Kendall; Goenjian, Armen K

    2015-06-01

    The present study focused on identifying risk factors for early readmission of patients discharged from an urban community hospital. Retrospective chart reviews were conducted on 207 consecutive inpatient psychiatric admissions that included patients who were readmitted within 15 days, within 3 to 6 months, and not admitted for at least 12 months post-discharge. Findings indicated that a diagnosis of schizophrenia/schizoaffective disorder (OR = 18; 95% CI 2.70-117.7; p < 0.05), history of alcohol abuse (OR = 9; 95% CI 1.80-40.60; p < 0.05), number of previous psychiatric hospitalizations (OR = 2; 95% CI 1.28-3.73; p < 0.05), and type of residence at initial admission (e.g., homeless, OR = 29; 95% CI 3.99-217; p < 0.05) were significant risk factors for early readmission, where OR compares readmission group 1 versus group 3 in the multinomial logistic regression. Initial positive urine drug screen, history of drug abuse or incarceration, and legal status at initial admission did not predict early readmission. Reducing the risk factors associated with psychiatric readmissions has the potential to lead to the identification and development of preventative intervention strategies that can significantly improve patient safety, quality of care, well-being, and contain health care expenditures. PMID:25974053

  4. 42 CFR 456.170 - Medical, psychiatric, and social evaluations.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 4 2010-10-01 2010-10-01 false Medical, psychiatric, and social evaluations. 456... Hospitals Medical, Psychiatric, and Social Evaluations and Admission Review § 456.170 Medical, psychiatric, and social evaluations. (a) Before admission to a mental hospital or before authorization for...

  5. College Student Utilization of a Comprehensive Psychiatric Emergency Program

    ERIC Educational Resources Information Center

    Mitchell, Sharon L.; Kader, Mahrin; Haggerty, Melinda Z.; Bakhai, Yogesh D.; Warren, Calvert G.

    2013-01-01

    The authors sought to identify college students at risk for experiencing a mental health crisis that warranted a psychiatric evaluation at a hospital and/or a psychiatric hospitalization. A retrospective chart review of college students evaluated at a comprehensive psychiatric emergency program during a 1-year period was conducted. Demographic…

  6. 42 CFR 456.170 - Medical, psychiatric, and social evaluations.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 4 2011-10-01 2011-10-01 false Medical, psychiatric, and social evaluations. 456... Hospitals Medical, Psychiatric, and Social Evaluations and Admission Review § 456.170 Medical, psychiatric, and social evaluations. (a) Before admission to a mental hospital or before authorization for...

  7. MENTAL HEALTH AND PSYCHIATRIC NURSING IN PRACTICAL NURSE EDUCATION. FINAL REPORT.

    ERIC Educational Resources Information Center

    CRAWFORD, ANNIE L.

    THIRTY-ONE PROFESSIONAL NURSE EDUCATORS IN SCHOOLS OF PRACTICAL NURSING IN THE SOUTHEAST ATTENDED A TWO-WEEK CLINICAL WORKSHOP ON PSYCHIATRIC NURSING AT WESTERN STATE HOSPITAL, STAUNTON, VIRGINIA, IN AUGUST 1966. THEY RECONVENED FOR A THREE-DAY FOLLOW-UP CONFERENCE AT ATLANTA, GEORGIA, IN JANUARY 1967. THE PROJECT WAS UNDERTAKEN TO UPDATE THE…

  8. Broader Indications for Psychiatric Consultation

    PubMed Central

    Steinberg, Paul

    1987-01-01

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

  9. Psychiatric morbidity in primary care.

    PubMed

    al-Haddad, M K; al-Garf, A; al-Jowder, S; al-Zurba, F I

    1999-01-01

    The prevalence of hidden psychiatric morbidity was assessed using the General Health Questionnaire (GHQ) and Hospital Anxiety Depression Scale (HAD). A total of 149 Bahraini patients aged > or = 16 years were selected randomly from those attending primary health care centres for problems other than psychiatric illness. The prevalence of psychiatric morbidity using GHQ was 45.1% (cut-off > or = 5) and 27.1% (cut-off > or = 9). Using the HAD scale, the prevalence was 44.4% (cut-off > or = 8) and 23.6% (cut-off > or = 11). Psychiatric morbidity was more common in women aged 50-55 years, in divorcees or widows and in lesser educated patients. Either instrument could be used to diagnose psychiatric illness.

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

    ERIC Educational Resources Information Center

    Silverman, Michael J.

    2009-01-01

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

  11. Motivational Interviewing to Reduce Substance Use in Adolescents with Psychiatric Comorbidity.

    PubMed

    Brown, Richard A; Abrantes, Ana M; Minami, Haruka; Prince, Mark A; Bloom, Erika Litvin; Apodaca, Timothy R; Strong, David R; Picotte, Dawn M; Monti, Peter M; MacPherson, Laura; Matsko, Stephen V; Hunt, Jeffrey I

    2015-12-01

    Substance use among adolescents with one or more psychiatric disorders is a significant public health concern. In this study, 151 psychiatrically hospitalized adolescents, ages 13-17 with comorbid psychiatric and substance use disorders, were randomized to a two-session Motivational Interviewing intervention to reduce substance use plus treatment as usual (MI) vs. treatment as usual only (TAU). Results indicated that the MI group had a longer latency to first use of any substance following hospital discharge relative to TAU (36 days versus 11 days). Adolescents who received MI also reported less total use of substances and less use of marijuana during the first 6 months post-discharge, although this effect was not significant across 12 months. Finally, MI was associated with a significant reduction in rule-breaking behaviors at 6-month follow-up. Future directions are discussed, including means of extending effects beyond 6 months and dissemination of the intervention to community-based settings.

  12. Psychiatric services utilization in completed suicides of a youth centres population

    PubMed Central

    Renaud, Johanne; Chagnon, François; Balan, Bogdan; Turecki, Gustavo; McGirr, Alexander; Marquette, Claude

    2006-01-01

    Background From a retrospective study of youth centres (YCs) and coroner's files, we investigated youths' history of medical service utilization who died by suicide. This is the second of two papers on YCs population, the first paper having shown that the rate of psychopathology was higher in the YCs population compared to the general adolescent population. Methods From 1995 to 2000, 422 youths, aged 18 years and younger, died as a result of suicide in Quebec. More than one-third received services from YCs at some point. Using the provincial physician payment and hospitalization database, we examined physical and psychiatric service utilization according to time intervals, as well as hospitalization for psychiatric reasons in the individuals' lifetime and in the year preceding suicide. Suicides were matched to living YCs youths for age, sex, and geographic area. YCs controls were then subdivided into two groups based on file information pertaining to the presence or absence of suicidal behavior or ideation. Results Compared to living YCs youths, suicides had a higher rate of psychiatric service utilization in the week, month, 90 days, and year preceding suicide, as well as higher levels of lifetime hospitalization for psychiatric reasons than controls with or without a history of suicidal behavior or ideation. We found that 28.3% YCs suicides made use of psychiatric services in the year preceding suicide. Conclusion The rate of psychiatric service utilization by YCs youth suicides is substantially inferior to the needs of this population. Our study underscores the need for appropriate recognition of psychiatric and suicidal problems among YCs population by social and psycho-educational professionals. At the same time, it highlights the issues of general practitioners' risk identification, psychiatric referral and treatment. Our findings suggest the need for improved organization and coordination of psychiatric services to ameliorate treatment delivery. PMID

  13. Lunar phase and psychiatric illness in goa.

    PubMed

    Parmeshwaran, R; Patel, V; Fernandes, J M

    1999-01-01

    There has been considerable research on the influence of the lunar cycle on mental illness with conflicting findings. The objective of this study was to determine the relationship between full moon (FM), new moon (NM), and other moon (OM) days and the frequency of specific psychiatric disorders in patients seen at a tertiary psychiatric hospital in Goa and to examine relationships with eclipses. Analysis of all new patients in two calendar years (1997 & 1993) was carried out. Diagnoses of interest were : Non affective psychoses; depression; and mania. The numbers of new patients seen at the OPD of the Institute of Psychiatry & Human Behaviour, Goa, with these diagnoses were compared between FM, NM and OM days. Numbers of patients with these diagnoses on eclipse days (lunar/solar) were also examined. A significant trend was observed for greater numbers of patients with non-affective psychoses on FM days, but no pattern was observed for mania or depression. The excess of non-affective psychoses was more marked on days of a visible lunar eclipse. A relationship between FM and non-affective psychoses has been demonstrated. Its implications for further research and the potential mechanism to explain these findings are discussed. PMID:21455355

  14. [A "people dump": marks of suffering and transformations at the former Hospital Colônia Sant'Ana and in psychiatric care in Santa Catarina, 1970-1996].

    PubMed

    Borges, Viviane Trindade

    2013-10-01

    The article explores transformations to psychiatric care in Santa Catarina starting in the 1970s, when the state's longtime asylum, Hospital Colônia Sant'Ana, reached the height of overcrowding. To this end, along with other sources, it analyzes interviews that had been conducted with professionals who worked at the hospital in that era, sourced from the facility's Center for Documentation and Research. The goal was to problematize these testimonies, examining the texture of the accounts and approaching them as memories that weave a history of the hospital through recollections marked by suffering. Within this proposed framework, suffering is understood as a historical event that can give rise to new social arrangements.

  15. North vs south differences in acute peptic ulcer hemorrhage in Croatia: hospitalization incidence trends, clinical features, and 30-day case fatality

    PubMed Central

    Ljubičić, Neven; Pavić, Tajana; Budimir, Ivan; Puljiz, Željko; Bišćanin, Alen; Bratanić, Andre; Nikolić, Marko; Hrabar, Davor; Troskot, Branko

    2014-01-01

    Aim To assess the seven-year trends of hospitalization incidence due to acute peptic ulcer hemorrhage (APUH) and associated risk factors, and examine the differences in these trends between two regions in Croatia. Methods The study collected sociodemographic, clinical, and endoscopic data on 2204 patients with endoscopically confirmed APUH who were admitted to the Clinical Hospital Center “Sestre Milosrdnice,” Zagreb and Clinical Hospital Center Split between January 1, 2005 and December 31, 2011. We determined hospitalization incidence rates, 30-day case fatality rate, clinical outcomes, and incidence-associated factors. Results No differences were observed in APUH hospitalization incidence rates between the regions. Age-standardized one-year cumulative APUH hospitalization incidence rate calculated using the European Standard Population was significantly higher in Zagreb than in Split region (43.2/100 000 vs 29.2/100,000). A significantly higher APUH hospitalization incidence rates were observed in the above 65 years age group. Overall 30-day case fatality rate was 4.9%. Conclusion The hospitalization incidence of APUH in two populations did not change over the observational period and it was significantly higher in the Zagreb region. The incidence of acute duodenal ulcer hemorrhage also remained unchanged, whereas the incidence of acute gastric ulcer hemorrhage increased. The results of this study allow us to monitor epidemiological indicators of APUH and compare data with other countries. PMID:25559836

  16. Teaching psychiatric ethics.

    PubMed

    Bloch, S

    1988-11-01

    In the last decade, we have witnessed a burgeoning of interest in ethical issues amongst psychiatrists. Teaching of the subject, however, remains at a rudimentary stage. Various approaches to such instruction are available, particularly modelling (students observe their experienced counterpart), the case method (examining specific clinical situations which involve a need for ethical decision-making), and the seminar approach (trainees are exposed to a core body of knowledge, mainly theoretical in nature). Faced with these different teaching models, the University of Oxford Department of Psychiatry has opted for a blend of all three approaches, which incorporates two goals: an increase in the trainees' sensitivity to the many intricate moral dilemmas facing the psychiatric profession; and their familiarity with salient concepts in moral philosophy which constitute a basis for ethical reasoning and which have a bearing on clinical practice. The teaching programme comprises the following: a pair of trainees prepares a presentation on an aspect of psychiatric ethics under the supervision of a senior psychiatrist. A moral philosopher assumes the role of discussant of the ethical problems raised by the trainees; this is followed by a general discussion. Topics have included involuntary hospitalization, dual loyalty, suicide, psychiatric diagnosis, and ethical issues in various spheres of psychiatric practice such as sex therapy, psychotherapy and child psychiatry. The approach has worked effectively and proved rewarding to all participants involved. PMID:3226351

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

    PubMed

    Spiro, A H

    1994-03-01

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

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

    PubMed

    Spiro, A H

    1994-03-01

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

  19. Substance abuse in an inpatient psychiatric sample.

    PubMed

    Brady, K; Casto, S; Lydiard, R B; Malcolm, R; Arana, G

    1991-01-01

    The relationship between psychoactive drug abuse and psychopathology is complex. There have been few systematic explorations of substance abuse in psychiatric populations since the recent epidemic of cocaine abuse. To update and further explore the relationship between psychiatric illness and substance abuse, 100 consecutively admitted patients to an inpatient psychiatry unit were administered a drug and alcohol use/abuse questionnaire. Sixty-four percent endorsed current or past problems with substance abuse and 29% met DSM-III-R criteria for substance abuse in the 30 days prior to admission. For the major diagnostic categories, there were no significant differences between groups in percentages of patients with substance abuse disorders. There was a trend (p less than or equal to .2) toward an increased number of lifetime psychiatric hospitalizations in the substance-abusing group. Alcohol was the most common drug of choice followed by stimulants, cannabis, and sedative hypnotics. Differences in drug choices between diagnostic categories are discussed. Forty-three percent of urine drug screens obtained were positive, and of those with positive urine drug screens, 42% denied drug use upon admission. Only 40% of patients with current or past substance abuse problems had received treatment for their chemical dependency. In our sample, while substance abuse was very prevalent, it was underreported and undertreated.

  20. An Evaluation of Rehabilitation Services and the Role of Industry in the Community Adjustment of Psychiatric Patients Following Hospitalization. Final Report.

    ERIC Educational Resources Information Center

    Schmidt, James R.; And Others

    The objectives of this study were to determine the extent to which private enterprise could participate in the vocational rehabilitation of the discharged psychiatric patient and to evaluate the effects of rehabilitation services on the community adjustment of such patients. A total of 202 subjects were randomly assigned to three research groups:…

  1. Security at a "model" psychiatric center.

    PubMed

    Camacho, H S; Cottrell, P A

    1997-01-01

    The security problems faced by a recently opened psychiatric center located on the campus of a hospital--including staffing, fire safety, access control, patient restraints, and budget cuts--and how they are being dealt with. PMID:10173429

  2. Poetry Therapy in Psychiatric Nursing.

    ERIC Educational Resources Information Center

    Anderson, Catherine J.

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

  3. The direct and interactive effects of physical abuse severity and negative affectivity on length of psychiatric hospitalization: evidence of differential reactivity to adverse environments in psychiatrically high-risk youth.

    PubMed

    Comas, Michelle; Valentino, Kristin; Bridgett, David J; Hayden, Lisa C

    2014-01-01

    The current study examined the interactive influence of multiple factors (i.e., physical abuse severity and negative affectivity) in predicting youth's inpatient psychiatric length of stay (LOS), extending previous research focused on identification of only single LOS predictors. Elevated physical abuse severity was hypothesized to predict longer youth LOS, and negative affectivity was anticipated to exacerbate this relationship. This study included 42 youth. Clinicians rated youth temperament, whereas physical abuse severity and LOS were coded from youth medical records. Controlling for other previously determined predictors of LOS (i.e., age, gender, and GAF), moderation analyses confirmed hypotheses, revealing a temperament by environment interaction. Specifically, physical abuse severity was positively associated with LOS only in the context of high negative affectivity. Findings highlighted the importance of disentangling the interactive effects of multiple factors in predicting LOS. Moreover, critical clinical implications involving prioritized trauma assessment and treatment for inpatient youth are discussed.

  4. Cohesion to the Group and Its Association with Attendance and Early Treatment Response in an Adult Day-Hospital Program for Eating Disorders: A Preliminary Clinical Investigation

    ERIC Educational Resources Information Center

    Crino, Natalie; Djokvucic, Ivana

    2010-01-01

    Treatment outcome studies demonstrate that day-hospital programs are effective in the treatment of eating disorders. Few descriptions are available on the specifics of treatment, particularly the process of therapy. The group therapy modality is thought to provide important therapeutic benefits. The present study aimed to examine the association…

  5. [Actual problems of inpatient psychiatric care in Russia].

    PubMed

    Iastrebov, V S; Mitikhin, V G; Solokhina, T A; Shevchenko, L S; Tvorogova, N A

    2013-01-01

    A comparative evaluation of inpatient psychiatric care in Russia and some other countries is presented. A systematic analysis of the performance of psychiatric hospitals is conducted. The process of the deinstitutionalization in Russian psychiatry is highlighted. A range of problems hindering a reform of inpatient psychiatric service of the country is singled out. PMID:24300798

  6. Psychiatric wards: places of safety?

    PubMed

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

    2010-03-01

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

  7. Psychiatric wards: places of safety?

    PubMed

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

    2010-03-01

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

  8. A SHOCKING REQUIREMENT IN THE LAW ON NEGLIGENCE LIABILITY FOR PSYCHIATRIC ILLNESS: LIVERPOOL WOMEN'S HOSPITAL NHS FOUNDATION TRUST V RONAYNE [2015] EWCA CIV 588.

    PubMed

    Burrows, Andrew S; Burrows, John H

    2016-01-01

    The Ronayne case concerned a husband who suffered a psychiatric illness, described as an adjustment disorder, in seeing the condition of his wife who was the primary victim of admitted medical negligence. His claim for compensation, as a 'secondary victim', failed because he could not satisfy the legal requirement that there must be a sudden shocking event. This commentary criticises that requirement which appears to make no medical sense. PMID:26856615

  9. Psychiatric manifestations in cerebrotendinous xanthomatosis

    PubMed Central

    Fraidakis, M J

    2013-01-01

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

  10. Psychiatric Emergencies.

    PubMed

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

    2016-06-01

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

  11. Brain Tumours Simulating Psychiatric Disease

    PubMed Central

    Hobbs, G. E.

    1963-01-01

    Brain tumours may present with symptoms indistinguishable from psychiatric disease. The impression of most psychiatrists is that individuals suffering from brain tumour rarely appear among their patients. A priori reasoning based on evidence from neurological, neurosurgical and pathological sources suggests the contrary. The present study is a frequency analysis of cases of previously undiagnosed brain tumours admitted to either an open psychoneurotic ward or a mental hospital over a period of 15 years. The results support the impression held by psychiatrists that brain tumours are uncommon among psychiatric patients. PMID:13954870

  12. Psychiatric pharmacogenomics in pediatric psychopharmacology.

    PubMed

    Wall, Christopher A; Croarkin, Paul E; Swintak, Cosima; Koplin, Brett A

    2012-10-01

    This article provides an overview of where psychiatric pharmacogenomic testing stands as an emerging clinical tool in modern psychotropic prescribing practice, specifically in the pediatric population. This practical discussion is organized around the state of psychiatric pharmacogenomics research when choosing psychopharmacologic interventions in the most commonly encountered mental illnesses in youth. As with the rest of the topics on psychopharmacology for children and adolescents in this publication, a clinical vignette is presented, this one highlighting a clinical case of a 16 year old genotyped during hospitalization for recalcitrant depression.

  13. Caffeine consumption in a long-term psychiatric hospital: Tobacco smoking may explain in large part the apparent association between schizophrenia and caffeine use.

    PubMed

    Arrojo-Romero, Manuel; Armas Barbazán, Carmen; López-Moriñigo, Javier D; Ramos-Ríos, Ramón; Gurpegui, Manuel; Martínez-Ortega, José M; Jurado, Dolores; Diaz, Francisco J; de Leon, Jose

    2015-05-01

    This study further explores the association between schizophrenia and caffeine use by combining two prior published Spanish samples (250 schizophrenia outpatients and 290 controls from the general population) with two Spanish long-term inpatient samples from the same hospital (145 with schizophrenia and 64 with other severe mental illnesses). The specific aims were to establish whether or not, after controlling for confounders including tobacco smoking, the association between schizophrenia and caffeine is consistent across schizophrenia samples and across different definitions of caffeine use. The frequency of caffeine use in schizophrenia inpatients was not significantly higher than that in non-schizophrenia inpatients (77%, 111/145 vs. 75%, 48/64) or controls but was significantly higher than in schizophrenia outpatients. The frequency of high caffeine users among caffeine users in schizophrenia inpatients was not significantly higher than in non-schizophrenia inpatients (45%, 50/111 vs. 52%, 25/48) or controls, but was significantly lower than in schizophrenia outpatients. Smoking was significantly associated with caffeine use across all samples and definitions. Between 2 and 3% of schizophrenia inpatients, schizophrenia outpatients and non-schizophrenia inpatients showed caffeinism (>700 mg/day in smokers). Several of these smoking patients with caffeinism were also taking other inducers, particularly omeprazole. The lack of consistent association between schizophrenia and caffeine use is surprising when compared with the very consistent association between tobacco smoking and caffeine use across all of our analyses (use and high use in users) and all our samples. The confounding effects of tobacco smoking may explain in large part the apparent association between schizophrenia and caffeine use.

  14. [Authority in the psychiatric clinic].

    PubMed

    Laemmel, K

    1983-01-01

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

  15. [Prescription for the day: infusion of cheer. Using art as an instrument in the care of hospitalized children].

    PubMed

    Françani, G M; Zilioli, D; Silva, P R; Sant'ana, R P; de Lima, R A

    1998-12-01

    The purpose of this study is to report on the experiment of a group of undergraduate students from the University of São Paulo at Ribeirão Preto College of Nursing, who use art (some aspects of the Clown Theatre) as a nursing resource in the care to hospitalized children. Having as basis the job performed by the group of physicians "Joy Doctors", and the theoretical grounding from Psychology and Pediatric and Neonatal Nursing, those students founded the Laugh Company that aims at rescuing laugh within the hospitalized child/family. This experiment has caused some changes in daily care: the hospital space has become more informal and relaxed, laugh can be heard more often and some items, such as, objects, sounds, movements, colours, rooms and people can become toys.

  16. [Prescription for the day: infusion of cheer. Using art as an instrument in the care of hospitalized children].

    PubMed

    Françani, G M; Zilioli, D; Silva, P R; Sant'ana, R P; de Lima, R A

    1998-12-01

    The purpose of this study is to report on the experiment of a group of undergraduate students from the University of São Paulo at Ribeirão Preto College of Nursing, who use art (some aspects of the Clown Theatre) as a nursing resource in the care to hospitalized children. Having as basis the job performed by the group of physicians "Joy Doctors", and the theoretical grounding from Psychology and Pediatric and Neonatal Nursing, those students founded the Laugh Company that aims at rescuing laugh within the hospitalized child/family. This experiment has caused some changes in daily care: the hospital space has become more informal and relaxed, laugh can be heard more often and some items, such as, objects, sounds, movements, colours, rooms and people can become toys. PMID:9934241

  17. Christmas and psychopathology. Data from a psychiatric emergency room population.

    PubMed

    Hillard, J R; Holland, J M; Ramm, D

    1981-12-01

    It is widely believed among psychiatrists and laymen alike that Christmas and other holidays are associated with an increased incidence of psychopathology. Statistical studies, however, consistently have been shown the Christmas season to be associated with a low incidence of suicide and psychiatric hospitalization. The present study examines the number and type of visits to a 24-hour psychiatric emergency service over a seven-year period. There is a decrease in the number of visits during the days and weeks before Christmas and an increase of roughly the same magnitude afterward. The effect is more prominent for women and older persons but does not seem to differentially affect persons of different racial, marital, or diagnostic status.

  18. [Social integration and contacts to reference persons of the normal social environment in inpatient treatment in the psychiatric hospital. A prospective catamnestic study of patients admitted for the first time with schizophrenic and cyclothymic psychoses].

    PubMed

    Böcker, F M

    1984-01-01

    Fifty first-admission inpatients (27 women, 23 men; mean age 35.1 years) with schizophrenia (n = 35) or affective disorders (n = 15) participated in a standardized, half-open interview about contact with people outside the hospital. The frequency of contact was compared with outcome, as based on a 1-year follow-up. Nearly all patients (48 of 50) had "direct" contact with relatives and friends during the week (means = 3/week): 45 patients had visitors, 13 went home on weekends. Thirty-five patients had contact with the outside by telephone, and 21 by letter; only 12 patients indicated no "indirect" contact. The frequency of contact had no relationship to sex, age or diagnosis. The significant factors were: structure of the patient's family, his/her educational and occupational level, social network, means of admission, conditions of hospitalization, and length of stay. The distance between the patient's residence and the hospital markedly influenced the frequency of visits and weekend holidays. The importance of frequent interaction with the usual social environment was verified by follow-up: 11 patients with rare or only average contact had unfavorable results (readmission or suicide by 1 year after discharge or long-term hospitalization); on the other hand, none of the patients with frequent direct contact outside the hospital showed poor results. There is no reason for indiscriminate criticism of the relatives of psychiatric inpatients according to etiological hypotheses of "family research"; above all, patients without relationships with a family or friends have to be regarded as at risk.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:6526062

  19. Neuropathological research at the "Deutsche Forschungsanstalt fuer Psychiatrie" (German Institute for Psychiatric Research) in Munich (Kaiser-Wilhelm-Institute). Scientific utilization of children's organs from the "Kinderfachabteilungen" (Children's Special Departments) at Bavarian State Hospitals.

    PubMed

    Steger, Florian

    2006-09-01

    During National Socialism, the politically motivated interest in psychiatric genetic research lead to the founding of research departments specialized in pathological-anatomical brain research, the two Kaiser Wilhelm-Institutes (KWI) in Berlin and Munich. The latter was indirectly provided with brain material by Bavarian State Hospitals, to three of which "Kinderfachabteilungen" (Special Pediatric Units) were affiliated. As children became victims of the systematically conducted child "euthanasia" in these Special Pediatric Units, this paper will address the question whether and to which extent the organs from victims of child "euthanasia" were used for (neuro-) pathological research at the KWI in Munich. By means of case studies and medical histories (with focus on the situation in Kaufbeuren-Irsee), I will argue that pediatric departments on a regular base delivered slide preparations, that the child "euthanasia" conduced in these departments systematically contributed to neuropathological research and that slide preparations from victims of child "euthanasia" were used in scientific publications after 1945.

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

    PubMed

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

    2008-09-01

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

  1. Oppositional defiant disorder symptoms in relation to psychopathic traits and aggression among psychiatrically hospitalized children: ADHD symptoms as a potential moderator.

    PubMed

    Becker, Stephen P; Luebbe, Aaron M; Fite, Paula J; Greening, Leilani; Stoppelbein, Laura

    2013-01-01

    Oppositional defiant disorder (ODD) is associated with elevated rates of psychopathic traits and aggression. However, it remains unclear if attention-deficit/hyperactivity disorder (ADHD) symptoms exacerbate these relations, particularly in samples of children who are severely clinically distressed. The purpose of the present study was to test ADHD symptoms as a potential moderator of the relations of ODD symptoms to psychopathic traits (i.e., callous-unemotional [CU] traits, narcissism) and to aggressive subtypes (i.e., proactive, reactive aggression) in a large sample of children in an acute psychiatric inpatient facility (n = 699; ages 6-12). Multiple regression analyses indicated that, after controlling for child demographic variables, ADHD symptoms marginally exacerbated the relation between ODD symptoms and CU traits. Both ODD and ADHD symptoms had an additive, but not a multiplicative effect, in predicting narcissism. In addition, for a subset of the full sample for whom data were available (n =351), ADHD symptoms exacerbated the relation between ODD symptoms and both reactive and proactive aggression. These results suggest that ADHD symptoms tend to have a negative effect on the relation between ODD symptoms and markers of antisociality among children receiving acute psychiatric care.

  2. [On the admittance of forensic patients to general psychiatric wards].

    PubMed

    Schalast, N; Balten, A; Leygraf, N

    2003-03-01

    In Germany, due to an increasing number of "hospital order sentences," the capacities of forensic hospitals are exhausted. In the late 1990s,general psychiatric hospitals admitted a remarkable number of mentally disturbed offenders. In this study,data of 140 patients treated in general psychiatric hospitals in the German lower Rhine region are presented. These patients clearly differ from those treated in forensic hospitals. Approximately 60% of them suffer from schizophrenic psychosis. Only a few reveal a long antisocial background, a severe personality disorder, or a sexual offence as an index crime. Though the staff in the general psychiatric units often complain about the circumstances of patients' admittance to the hospitals, in about half of the cases they do not agree with a transferring of their patients to a forensic hospital. The results of this study are discussed in regard to general questions of organizing forensic psychiatric treatment.

  3. Postgraduate education in psychiatric nursing in Israel: closing the gap.

    PubMed

    Haron, Yafa; Gun-Usishkin, Monica; Shor, Razia; Tran, Dror; Riba, Shoshana

    2014-12-01

    Deinstitutionalization policies are being gradually implemented in Israel. Most recently, an insurance reform has been approved, in which mental health services will be included in the HMO's service package. As most Israeli mental health nurses are currently employed in institutional settings, the Ministry of Health's Nursing Division seeks to estimate their scope of employment in preparation for the anticipated changes. The aim of this study is to describe present-day professional practice characteristics of qualified psychiatric nurses and identify practice areas for which advanced training may be required. The research design is cross-sectional on a national level, including all state psychiatric hospitalization services. A countrywide sample of nurses with post-basic training in state psychiatric hospitals identified areas of practice in which further training may be required: psychotherapy intervention (60% of respondents); consultation for the elderly (60%); care prescriptions (64%); community drug treatment management (69%); and referral to professionals and community resources (56%). Nurses reported gaps in continued care and community rehabilitation activities. These findings have training implications in an era of increased focus on chronic mental illness in the community. PMID:25383713

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

    PubMed Central

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

    2016-01-01

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

  5. Is Survival After Out-of-Hospital Cardiac Arrests Worse During Days of National Academic Meetings in Japan? A Population-Based Study

    PubMed Central

    Kitamura, Tetsuhisa; Kiyohara, Kosuke; Matsuyama, Tasuku; Hatakeyama, Toshihiro; Shimamoto, Tomonari; Izawa, Junichi; Nishiyama, Chika; Iwami, Taku

    2016-01-01

    Background Outcomes after out-of-hospital cardiac arrests (OHCAs) might be worse during academic meetings because many medical professionals attend them. Methods This nationwide population-based observation of all consecutively enrolled Japanese adult OHCA patients with resuscitation attempts from 2005 to 2012. The primary outcome was 1-month survival with a neurologically favorable outcome. Calendar days at three national meetings (Japanese Society of Intensive Care Medicine, Japanese Association for Acute Medicine, and Japanese Circulation Society) were obtained for each year during the study period, because medical professionals who belong to these academic societies play an important role in treating OHCA patients after hospital admission, and we identified two groups: the exposure group included OHCAs that occurred on meeting days, and the control group included OHCAs that occurred on the same days of the week 1 week before and after meetings. Multiple logistic regression analysis was used to adjust for confounding variables. Results A total of 20 143 OHCAs that occurred during meeting days and 38 860 OHCAs that occurred during non-meeting days were eligible for our analyses. The proportion of patients with favorable neurologic outcomes after whole arrests did not differ during meeting and non-meeting days (1.6% [324/20 143] vs 1.5% [596/38 855]; adjusted odds ratio 1.02; 95% confidence interval, 0.88–1.19). Regarding bystander-witnessed ventricular fibrillation arrests of cardiac origin, the proportion of patients with favorable neurologic outcomes also did not differ between the groups. Conclusions In this population, there were no significant differences in outcomes after OHCAs that occurred during national meetings of professional organizations related to OHCA care and those that occurred during non-meeting days. PMID:26639754

  6. Assessing Risk Factors for Hospital-Based, Acute Care Within Thirty Days of Craniosynostosis Surgery Using the Healthcare Cost and Utilization Project.

    PubMed

    Xu, Wen; Fox, Justin P; Gerety, Patrick A; Li, Jing; Wes, Ari M; Bartlett, Scott P; Taylor, Jesse A

    2016-09-01

    While in-hospital outcomes and long-term results of craniosynostosis surgery have been described, no large studies have reported on postoperative readmission and emergency department (ED) visits. The authors conducted this study to describe the incidence, associated diagnoses, and risk factors for these encounters within 30 days of craniosynostosis surgery.Using 4 state-level databases, the authors conducted a retrospective cohort study of patients <3 years of age who underwent surgery for craniosynostosis. The primary outcome was any hospital based, acute care (HBAC; ED visit or hospital readmission) within 30 days of discharge. Multivariate logistic regression modeling was used to identify factors associated with this outcome.The final sample included 1120 patients. On average, patients were ages 4.6 months with the majority being male (67.3%) and having Medicaid (52%) or private (48.0%) insurance. Ninety-nine patients (8.8%) had at least 1 HBAC encounter within 30 days and 13 patients (1.2%) had 2 or more. The majority of encounters were managed in the ED without hospital admission (56.6%). In univariate analysis, age, race, insurance status, and initial length of stay significantly differed between the HBAC and non-HBAC groups. In multivariate analysis, only African-American race (adjusted odds ratio [AOR] = 5.98 [1.49-23.94]) and Hispanic ethnicity (AOR = 5.31 [1.88-14.97]) were associated with more frequent HBAC encounters.Nearly 10% of patients with craniosynostosis require HBAC postoperatively with ED visits accounting for the majority of these encounters. Race is independently associated with HBAC, the cause of which is unknown and will be the focus of future research. PMID:27526238

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

    PubMed

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

    2015-09-01

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

  8. Present-Day Hospital Readmissions after Left Ventricular Assist Device Implantation: A Large Single-Center Study.

    PubMed

    Hernandez, Ruben E; Singh, Steve K; Hoang, Dale T; Ali, Syed W; Elayda, MacArthur A; Mallidi, Hari R; Frazier, O H; Meyers, Deborah E

    2015-10-01

    Left ventricular assist device (LVAD) therapy improves survival, hemodynamic status, and end-organ perfusion in patients with refractory advanced heart failure. Hospital readmission is an important measure of the intensity of LVAD support care. We analyzed readmissions of 148 patients (mean age, 53.6 ± 12.7 yr; 83% male) who received a HeartMate II LVAD from April 2008 through June 2012. The patients had severe heart failure; 60.1% were in Interagency Registry for Mechanically Assisted Circulatory Support class 1 or 2. All patients were observed for at least 12 months, and readmissions were classified as planned or unplanned. Descriptive and multivariate regression analyses were used to identify predictors of unplanned readmission. Twenty-seven patients (18.2%) had no readmissions or 69 planned readmissions, and 121 patients (81.8%) had 460 unplanned readmissions. The LVAD-related readmissions were for bleeding, thrombosis, and anticoagulation (n=103; 49.1%), pump-related infections (n=60; 28.6%), and neurologic events (n=28; 13.3%). The readmission rate was 2.1 per patient-year. Unplanned readmissions were for comorbidities and underlying cardiac disease (54.3%) or LVAD-related causes (45.7%). In the unplanned-readmission rate, there was no significant difference between bridge-to-transplantation and destination-therapy patients. Unplanned readmissions were associated with diabetes mellitus (odds ratio [OR]=3.3; P=0.04) and with shorter mileage from residence to hospital (OR=0.998; P=0.046). Unplanned admissions for LVAD-related sequelae and ongoing comorbidities were common. Diabetes mellitus and shorter distance from residence to hospital were significant predictors of readmission. We project that improved management of comorbidities and of anticoagulation therapy will reduce unplanned readmissions of LVAD patients in the future.

  9. Present-Day Hospital Readmissions after Left Ventricular Assist Device Implantation: A Large Single-Center Study.

    PubMed

    Hernandez, Ruben E; Singh, Steve K; Hoang, Dale T; Ali, Syed W; Elayda, MacArthur A; Mallidi, Hari R; Frazier, O H; Meyers, Deborah E

    2015-10-01

    Left ventricular assist device (LVAD) therapy improves survival, hemodynamic status, and end-organ perfusion in patients with refractory advanced heart failure. Hospital readmission is an important measure of the intensity of LVAD support care. We analyzed readmissions of 148 patients (mean age, 53.6 ± 12.7 yr; 83% male) who received a HeartMate II LVAD from April 2008 through June 2012. The patients had severe heart failure; 60.1% were in Interagency Registry for Mechanically Assisted Circulatory Support class 1 or 2. All patients were observed for at least 12 months, and readmissions were classified as planned or unplanned. Descriptive and multivariate regression analyses were used to identify predictors of unplanned readmission. Twenty-seven patients (18.2%) had no readmissions or 69 planned readmissions, and 121 patients (81.8%) had 460 unplanned readmissions. The LVAD-related readmissions were for bleeding, thrombosis, and anticoagulation (n=103; 49.1%), pump-related infections (n=60; 28.6%), and neurologic events (n=28; 13.3%). The readmission rate was 2.1 per patient-year. Unplanned readmissions were for comorbidities and underlying cardiac disease (54.3%) or LVAD-related causes (45.7%). In the unplanned-readmission rate, there was no significant difference between bridge-to-transplantation and destination-therapy patients. Unplanned readmissions were associated with diabetes mellitus (odds ratio [OR]=3.3; P=0.04) and with shorter mileage from residence to hospital (OR=0.998; P=0.046). Unplanned admissions for LVAD-related sequelae and ongoing comorbidities were common. Diabetes mellitus and shorter distance from residence to hospital were significant predictors of readmission. We project that improved management of comorbidities and of anticoagulation therapy will reduce unplanned readmissions of LVAD patients in the future. PMID:26504434

  10. Safety and Traceability in Patient Healthcare through the Integration of RFID Technology for Intravenous Mixtures in the Prescription-Validation-Elaboration-Dispensation-Administration Circuit to Day Hospital Patients.

    PubMed

    Martínez Pérez, María; Vázquez González, Guillermo; Dafonte, Carlos

    2016-01-01

    This work presents the integration of the RFID technology with the aim of ensuring the traceability of patients and minimization of adverse events during the process of prescription-validation-elaboration-dispensation-administration of medication by means of the implementation of various passive and active WIFI RFID systems in the Pharmacy and Day Hospital services of the Complejo Hospitalario Universitario A Coruña. Obtaining patient traceability and using the patient/drug binomial during this process allows us to minimize the occurrence of adverse events. The key points in this work are the unmistakably unique identification and accurate real time location of the controlled items (patients and medication). RFID technology has proved to be invaluable in assisting with the everyday clinical practice of a hospital, and has been successfully implemented in this environment and others. In services such as the day hospital, the implementation of said technology is further justified by the high costs of the service and the high risk to the patient. PMID:27483269

  11. Safety and Traceability in Patient Healthcare through the Integration of RFID Technology for Intravenous Mixtures in the Prescription-Validation-Elaboration-Dispensation-Administration Circuit to Day Hospital Patients

    PubMed Central

    Martínez Pérez, María; Vázquez González, Guillermo; Dafonte, Carlos

    2016-01-01

    This work presents the integration of the RFID technology with the aim of ensuring the traceability of patients and minimization of adverse events during the process of prescription-validation-elaboration-dispensation-administration of medication by means of the implementation of various passive and active WIFI RFID systems in the Pharmacy and Day Hospital services of the Complejo Hospitalario Universitario A Coruña. Obtaining patient traceability and using the patient/drug binomial during this process allows us to minimize the occurrence of adverse events. The key points in this work are the unmistakably unique identification and accurate real time location of the controlled items (patients and medication). RFID technology has proved to be invaluable in assisting with the everyday clinical practice of a hospital, and has been successfully implemented in this environment and others. In services such as the day hospital, the implementation of said technology is further justified by the high costs of the service and the high risk to the patient. PMID:27483269

  12. Safety and Traceability in Patient Healthcare through the Integration of RFID Technology for Intravenous Mixtures in the Prescription-Validation-Elaboration-Dispensation-Administration Circuit to Day Hospital Patients.

    PubMed

    Martínez Pérez, María; Vázquez González, Guillermo; Dafonte, Carlos

    2016-07-28

    This work presents the integration of the RFID technology with the aim of ensuring the traceability of patients and minimization of adverse events during the process of prescription-validation-elaboration-dispensation-administration of medication by means of the implementation of various passive and active WIFI RFID systems in the Pharmacy and Day Hospital services of the Complejo Hospitalario Universitario A Coruña. Obtaining patient traceability and using the patient/drug binomial during this process allows us to minimize the occurrence of adverse events. The key points in this work are the unmistakably unique identification and accurate real time location of the controlled items (patients and medication). RFID technology has proved to be invaluable in assisting with the everyday clinical practice of a hospital, and has been successfully implemented in this environment and others. In services such as the day hospital, the implementation of said technology is further justified by the high costs of the service and the high risk to the patient.

  13. The prevalence of early postpartum psychiatric morbidity in Dubai: a transcultural perspective.

    PubMed

    Abou-Saleh, M T; Ghubash, R

    1997-05-01

    There have been numerous studies of the prevalence of postpartum psychiatric illness and its putative risk factors in Western Europe and North America, but very few studies have been undertaken in developing countries, including the Arab world. A total of 95 women admitted to the New Dubai Hospital in Dubai, United Arab Emirates, for childbirth were studied. All subjects were assessed in the postpartum period using clinical and socio-cultural instruments, namely the Self-Reporting Questionnaire (SRQ) on day 2 and the Edinburgh Postnatal Depression Scale (EPDS) on day 7 after delivery. The prevalence of psychiatric morbidity was 24% according to the SRQ and 18% according to the EPDS. A number of psychosocial factors emerged as putative risk factors for postpartum psychiatric disturbance, including depressive illness. It is concluded that the prevalence of postpartum psychiatric morbidity and its risk factors in this Arab culture are similar to the results obtained in numerous previous studies conducted in industrialized countries. These findings have implications for the early detection and care of women at risk for postpartum psychiatric illness.

  14. Teaching transcendental meditation in a psychiatric setting.

    PubMed

    Candelent, T; Candelent, G

    1975-03-01

    For two and a half years the authors have taught Transcendental Meditation (TM) to psychiatric patients at the Institute of Living in Hartford, Connecticut. They have also presented programs to hospital staff to acquaint them with the technique and practice of TM. In this paper they describe briefly the instruction program given to patients at the institute and point out some of the benefits of regular practice of TM for psychiatric patients.

  15. [Rehabilitation work in a psychiatric service].

    PubMed

    Correa, J O; Ingala, E M; Justo, S N

    1987-06-01

    A description of rehabilitation work at a psychiatric ward with all the benefits specific modalities, and results involved is offered. Focusing from a multidisciplinary angle the authors aim at laying the foundations for the setting up of rehabilitation workteams, in the frame of psychiatric hospitals in our country. At the same time clinical examples are submitted to illustrate situations which had to be met during the work and their linking to setting and transference as well.

  16. An annotated bibliography of psychiatric medical ethics.

    PubMed

    Anzia, D J; La Puma, J

    1991-03-01

    We offer an annotated bibliography of psychiatric medical ethics that we hope will be useful for psychiatrists and other mental health professionals who are interested in the moral dimensions of psychiatric care. We present the educational and clinical rationale for the bibliography, ways to use the bibliography, and the bibliography itself. Using the American Psychiatric Association's Principles of Medical Ethics With Annotations Especially Applicable to Psychiatry as a principled framework, we selected references based primarily on educational and clinical relevance for physicians. We include both empirical and conceptual analyses of the ethical issues seen daily in the office, clinic, hospital, nursing home, and in society at large.

  17. The impact of shift work on the psychological and physical health of nurses in a general hospital: a comparison between rotating night shifts and day shifts

    PubMed Central

    Ferri, Paola; Guadi, Matteo; Marcheselli, Luigi; Balduzzi, Sara; Magnani, Daniela; Di Lorenzo, Rosaria

    2016-01-01

    Background Shift work is considered necessary to ensure continuity of care in hospitals and residential facilities. In particular, the night shift is one of the most frequent reasons for the disruption of circadian rhythms, causing significant alterations of sleep and biological functions that can affect physical and psychological well-being and negatively impact work performance. Objectives The aim of this study was to highlight if shift work with nights, as compared with day work only, is associated with risk factors predisposing nurses to poorer health conditions and lower job satisfaction. Methods This cross-sectional study was conducted from June 1, 2015 to July 31, 2015 in 17 wards of a general hospital and a residential facility of a northern Italian city. This study involved 213 nurses working in rotating night shifts and 65 in day shifts. The instrument used for data collection was the “Standard Shift Work Index,” validated in Italian. Data were statistically analyzed. Results The response rate was 86%. The nurses engaged in rotating night shifts were statistically significantly younger, more frequently single, and had Bachelors and Masters degrees in nursing. They reported the lowest mean score in the items of job satisfaction, quality and quantity of sleep, with more frequent chronic fatigue, psychological, and cardiovascular symptoms in comparison with the day shift workers, in a statistically significant way. Conclusion Our results suggest that nurses with rotating night schedule need special attention due to the higher risk for both job dissatisfaction and undesirable health effects. PMID:27695372

  18. The impact of shift work on the psychological and physical health of nurses in a general hospital: a comparison between rotating night shifts and day shifts

    PubMed Central

    Ferri, Paola; Guadi, Matteo; Marcheselli, Luigi; Balduzzi, Sara; Magnani, Daniela; Di Lorenzo, Rosaria

    2016-01-01

    Background Shift work is considered necessary to ensure continuity of care in hospitals and residential facilities. In particular, the night shift is one of the most frequent reasons for the disruption of circadian rhythms, causing significant alterations of sleep and biological functions that can affect physical and psychological well-being and negatively impact work performance. Objectives The aim of this study was to highlight if shift work with nights, as compared with day work only, is associated with risk factors predisposing nurses to poorer health conditions and lower job satisfaction. Methods This cross-sectional study was conducted from June 1, 2015 to July 31, 2015 in 17 wards of a general hospital and a residential facility of a northern Italian city. This study involved 213 nurses working in rotating night shifts and 65 in day shifts. The instrument used for data collection was the “Standard Shift Work Index,” validated in Italian. Data were statistically analyzed. Results The response rate was 86%. The nurses engaged in rotating night shifts were statistically significantly younger, more frequently single, and had Bachelors and Masters degrees in nursing. They reported the lowest mean score in the items of job satisfaction, quality and quantity of sleep, with more frequent chronic fatigue, psychological, and cardiovascular symptoms in comparison with the day shift workers, in a statistically significant way. Conclusion Our results suggest that nurses with rotating night schedule need special attention due to the higher risk for both job dissatisfaction and undesirable health effects.

  19. Psychiatric Thoughts in Ancient India*

    PubMed Central

    Abhyankar, Ravi

    2015-01-01

    A review of the literature regarding psychiatric thoughts in ancient India is attempted. Besides interesting reading, many of the concepts are still relevant and can be used in day-to-day practice especially towards healthy and happy living. Certain concepts are surprisingly contemporary and valid today. They can be used in psychotherapy and counselling and for promoting mental health. However, the description and classification of mental illness is not in tune with modern psychiatry. PMID:25838724

  20. Model-based testing for space-time interaction using point processes: An application to psychiatric hospital admissions in an urban area.

    PubMed

    Meyer, Sebastian; Warnke, Ingeborg; Rössler, Wulf; Held, Leonhard

    2016-05-01

    Spatio-temporal interaction is inherent to cases of infectious diseases and occurrences of earthquakes, whereas the spread of other events, such as cancer or crime, is less evident. Statistical significance tests of space-time clustering usually assess the correlation between the spatial and temporal (transformed) distances of the events. Although appealing through simplicity, these classical tests do not adjust for the underlying population nor can they account for a distance decay of interaction. We propose to use the framework of an endemic-epidemic point process model to jointly estimate a background event rate explained by seasonal and areal characteristics, as well as a superposed epidemic component representing the hypothesis of interest. We illustrate this new model-based test for space-time interaction by analysing psychiatric inpatient admissions in Zurich, Switzerland (2007-2012). Several socio-economic factors were found to be associated with the admission rate, but there was no evidence of general clustering of the cases. PMID:27246269

  1. A Protocolised Once a Day Modified Early Warning Score (MEWS) Measurement Is an Appropriate Screening Tool for Major Adverse Events in a General Hospital Population

    PubMed Central

    Ludikhuize, Jeroen; Kramer, Mark H. H.

    2016-01-01

    Background The Modified Early Warning Score (MEWS) was developed to timely recognise clinically deteriorating hospitalised patients. However, the ability of the MEWS in predicting serious adverse events (SAEs) in a general hospital population has not been examined prospectively. The aims were to (1) analyse protocol adherence to a MEWS protocol in a real-life setting and (2) to determine the predictive value of protocolised daily MEWS measurement on SAEs: death, cardiac arrests, ICU-admissions and readmissions. Methods All adult patients admitted to 6 hospital wards in October and November 2015 were included. MEWS were checked each morning by the research team. For each critical score (MEWS ≥ 3), the clinical staff was inquired about the actions performed. 30-day follow-up for SAEs was performed to compare between patients with and without a critical score. Results 1053 patients with 3673 vital parameter measurements were included, 200 (19.0%) had a critical score. The protocol adherence was 89.0%. 18.2% of MEWS were calculated wrongly. Patients with critical scores had significant higher rates of unplanned ICU admissions [7.0% vs 1.3%, p < 0.001], in-hospital mortality [6.0% vs 0.8%, p < 0.001], 30-day readmission rates [18.6% vs 10.8%, p < 0.05], and a longer length of stay [15.65 (SD: 15.7 days) vs 6.09 (SD: 6.9), p < 0.001]. Specificity of MEWS related to composite adverse events was 83% with a negative predicting value of 98.1%. Conclusions Protocol adherence was high, even though one-third of the critical scores were calculated wrongly. Patients with a MEWS ≥ 3 experienced significantly more adverse events. The negative predictive value of early morning MEWS < 3 was 98.1%, indicating the reliability of this score as a screening tool. PMID:27494719

  2. “Too Young to be Worried!” Psychiatric Assessment and Follow-up of Young People After Severe Physical Assault in an Inner City Hospital of South London

    PubMed Central

    Viswanathan, S; Datta, SS; Sheridan, PB; Lax-Pericall, T

    2014-01-01

    Background: Interpersonal violence amongst youth is on the rise world-wide and London is no exception. The resulting injuries can be very serious and even result in death. This is a difficult to engage subgroup of patients and there is likely to be significant unmet social and mental health needs. Aim: The current paper discusses the results of immediate psychiatric and social assessment of young people following a serious physical assault as assessed by a pediatric liaison Child and Adolescent Mental Health Service (CAMHS). CAMHS in Kings College Hospital, London in one calendar year and also the help seeking behavior of the young people following the assault. Subjects and Methods: The Department of Pediatric Liaison Psychiatry is based within the Kings College Hospital and has a multidisciplinary team comprising of nurses, consultant child and adolescent psychiatrists and social workers who reviewed all patients who were referred to them following an episode of assault. All young people who were referred to the department of pediatric liaison psychiatry based within Kings College Hospital over one calendar year were included in the analysis. Results: 83% (29/35) of the victims were male and 83% (29/35) were from minority ethnic backgrounds. Although 70% (25/35) of the young people included in this study had significant safe guarding concerns, only 17% (6/35) turned up for their follow-up appointments with child mental health teams. Conclusions: Innovative models of service delivery are required to cater to the unique needs of this group of extremely vulnerable young people. PMID:24669337

  3. E-procurement in hospitals.

    PubMed

    Hidalgo, Julio Villalobos; Orrit, Joan; Villalobos, Juan Pablo

    2011-01-01

    This article describes the history, current status, advantages of and opposition to the implementation of e-procurement in hospitals and examines the results of its implementation in a psychiatric hospital.

  4. Substance use and response to psychiatric treatment in methadone-treated outpatients with comorbid psychiatric disorder.

    PubMed

    Kidorf, Michael; King, Van L; Peirce, Jessica; Gandotra, Neeraj; Ghazarian, Sharon; Brooner, Robert K

    2015-04-01

    The psychiatric care of opioid users receiving agonist therapies is often complicated by high rates of illicit drug use (Brooner et al., 2013). The present study evaluates if illicit drug use (i.e., opioids, cocaine, sedatives) detected at the start of psychiatric care affects treatment response. Methadone maintenance patients (n = 125) with at least one current psychiatric disorder completed a 3-month randomized clinical trial evaluating the efficacy of financial incentives on attendance to on-site integrated substance abuse and psychiatric services (Kidorf et al., 2013). The present study re-analyzes the data set by grouping participants into one of two conditions based on the 4-week baseline observation: (1) no illicit drug use (baseline negative; n = 50), or (2) any illicit drug use (baseline positive; n = 75). All participants received a similar schedule of psychiatric services, and had good access to prescribed psychiatric medications. The Global Severity Index (GSI) of the Hopkins Symptom Checklist-Revised was administered monthly to evaluate changes in psychiatric distress. Results showed that while both conditions evidenced similar utilization of on-site psychiatric services, baseline negative participants remained in treatment somewhat longer (80.7 vs. 74.8 days, p = .04) and demonstrated greater reductions in GSI scores than baseline positive participants at month 3 (p = .004). These results have implications for interpreting previous studies that have shown inconsistent efficacy of pharmacotherapy and other psychiatric treatments, and for providing clinical care for patients with co-occurring substance use and psychiatric disorders.

  5. Irresistible impulse: psychiatric viewpoint.

    PubMed

    Weil, F

    1989-01-01

    The responses of the psychiatric profession to the legal criteria applied to irresistible impulse in cases of psychotic offenders are examined. An illustrative case, and its legal consequences, support the desirability of the psychiatric approach.

  6. De-hospitalization of the pediatric day surgery by means of a freestanding surgery center: pilot study in the lazio region

    PubMed Central

    2012-01-01

    Background Day surgery should take place in appropriate organizational settings. In the presence of high volumes, the organizational models of the Lazio Region are represented by either Day Surgery Units within continuous-cycle hospitals or day-cycle Day Surgery Centers. This pilot study presents the regional volumes provided in 2010 and the additional volumes that could be provided based on the best performance criterion with a view to suggesting the setting up of a regional Freestanding Center of Pediatric Day Surgery. Methods This is an observational retrospective study. The activity volumes have been assessed by means of a DRG (Diagnosis Related Group)-specific indicator that measures the ratio of outpatients to the total number of treated patients (freestanding indicator, FI). The included DRGs had an FI exceeding the 3rd quartile present in at least a health-care facility and a volume exceeding 0.5% of the total patients of the pediatric surgery and urology facilities of the Lazio Region. The relevant data have been provided by the Public Health Agency and relate to 2010. The best performance FI has been used to calculate the theoretical volume of transferability of the remaining facilities into freestanding surgery centers. Patients under six months of age and DRGs common to other disciplines have been excluded. The Chi Square test has been used to compare the FI of the health-care facilities and the FI of the places of origin of the patients. Results The DRG provided in 2010 amounted to a total of 5768 belonging to 121 types of procedures. The application of the criteria of inclusion have led to the selection of seven final DRG categories of minor surgery amounting to 3522 cases. Out of this total number, there were 2828 outpatients and 694 inpatients. The recourse of the best performance determines a potential transfer of 497 cases. The total outpatient volume is 57%. The Chi Square test has pointed to a statistically significant difference of the

  7. Impact of risperidone long acting injection on resource utilization in psychiatric secondary care.

    PubMed

    Taylor, M; Currie, A; Lloyd, K; Price, M; Peperell, Kate

    2008-03-01

    Risperidone long acting injection (RLAI) is the only long acting atypical antipsychotic available in the UK. Its impact on NHS resource use has not been widely studied. This review of medical records was conducted to quantify the impact of RLAI on NHS psychiatric secondary care resource use, primarily in terms of episodes of inpatient hospital care 12 months before and 12 months after RLAI initiation. Data on number of hospitalizations and hospital bed days were collected retrospectively, from patient notes and hospital databases in four acute psychiatric units in the UK for all individuals with a diagnosis of schizophrenia or schizoaffective disorder who were prescribed RLAI more than 12 months previously. Data were collected on 100 individuals (58 male) with a mean age 40.8 years (range 19-70). The median duration of illness before RLAI initiation was 12 years (range six months to 43 years). There were 62 admissions in the 12 months pre-RLAI, falling to 22 admissions in the 12 months post-RLAI. Number of admissions, we argue, offer a more reliable indicator of the impact of treatment than total hospital bed days in this type of study. In this study there were 40 fewer admissions in the 12 months after RLAI was initiated compared with the previous 12 months. This is important as readmission is a good proxy measure of relapse, and adherence to medication is known to be a key factor in relapse prevention. PMID:18308820

  8. Attitudes of Psychiatric Nurses about the Request for Euthanasia on the Basis of Unbearable Mental Suffering(UMS)

    PubMed Central

    Wampers, Martien; De Lepeleire, Jan; Correll, Christophe U.

    2015-01-01

    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

  9. Profiling psychiatric inpatient suicide attempts in Japan.

    PubMed

    Ikeshita, Katsumi; Shimoda, Shigero; Norimoto, Kazunobu; Arita, Keisuke; Shimamoto, Takuya; Murata, Kiyoshi; Makinodan, Manabu; Kishimoto, Toshifumi

    2014-01-01

    Suicide is an adverse event that can occur even when patient are hospitalized in psychiatric facilities. This study delineates the demographic characteristics of suicide attempts in mental hospitals and psychiatric wards of general hospitals in Japan, a country where the suicide rate is remarkably high. Analyses of incident reports on serious suicide attempts in psychiatric inpatients were performed using prefectural incident records between April 1, 2001, and December 31, 2012. Suicide reports were included for 35 incidents that occurred over 11 years, and demonstrated that 83% of patients (n = 29) committed suicide and 17% (n = 6) survived their attempt with serious aftereffects, such as cognitive impairment or persistent vegetative state. The male/female ratio of inpatient suicide was 1.5:1. The mean age of the attempters was 50.5 years (SD = 18.2). The most common psychiatric diagnoses for those with suicide incident reports were schizophrenia spectrum disorders (51.4%) and affective disorders (40%). Hanging (60%) was the most common method of suicide attempt, followed by jumping in front of moving objects (14.3%) and jumping from height (11.4%). Fifty-four percent of suicides (n = 19) occurred within hospital sites and the remainder (46%; n = 16) occurred outside hospital sites (e.g., on medical leave or elopement) while they were still inpatients. PMID:25345233

  10. No effect of lunar cycle on psychiatric admissions or emergency evaluations.

    PubMed

    McLay, Robert N; Daylo, Amado A; Hammer, Paul S

    2006-12-01

    It is a popularly held belief that psychiatric behavior worsens during a full moon. Research in this area has yielded mixed results. Records from Naval Medical Center San Diego for 1993-2001 were examined to see whether there were higher rates of psychiatric admission associated with particular phases of the moon. Records from 8,473 admissions revealed that there were no more admission on days with a full moon, a new moon, any quarter of the moon, a waxing moon, or a waning moon. This held true for psychiatric patients as a whole, as well as for individuals with particular diagnoses, such as those with a mood disorder or psychotic disorder. Records from 1,909 emergency psychiatric evaluations that occurred between 2002 and 2003 were also examined to see whether a higher percentage of patients might present, but not require hospitalization, during a particular phase of the moon. Once again, no significant effect was found. In summary, lunar phase was not associated in any significant way with psychiatric admissions or emergency presentation.

  11. Variation between Hospitals with Regard to Diagnostic Practice, Coding Accuracy, and Case-Mix. A Retrospective Validation Study of Administrative Data versus Medical Records for Estimating 30-Day Mortality after Hip Fracture

    PubMed Central

    Kristoffersen, Doris Tove; Skyrud, Katrine Damgaard; Lindman, Anja Schou

    2016-01-01

    Background The purpose of this study was to assess the validity of patient administrative data (PAS) for calculating 30-day mortality after hip fracture as a quality indicator, by a retrospective study of medical records. Methods We used PAS data from all Norwegian hospitals (2005–2009), merged with vital status from the National Registry, to calculate 30-day case-mix adjusted mortality for each hospital (n = 51). We used stratified sampling to establish a representative sample of both hospitals and cases. The hospitals were stratified according to high, low and medium mortality of which 4, 3, and 5 hospitals were sampled, respectively. Within hospitals, cases were sampled stratified according to year of admission, age, length of stay, and vital 30-day status (alive/dead). The final study sample included 1043 cases from 11 hospitals. Clinical information was abstracted from the medical records. Diagnostic and clinical information from the medical records and PAS were used to define definite and probable hip fracture. We used logistic regression analysis in order to estimate systematic between-hospital variation in unmeasured confounding. Finally, to study the consequences of unmeasured confounding for identifying mortality outlier hospitals, a sensitivity analysis was performed. Results The estimated overall positive predictive value was 95.9% for definite and 99.7% for definite or probable hip fracture, with no statistically significant differences between hospitals. The standard deviation of the additional, systematic hospital bias in mortality estimates was 0.044 on the logistic scale. The effect of unmeasured confounding on outlier detection was small to moderate, noticeable only for large hospital volumes. Conclusions This study showed that PAS data are adequate for identifying cases of hip fracture, and the effect of unmeasured case mix variation was small. In conclusion, PAS data are adequate for calculating 30-day mortality after hip-fracture as a quality

  12. [What do psychiatric patients expect of inpatient psychiatric hospital treatment?].

    PubMed

    Fleischmann, Heribert

    2003-05-01

    Patients are mostly passive utilizer of the health-care-system. They are confronted with a supply of medical service and they are allowed to show their satisfaction with it retrospectively. Our medical system has in future to develop itself from an effective perspective to an utilizer orientated medicine. Orientation to the utilizers means to ask for the expectations of the patients for supply (at customer's option). Aim of our investigation was to check the subjective expectations of the patients before the beginning of in-patient treatment: 1. What is their opinion about the label of the disorder, they are suffering. 2. Of what therapeutic measures do they expect help for theirselves. 3. Do they want to play a part in planning of therapeutic measures. 209 of 344 (61%) of the patients were at admission ready for answering a self designed questionnaire. Only 4% of the patients said, that their disorder is called insanity. They preferred labels like mental illness (45%), somatic illness (43%) and mental health problem (42%). A pharmacological therapy expected in totally 61% of the patients. Mostly were expected drugs against depressive disorders (32%), drugs against addiction (31%) and tranquilizers (29%). Only 10% of the patients expected to get antipsychotic drugs. A verbal therapeutic intervention expected 76% of the patients. To have a speak with the doctor is with 69% a first rank desire, followed by speaking with the psychologist (60%), the nurses (58%) and the patients comrades (56%). Psychotherapy in a narrower sense expect only 40% of the patients. Furthermore there are privacy and recreation through promenades in front of the expectations (69%), followed by relaxation (59%), occupational therapy (55%) and sports or active exercise therapy (54%). 75% of the patients want to be informed about the therapy. 69% want to cooperate with planning of the therapy. Only 21% commit the therapy to the doctor. About one third of the patients expect a consultation with their relatives, the custodians and their family doctor.

  13. Chromosomal abnormalities in a psychiatric population

    SciTech Connect

    Lewis, K.E.; Lubetsky, M.J.; Wenger, S.L.; Steele, M.W.

    1995-02-27

    Over a 3.5 year period of time, 345 patients hospitalized for psychiatric problems were evaluated cytogenetically. The patient population included 76% males and 94% children with a mean age of 12 years. The criteria for testing was an undiagnosed etiology for mental retardation and/or autism. Cytogenetic studies identified 11, or 3%, with abnormal karyotypes, including 4 fragile X positive individuals (2 males, 2 females), and 8 with chromosomal aneuploidy, rearrangements, or deletions. While individuals with chromosomal abnormalities do not demonstrate specific behavioral, psychiatric, or developmental problems relative to other psychiatric patients, our results demonstrate the need for an increased awareness to order chromosomal analysis and fragile X testing in those individuals who have combinations of behavioral/psychiatric, learning, communication, or cognitive disturbance. 5 refs., 1 fig., 2 tabs.

  14. Development of the Riverview Psychiatric Inventory.

    PubMed

    Haley, Glenn M T; Iverson, Grant L; Moreau, Margaret

    2002-01-01

    The present study describes the development and initial validation of a behavioral rating scale, the Riverview Psychiatric Inventory (RPI). The RPI is a 36-item scale that is scored into four subscales covering daily routine problems, psychological symptoms, social interaction problems, and aggressive behavior. Interrater reliability using 70 pairs of raters assessing 145 patients resulted in a reliability coefficient of .89. Internal consistency for the total score was high (alpha = .93) and each of the subscales showed alpha coefficients ranging from .76 to .87. Validity was evaluated on a sample of 359 adult psychiatric inpatients. The RPI total score significantly distinguished three groups of patients on hospital units designed to treat differing levels of psychiatric illness. The RPI is superior to other behavioral rating scales employed by mental health clinicians because it does not require lengthy training in administration and scoring. The scale is useful for routine assessments on a busy psychiatric unit. PMID:12143086

  15. Homelessness and discharge delays from an urban safety net hospital

    PubMed Central

    Feigal, Jacob; Park, Brian; Bramante, Carolyn; Nordgaard, Curt; Menk, Jeremiah; Song, John

    2014-01-01

    Objectives Homelessness is associated with increased morbidity and mortality, as well as increased rates of hospitalizations. Once hospitalized, homeless patients have longer hospital stays than housed persons, and hospital costs have been found to be increased for homeless patients. We sought to describe hospital discharge delays for nonmedical reasons and their relationship to the housing status of participants. Study Design Retrospective chart review of admissions and discharges between January 1 and June 30, 2009 at a large, urban safety net hospital. Methods All inpatients who experienced discharge delays for nonmedical or external causes were participants, and the main measures included length of and reasons for discharge delay. Results Persons identified as homeless constituted 106 (42.9%) of the discharge delays. Homeless patients were younger, more likely to be male, and more likely to be uninsured than housed patients. The unadjusted median number of delay days was significantly longer for homeless (8 days) than housed patients (4 days) (p<0.001). Multivariate analyses demonstrated that homeless patients without a psychiatric diagnosis had 60.1% longer discharge delays than housed patients without a psychiatric diagnosis (p=0.011). Discussion Among patients without psychiatric diagnoses who are medically ready for discharge, homeless patients experience more frequent and longer discharge delays than housed patients. Medical respite care has the potential to decrease unnecessary hospitalization days and improve access to after-hospital services that have proven to be beneficial for this population. Further prospective study of discharge delays may help to establish the cost-effectiveness of respite care. PMID:25443103

  16. Psychiatric Adjustment in the Year after Meningococcal Disease in Childhood

    ERIC Educational Resources Information Center

    Shears, Daniel; Nadel, Simon; Gledhill, Julia; Gordon, Fabiana; Garralda, M. Elena

    2007-01-01

    Objective: To assess psychiatric status after meningococcal disease. Method: Cohort study of 66 children (34 boys, 32 girls) ages 4 to 17 years admitted to pediatric hospitals with meningococcal disease. The main outcome measure was psychiatric disorder (1-year period and point prevalence on the Schedule for Affective Disorders and Schizophrenia…

  17. [Current problems in psychiatric health care in Poland (2005)].

    PubMed

    Puzyński, Stanisław; Langiewicz, Wanda; Pietrzykowska, Bozena

    2006-01-01

    The paper is a presentation of the most important and actual psychiatric health care problems in Poland: the financial situation of hospitals, the risk faced by the out-patient psychiatric care,ethical problems related to clinical practice, as well as issues on postgraduate education.

  18. The relationship of illness management and recovery to state hospital readmission.

    PubMed

    Bartholomew, Tom; Zechner, Michelle

    2014-09-01

    The current study examined the association between number of hours attended of the Illness Management and Recovery (IMR) program and psychiatric readmission rates after discharge from a state psychiatric hospital. The study used archival data, N = 1186, from a large northeastern state psychiatric hospital in the United States. A Cox's regression survival analyses was conducted, adjusting for extreme outliers and controlling for sociodemographic covariates, to examine the association between different amounts of IMR and the risk for returning to the hospital. After controlling for the client characteristics of age, sex, marital status, psychiatric diagnosis, and Global Assessment of Functioning score at discharge, as well as controlling for mean daily dose of generic hospital programming and the number of days of hospitalization, it was found that, for each hour of IMR, there was an associated 1.1% reduction in the risk for returning to the hospital. This suggests that participation in IMR while in inpatient settings may assist individuals in reducing their risk for returning to the hospital. PMID:25099301

  19. The relationship of illness management and recovery to state hospital readmission.

    PubMed

    Bartholomew, Tom; Zechner, Michelle

    2014-09-01

    The current study examined the association between number of hours attended of the Illness Management and Recovery (IMR) program and psychiatric readmission rates after discharge from a state psychiatric hospital. The study used archival data, N = 1186, from a large northeastern state psychiatric hospital in the United States. A Cox's regression survival analyses was conducted, adjusting for extreme outliers and controlling for sociodemographic covariates, to examine the association between different amounts of IMR and the risk for returning to the hospital. After controlling for the client characteristics of age, sex, marital status, psychiatric diagnosis, and Global Assessment of Functioning score at discharge, as well as controlling for mean daily dose of generic hospital programming and the number of days of hospitalization, it was found that, for each hour of IMR, there was an associated 1.1% reduction in the risk for returning to the hospital. This suggests that participation in IMR while in inpatient settings may assist individuals in reducing their risk for returning to the hospital.

  20. Negative Rumor: Contagion of a Psychiatric Department

    PubMed Central

    McEwan, Stephanie; Bota, Robert G.

    2014-01-01

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

  1. [German pilot study of psychiatric inpatients with histories of migration].

    PubMed

    Koch, E; Hartkamp, N; Siefen, R G; Schouler-Ocak, M

    2008-03-01

    The work group on psychiatry and migration of the Conference of Directors of Psychiatric Hospitals in Germany conducted a study on the use of inpatient psychiatric services by migrants in 12 psychiatric and psychotherapeutic hospitals and hospital departments. In contrast to previous studies the proportion of migrants in psychiatric hospitals (17.4%) equaled that of migrants in the general population. However there still was a high rate of diagnostic and treatment problems resulting from cultural differences and, to a lesser extent, from language problems. A high proportion of migrants suffered from delusional and schizophrenic disorders, while there were considerable differences in the distribution of diagnoses between different groups of migrants, e.g. those from Turkey and eastern Europe, respectively. Roughly half of all migrants studied had German citizenship. Among the migrants of Turkish background, a high proportion was born in Germany. The number of asylum seekers and refugees was disproportionately high.

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

    ERIC Educational Resources Information Center

    Milazzo-Sayre, Laura J.; And Others

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

  3. Differences in Epidemiological and Molecular Characteristics of Nasal Colonization with Staphylococcus aureus (MSSA-MRSA) in Children from a University Hospital and Day Care Centers

    PubMed Central

    Rodríguez, Erika A.; Correa, Margarita M.; Ospina, Sigifredo; Atehortúa, Santiago L.; Jiménez, J. Natalia

    2014-01-01

    Background Clinical significance of Staphylococcus aureus colonization has been demonstrated in hospital settings; however, studies in the community have shown contrasting results regarding the relevance of colonization in infection by community-associated MRSA (CA-MRSA). In Colombia there are few studies on S. aureus colonization. The aim of this study was to determine the molecular and epidemiological characteristics of nasal colonization by S. aureus (MSSA-MRSA) in children from a university hospital and day care centers (DCCs) of Medellin, Colombia. Methods An observational cross-sectional study was conducted in 400 children (200 in each setting), aged 0 months to 5 years, during 2011. Samples were collected from each nostril and epidemiological information was obtained from the parents. Genotypic analysis included spa typing, PFGE, MLST, SCCmec typing, detection of genes for virulence factors and agr groups. Results Frequency of S. aureus colonization was 39.8% (n = 159) (hospital 44.5% and DCCs 35.0%) and by MRSA, 5.3% (n = 21) (hospital 7.0% and DCCs 3.5%). Most S. aureus colonized children were older than two years (p = 0.005), the majority of them boys (59.1%), shared a bedroom with a large number of people (p = 0.028), with history of β-Lactamase inhibitors usage (p = 0.020). MSSA strains presented the greatest genotypic diversity with 15 clonal complexes (CC). MRSA isolates presented 6 CC, most of them (47.6%) belonged to CC8-SCCmec IVc and were genetically related to previously reported infectious MRSA strains. Conclusion Differences in epidemiological and molecular characteristics between populations may be useful for the understanding of S. aureus nasal colonization dynamics and for the design of strategies to prevent S. aureus infection and dissemination. The finding of colonizing MRSA with similar molecular characteristics of those causing infection demonstrates the dissemination capacity of S. aureus and the risk of infection

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

    PubMed Central

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

    2015-01-01

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

  5. Remote Psychiatric and Psychological Services via the Communications Technology Satellite (CTS).

    ERIC Educational Resources Information Center

    Covvey, H. Dominic; And Others

    To provide remote psychiatric services to a population in Moose Factory, Ontario, via satellite, digital data links will be used to provide 24-hour access to the psychiatric medical file system and the psychiatric patient register at University Hospital, London, Ontario, and to permit scoring and interpretation of standard psychological tests. The…

  6. Sustained Uptake of a Hospital-Based Handwashing with Soap and Water Treatment Intervention (Cholera-Hospital-Based Intervention for 7 Days [CHoBI7]): A Randomized Controlled Trial.

    PubMed

    George, Christine Marie; Jung, Danielle S; Saif-Ur-Rahman, K M; Monira, Shirajum; Sack, David A; Mahamud-ur Rashid; Mahmud, Md Toslim; Mustafiz, Munshi; Rahman, Zillur; Bhuyian, Sazzadul Islam; Winch, Peter J; Leontsini, Elli; Perin, Jamie; Begum, Farzana; Zohura, Fatema; Biswas, Shwapon; Parvin, Tahmina; Sack, R Bradley; Alam, Munirul

    2016-02-01

    Diarrhea is the second leading cause of death in children under 5 years of age globally. The time patients and caregivers spend at a health facility for severe diarrhea presents the opportunity to deliver water, sanitation, and hygiene (WASH) interventions. We recently developed Cholera-Hospital-Based Intervention for 7 days (CHoBI7), a 1-week hospital-based handwashing with soap and water treatment intervention, for household members of cholera patients. To investigate if this intervention could lead to sustained WASH practices, we conducted a follow-up evaluation of 196 intervention household members and 205 control household members enrolled in a randomized controlled trial of the CHoBI7 intervention 6 to 12 months post-intervention. Compared with the control arm, the intervention arm had four times higher odds of household members' handwashing with soap at a key time during 5-hour structured observation (odds ratio [OR]: 4.71, 95% confidence interval [CI]: 2.61, 8.49) (18% versus 50%) and a 41% reduction in households in the World Health Organization very high-risk category for stored drinking water (OR: 0.38, 95% CI: 0.15, 0.96) (58% versus 34%) 6 to 12 months post-intervention. Furthemore, 71% of observed handwashing with soap events in the intervention arm involved the preparation and use of soapy water, which was promoted during the intervention, compared to 9% of control households. These findings demonstrate that the hospital-based CHoBI7 intervention can lead to significant increases in handwashing with soap practices and improved stored drinking water quality 6 to 12 months post-intervention. PMID:26728766

  7. Sustained Uptake of a Hospital-Based Handwashing with Soap and Water Treatment Intervention (Cholera-Hospital-Based Intervention for 7 Days [CHoBI7]): A Randomized Controlled Trial.

    PubMed

    George, Christine Marie; Jung, Danielle S; Saif-Ur-Rahman, K M; Monira, Shirajum; Sack, David A; Mahamud-ur Rashid; Mahmud, Md Toslim; Mustafiz, Munshi; Rahman, Zillur; Bhuyian, Sazzadul Islam; Winch, Peter J; Leontsini, Elli; Perin, Jamie; Begum, Farzana; Zohura, Fatema; Biswas, Shwapon; Parvin, Tahmina; Sack, R Bradley; Alam, Munirul

    2016-02-01

    Diarrhea is the second leading cause of death in children under 5 years of age globally. The time patients and caregivers spend at a health facility for severe diarrhea presents the opportunity to deliver water, sanitation, and hygiene (WASH) interventions. We recently developed Cholera-Hospital-Based Intervention for 7 days (CHoBI7), a 1-week hospital-based handwashing with soap and water treatment intervention, for household members of cholera patients. To investigate if this intervention could lead to sustained WASH practices, we conducted a follow-up evaluation of 196 intervention household members and 205 control household members enrolled in a randomized controlled trial of the CHoBI7 intervention 6 to 12 months post-intervention. Compared with the control arm, the intervention arm had four times higher odds of household members' handwashing with soap at a key time during 5-hour structured observation (odds ratio [OR]: 4.71, 95% confidence interval [CI]: 2.61, 8.49) (18% versus 50%) and a 41% reduction in households in the World Health Organization very high-risk category for stored drinking water (OR: 0.38, 95% CI: 0.15, 0.96) (58% versus 34%) 6 to 12 months post-intervention. Furthemore, 71% of observed handwashing with soap events in the intervention arm involved the preparation and use of soapy water, which was promoted during the intervention, compared to 9% of control households. These findings demonstrate that the hospital-based CHoBI7 intervention can lead to significant increases in handwashing with soap practices and improved stored drinking water quality 6 to 12 months post-intervention.

  8. Psychiatric morbidity in prisoners

    PubMed Central

    Goyal, Sandeep Kumar; Singh, Paramjit; Gargi, Parshotam D.; Goyal, Samta; Garg, Aseem

    2011-01-01

    Context: The prevalence of psychiatric illness in correctional settings is significantly elevated, with higher than community rates reported for most mental disorders. Aims: (1) To examine the socio-demographic profile of convicted prisoners. (2) To evaluate the prevalence of psychiatric disorders in convicted prisoners. Materials and Methods: 500 convicts were assessed for psychiatric morbidity with the help of (a) Socio-demographic proforma, (b) Pareek Udai and Trivedi G's socio-economic status scale (rural) (household schedule), (c) Kuppuswamy's economic status scale (urban) and (d) Present State Examination (PSE). Results: 23.8% of the convicted prisoners were suffering from psychiatric illness excluding substance abuse. 56.4% of the prisoners had history of substance abuse / dependence prior to incarceration. Conclusions: The results suggest that a substantial burden of psychiatric morbidity exists in the prison population of India and the burden of psychiatric illness in this vulnerable and marginalized population poses a serious challenge to psychiatrists. PMID:22135446

  9. Parental psychiatric disorders and autism spectrum disorders

    PubMed Central

    Jokiranta, Elina; Brown, Alan S.; Heinimaa, Markus; Cheslack-Postava, Keely; Partanen, Auli; Sourander, Andre

    2013-01-01

    The present population-based, case-control study examines associations between specific parental psychiatric disorders and autism spectrum disorders (ASD) including childhood autism, Asperger’s syndrome and pervasive developmental disorder (PDD-NOS). The cohort includes 4713 children born between 1987 and 2005 with diagnoses of childhood autism, Asperger’s syndrome or PDD-NOS. Cases were ascertained from the Finnish Hospital Discharge Register, and each was matched to four controls by gender, date of birth, place of birth, and residence in Finland. Controls were selected from the Finnish Medical Birth Register. Parents were identified through the Finnish Medical Birth Register and Finnish Central Population Register. Parental psychiatric diagnoses from inpatient care were collected from the Finnish Hospital Discharge Register. Conditional logistic regression models were used to assess whether parents’ psychiatric disorders predicted ASD after controlling for parents’ age, smoking during pregnancy and weight for gestational age. In summary, parental schizophrenia spectrum disorders and affective disorders were associated with the risk of ASD regardless of the subgroup. PDD-NOS was associated with all parental psychiatric disorders investigated. Further studies are needed to replicate these findings. These results may facilitate the investigation of shared genetic and familial factors between ASD and other psychiatric disorders. PMID:23391634

  10. Psychiatric illness in the New Zealand Maori.

    PubMed

    Sachdev, P S

    1989-12-01

    This paper compares psychiatric illness in the contemporary Maori with that in the non-Maori New Zealander. The ethnic data available are all from secondary sources. The limitations of this and the problems of achieving a satisfactory definition of "a Maori" are discussed. The data suggest that the Maori have a slightly greater risk of psychiatric hospitalization than the non-Maori. First admission rates for schizophrenia are higher for the Maori, as are the readmission rates. First admission rates for major affective illness are roughly comparable in the two groups, and those for neuroses and neurotic depression are lower in the Maori. Rates of admission for alcohol abuse, alcohol dependence and personality disorders are much higher for the Maori male aged 20-40 years and this group is at greatest risk of psychiatric hospitalization. A larger proportion of Maori are admitted involuntarily, especially under the Criminal Justice Act. The median stay in hospital is not longer for the Maori but their re-admissions are more frequent. The Maori have shown an increase in first psychiatric admission rates since the 1950s, with rapid increases in the early 60s and the 80s. The rates for psychotic disorders have been relatively constant and the most significant changes have been for alcohol abuse, alcohol dependence and personality disorders. The author relates this historical change to socioeconomic and politico-cultural factors, particularly the stress of rapid urbanization. PMID:2610653

  11. Criterion-referenced evaluation of day one clinical competencies of veterinary students: VOLES-the VMTH (Veterinary Medicine Teaching Hospital) Online Evaluation System.

    PubMed

    Zeck, Steven; Wall, Judy A; Smith, Bradford P; Wilson, W David; Walsh, Donal A

    2012-01-01

    This article describes an extensive online criterion-referenced evaluation system for the assessment of veterinary students' achievement during their final year's Doctor of Veterinary Medicine (or equivalent) clinical education. Data are reported for the 2001 to 2009 University of California at Davis veterinary graduates, for a total of more than 1,100 students. These criterion-referenced evaluations extensively document the level of clinical skills attained and demonstrated during the individual clinical rotations that comprise the fourth-year curriculum. On average, in each of the 17,500 clinical rotations undertaken during this time period, student performance was assessed in at least 11 separate areas of skills, knowledge, and professional attributes. This provided more than 200,000 criterion-referenced judgments of the individual clinical attributes of graduates over nine years. The system is based on a previously detailed and validated definition of the skills, knowledge, and professional attributes that students should have demonstrated before graduation. The extensive database that this system has provided has established that this system, termed VOLES (VMTH [Veterinary Medicine Teaching Hospital] On-Line Evaluation System), is an effective tool to assess the clinical capabilities of veterinary students and their achievement of the "Day One" skills required for entering clinical practice. These expected proficiencies are balanced according to the differing expectations that each area of veterinary clinical practice demands.

  12. Criterion-referenced evaluation of day one clinical competencies of veterinary students: VOLES-the VMTH (Veterinary Medicine Teaching Hospital) Online Evaluation System.

    PubMed

    Zeck, Steven; Wall, Judy A; Smith, Bradford P; Wilson, W David; Walsh, Donal A

    2012-01-01

    This article describes an extensive online criterion-referenced evaluation system for the assessment of veterinary students' achievement during their final year's Doctor of Veterinary Medicine (or equivalent) clinical education. Data are reported for the 2001 to 2009 University of California at Davis veterinary graduates, for a total of more than 1,100 students. These criterion-referenced evaluations extensively document the level of clinical skills attained and demonstrated during the individual clinical rotations that comprise the fourth-year curriculum. On average, in each of the 17,500 clinical rotations undertaken during this time period, student performance was assessed in at least 11 separate areas of skills, knowledge, and professional attributes. This provided more than 200,000 criterion-referenced judgments of the individual clinical attributes of graduates over nine years. The system is based on a previously detailed and validated definition of the skills, knowledge, and professional attributes that students should have demonstrated before graduation. The extensive database that this system has provided has established that this system, termed VOLES (VMTH [Veterinary Medicine Teaching Hospital] On-Line Evaluation System), is an effective tool to assess the clinical capabilities of veterinary students and their achievement of the "Day One" skills required for entering clinical practice. These expected proficiencies are balanced according to the differing expectations that each area of veterinary clinical practice demands. PMID:22430080

  13. Multisystemic Therapy Effects on Attempted Suicide by Youths Presenting Psychiatric Emergencies

    ERIC Educational Resources Information Center

    Huey, Stanley J.; Henggeler, Scott W.; Rowland, Melisa D.; Halliday-Boykins, Colleen A.; Cunningham, Phillippe B.; Pickrel, Susan G.; Edwards, James

    2004-01-01

    Objective: To evaluate the efficacy of multisystemic therapy (MST) in reducing attempted suicide among predominantly African American youths referred for emergency psychiatric hospitalization. Method: Youths presenting psychiatric emergencies were randomly assigned to MST or hospitalization. Indices of attempted suicide, suicidal ideation,…

  14. Suicide Prevention in the Psychiatric Hospital

    ERIC Educational Resources Information Center

    Matakas, Frank; Rohrbach, Elisabeth

    2007-01-01

    It is currently impossible to distinguish between patients with depression who will make a suicide attempt and those who will not. Prevention, therefore, must be based on the assumption that any patient with more than mild symptoms of depression is at risk of suicide, and can only be effective if it is applicable to all patients with moderate to…

  15. Zonisamide produces weight loss in psychotropic drug-treated psychiatric outpatients.

    PubMed

    Lim, JaeHyoung; Ko, Young-Hoon; Joe, Sook-Haeng; Han, Changsu; Lee, Moon-Soo; Yang, Jaewon

    2011-12-01

    This study examined the long-term effectiveness and tolerability of zonisamide for weight control in psychiatric outpatients using various psychotropic medications. We conducted a systematic chart review of 82 psychiatric outpatients with unwanted weight gain after the introduction of psychotropic drugs between January 2008 and September 2009 at Korea University Ansan Hospital. The primary outcome measure was the effect of zonisamide on body mass index (BMI). Additional outcome measures included safety and tolerability as assessed by the clinical global impression-severity of illness scale (CGI-S) and discontinuation rate. The mean final dose of zonisamide was 124.6±53.4 mg/day and ranged from 50mg/day to 300 mg/day. The mean BMI reduction was 0.8±1.7 kg/m(2) and ranged from -2.9 kg/m(2) to 4.7 kg/m(2) (p<0.001). We also observed a significant reduction in CGI-S scores from the baseline (3.8±0.9) to the endpoint (3.3±0.8; p<0.001). Twelve patients (14.6%) discontinued their zonisamide treatment due to its side effects. Patients treated with zonisamide showed significant weight loss. Furthermore, its treatment was generally safe and well tolerated with few negative effects on patients' overall psychiatric symptoms. Additional research is required to confirm these results and to investigate whether patients have rebound weight gains after discontinuing zonisamide.

  16. Sexuality, vulnerability to HIV, and mental health: an ethnographic study of psychiatric institutions.

    PubMed

    Pinto, Diana de Souza; Mann, Claudio Gruber; Wainberg, Milton; Mattos, Paulo; Oliveira, Suely Broxado de

    2007-09-01

    This paper presents data from the ethnographic based formative phase of the Interdisciplinary Project on Sexuality, Mental Health, and AIDS (PRISSMA), sponsored by the National Institute of Mental Health (NIMH) and carried out in two psychiatric institutions in the city of Rio de Janeiro, Brazil. Results from ethnographic observations, focus groups, and key informant interviews with different groups of mental health care providers and day hospital and outpatient mental health clients regarding conceptions of sexuality and HIV vulnerability are described. The results suggest a diversity of notions about sexuality by both groups and point out the high HIV sexual risk in this psychiatric population. This formative phase has served as the basis for the cultural adaptation and creation of a Brazilian intervention for HIV prevention in the severely mentally ill, the feasibility of which has been successfully evaluated in the pilot phase.

  17. [Emil Kraepelin and psychiatric science in Rio de Janeiro, 1903-1933].

    PubMed

    Facchinetti, Cristiana; Muñoz, Pedro Felipe Neves de

    2013-03-01

    The article addresses the penetration of German psychiatric science in early twentieth-century Brazil. More specifically, it explores how the theory and practices of Emil Kraepelin were absorbed by both Juliano Moreira, director of the National Hospital for the Insane (Hospício Nacional de Alienados) and of the agency for Assistance to the Insane (Assistência a Alienados) in the Federal District (Rio de Janeiro), and also by the circle of physicians with close ties to Moreira from 1903 to 1933. It discusses the ways in which Kraepelin's work was adopted, taking into account the day's medical-mental repertoire, the political and scientific context, and the controversies within the Brazilian psychiatric field. Lastly, the study analyzes these choices based on the prevailing relations between Brazilian and German psychiatry back then.

  18. Reducing the use of seclusion and restraint in psychiatric emergency and adult inpatient services- improving patient-centered care.

    PubMed

    Wale, Joyce B; Belkin, Gary S; Moon, Robert

    2011-01-01

    The reduction of seclusion and restraint (S/R) use has been given national priority by the US government, The Joint Commission, and patient advocacy groups. It is associated with high rates of patient and staff injuries and is a coercive and potentially traumatizing intervention. The New York City Health and Hospitals Corporation (HHC) is the largest municipal health care system in the country, with 11 HHC facilities operating psychiatric emergency services and inpatient psychiatric services. HHC operates 1117 adult inpatient psychiatric beds with an average length of stay of 22.2 days that generated over 19,000 discharges in 2009. In 2009, there were over 36,000 psychiatric emergency services visits. HHC's Office of Behavioral Health provides strategic leadership, planning, and support for the operations and quality objectives of these services. In January 2007, the corporate office initiated the Seclusion and Restraint Reduction Initiative, with a sequenced, intensive series of interventions and strategies to help focus the behavioral health leadership and staff on the need for continued culture change toward a more patient-centered and safe system of psychiatric emergency and adult inpatient care. From 2007 to 2009, there was a substantial decline in HHC's overall rate of S/R incidents in inpatient units. The more substantial impact was in the reduced overall time spent in S/R; the reduced frequency of use of S/R; and the reduced likelihood of patient injury from S/R use. PMID:21841927

  19. Psychiatric thoughts in the Tamil culture.

    PubMed

    Somasundaram, O

    2002-04-01

    THE SIGNIFICANCE OF PSYCHIATRIC THOUGHTS IN TAMIL CULTURE IS BROUGHT FORTH WITH RELEVANT HISTORICAL AND LITERARY EVIDENCES: psycho-physiological aspects of emotions, descriptions of severely disturbed individuals, attitude of the society towards the mentally ill and epigraphic material describing hospital care of psychiatric patients in the first millennium are alluded. These references unravel the advanced psychiatric medical knowledge in the Ancient Tamil system of Medicine namely the Siddha system. The mythical origin of Siddha Medicine, attributes of the Siddhars (knowledgeable persons) and short biographical notes of eminent siddhars like Agathiyar, Bogar, Therayar and Thirumoolar are cited. Ancient theories of etiopathogenesis, namely the Panchaboothas and Tridoshas are detailed. Agathiyar's deschptions, classification and treatment of mental illnesses and Yogi Siddhar's contribution to psychiatry require significant mentioning. Siddha system has proved its potential effect by displaying promising results in treating HIV and Hepatitis-B. Likewise the author encourages similar discoveries in Siddha Medicine with relevance to psychiatry.

  20. The influence of institutional characteristics on length of stay for psychiatric patients: a national database study in South Korea.

    PubMed

    Chung, Woojin; Cho, Woo Hyun; Yoon, Chung Won

    2009-03-01

    The institutionalization of psychiatric patients has put a tremendous burden on many societies, but few studies have examined the effects of institutional characteristics on patient length of stay (LOS). This paper investigated the association between institutional characteristics and LOS for 160,517 psychiatric patients in South Korea by applying a two-level modeling technique to administrative claims databases covering the entire patient population. Patient LOS, expressed in terms of days, was analyzed by taking account of institutional type, ownership, location, inpatient capacity, staffing, and patient demographics. The characteristics of inpatients were used as control variables and consisted of gender, age, sub-diagnosis, and the type of national health security program. The main findings of this study are: (1) patient LOS was 69% longer at psychiatric hospitals than at tertiary-care hospitals; (2) neither location nor inpatient capacity was associated with LOS; (3) larger staffs reduced LOS; and (4), LOS increased with a higher proportion of male inpatients, inpatients > or =65 years old, or inpatients diagnosed with organic or schizophrenic disorders, possibly through contextual effects. The results of this study suggest that researchers and policy makers could improve their assessment of psychiatric patient LOS and its association with health outcome by taking into account institutional characteristics and using multi-level analyses.

  1. Teaching Scholarly Activity in Psychiatric Training: Years 6 and 7

    ERIC Educational Resources Information Center

    Zisook, Sidney; Boland, Robert; Cowley, Deborah; Cyr, Rebecca L.; Pato, Michele T.; Thrall, Grace

    2013-01-01

    Objective: To address nationally recognized needs for increased numbers of psychiatric clinician-scholars and physician-scientists, the American Association of Directors of Psychiatric Residency Training (AADPRT) has provided a series of full-day conferences of psychiatry residency training directors designed to increase their competence in…

  2. Neighborhood Transition and Mental Hospitalization Patterns.

    ERIC Educational Resources Information Center

    Muhlin, Gregory L.

    1979-01-01

    Assesses the relationship of change in neighborhood ethnic composition and 1970 psychiatric hospitalization rates for persons born in Ireland, Germany, Poland, Austria, Hungary, the U.S.S.R., and Italy. Concludes that such neighborhood change was unrelated to psychiatric hospitalization rates of the foreign born. Discusses policy implications and…

  3. 42 CFR 488.6 - Other national accreditation programs for hospitals and other providers and suppliers.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... national accreditation program for hospitals; psychiatric hospitals; transplant centers, except for kidney transplant centers; SNFs; HHAs; ASCs; RHCs; CORFs; hospices; religious nonmedical health care...

  4. 42 CFR 488.6 - Other national accreditation programs for hospitals and other providers and suppliers.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... national accreditation program for hospitals; psychiatric hospitals; transplant centers, except for kidney transplant centers; SNFs; HHAs; ASCs; RHCs; CORFs; hospices; religious nonmedical health care...

  5. 42 CFR 488.6 - Other national accreditation programs for hospitals and other providers and suppliers.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... national accreditation program for hospitals; psychiatric hospitals; transplant centers, except for kidney transplant centers; SNFs; HHAs; ASCs; RHCs; CORFs; hospices; religious nonmedical health care...

  6. 42 CFR 488.6 - Other national accreditation programs for hospitals and other providers and suppliers.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... national accreditation program for hospitals; psychiatric hospitals; transplant centers, except for kidney transplant centers; SNFs; HHAs; ASCs; RHCs; CORFs; hospices; religious nonmedical health care...

  7. Neuroinflammation and psychiatric illness

    PubMed Central

    2013-01-01

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

  8. Psychiatric testimony in Britain.

    PubMed

    Chiswick, D

    1989-01-01

    In the criminal-justice system psychiatric evidence may be relevant both before and after conviction. The scope of psychiatric testimony in the criminal courts has been more restricted in Britain than it has been elsewhere. It is generally confined to questions of fitness to plead, responsibility and disposal after conviction. A distinction must be made between matters of clinical psychiatry and those of moral culpability or legal competence. When psychiatric evidence strays from purely clinical questions there is an increased likelihood of misuse and abuse. Even when considering clinical issues there are factors of a non-clinical nature which may distort the type of evidence given. The implications of these matters for psychiatric witnesses are discussed. It is suggested that forensic psychiatrists are refining their role as expert witnesses.

  9. Comprehensive Psychiatric Evaluation

    MedlinePlus

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

  10. The development of new psychiatric legislation in Sweden.

    PubMed

    Johanson, E

    1993-01-01

    The development of Swedish psychiatric legislation is summarized, from the law that came into force on 1 January 1967 to the new law promulgated on 1 January 1992. There are now separate laws for (a) patients who are seriously mentally disturbed and urgently in need of psychiatric hospital care; who oppose care or evidently lack capacity to express a well-grounded opinion as to their needs; and (b) patients sentenced by court to forensic psychiatric care, who have to be seriously mentally disturbed but need not oppose care. As earlier, it seems to be possible to take care of them in general psychiatric wards but special wards for forensic psychiatric care are anticipated. Sweden so far has few such facilities.

  11. Psychiatric disorders and sleep issues.

    PubMed

    Sutton, Eliza L

    2014-09-01

    Sleep issues are common in people with psychiatric disorders, and the interaction is complex. Sleep disorders, particularly insomnia, can precede and predispose to psychiatric disorders, can be comorbid with and exacerbate psychiatric disorders, and can occur as part of psychiatric disorders. Sleep disorders can mimic psychiatric disorders or result from medication given for psychiatric disorders. Impairment of sleep and of mental health may be different manifestations of the same underlying neurobiological processes. For the primary care physician, key tools include recognition of potential sleep effects of psychiatric medications and familiarity with treatment approaches for insomnia in depression and anxiety.

  12. Witches, multiple personalities, and other psychiatric artifacts.

    PubMed

    McHugh, P R

    1995-02-01

    Contemporary psychiatric misdirections derived primarily from standard medical errors of oversimplification, misplaced emphasis, and invention are reviewed. These particular errors, however, were in part prompted and sustained by the sociocultural fads and fashions of the day. The results have been disastrous for everyone--patients, families, the public and psychiatry itself.

  13. [Cerebral hydatic cyst and psychiatric disorders. Two cases].

    PubMed

    Asri, F; Tazi, I; Maaroufi, K; El Moudden, A; Ghannane, H; Ait Benali, S

    2007-01-01

    unconscious of his disorders. The patient has first been put under classical neuroleptic 9 mg/day of Haloperidol and 200 mg/day of chlorpromazine. The diagnosis of schizophrenia has been kept according to criteria of DSM IV. The PANSS (Positive and Negative Syndrome Scale) was to 137 (score on a positive scale was to 34, score on a negative scale was to 35 and the general psychopathologie scale was to 58). One week after his hospitalization, he developed headache with subconfusion, a cerebral scanning has been made in emergency and showed a voluminous cyst in oval foramen compressing the mesencephalon strongly. The cyst was well limited, hypodense, not taking the contrast, and without intracerebral oedema, the diagnosis of cerebral hydatic cyst has been made. The complementary exploration didn't show any other localizations, and biologic exam results didn't show any particular anomalies. The patient has been operated in neurosurgery. The immediate evolution was favorable with disappearance of confusion and absence of complications. The patient was lost of view. Six months after, the patient has been readmitted to the psychiatric emergency. He dropped his neuroleptic treatment. He was aggressive, raving, hallucinated and depersonalized. The global score to the PANSS was 63. He has been put back under neuroleptics. Three weeks after improvement and passage of the PANSS to 30, the patient went out. We couldn't have a cerebral scanner of control because the patient had no medical assurance and no money for cerebral scanner. Case 2 - Patient aged of 53 years, father of four children, uneducated, native and resident of Marrakech, confectioner as profession. He is in contact with dogs since 12 years. He has been brought to the psychiatric emergencies by his family after an agitation. The history of his illness seemed to go back at eight months ago, by the progressive apparition of an instability, sleep disorders, hostility, associated with an emotional lability. To the interview he

  14. Diagnostic Stability of Psychiatric Disorders in Re-Admitted Psychiatric Patients in Kerman, Iran

    PubMed Central

    Alavi, Fatemeh; Nakhaee, Nouzar; Sabahi, Abdolreza

    2014-01-01

    Background: Several studies have evaluated the stability of psychiatric diagnosis follow in readmission of patients in psychiatric hospitals. However, there is little data concerning this matter from Iran. This study is designed to evaluate this diagnostic stability of the commonest psychiatric disorders in Iran. Objectives: The objective of this study was to determine the long-term diagnostic stability of the most prevalent psychiatric disorders among re-admitted patients at the Shahid Beheshti teaching hospital in Kerman, Iran. Patients and Methods: This study was based on 485 adult patients re-admitted at the Shahid Beheshti hospital between July and November 2012. All of the diagnoses were made according to DSM IV TR. Prospective and retrospective consistency and the ratio of patients who were obtained a diagnosis in at least 75%, 100% of the admissions were calculated. Results: The most frequent diagnoses at the first admission were bipolar disorder (48.5%) and Major depressive disorder (18.8%). The most stable diagnosis was bipolar disorder (71% prospective consistency, 69.4% retrospective consistency). Schizoaffective disorder had the greatest diagnostic instability (28.5% prospective consistency, 16.6% retrospective consistency). Conclusions: Among the cases evaluated, bipolar disorder had the most stability in diagnosis and the stability of schizoaffective disorder was poor. PMID:25168983

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

    PubMed

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

    2008-06-01

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

  16. Religious Affiliation as a Predictor of Involuntary Psychiatric Admission: A Brazilian 1-Year Follow-Up Study

    PubMed Central

    Casella, Caio Borba; Loch, Alexandre Andradade

    2014-01-01

    Objective: The aim of this study was to analyze factors associated with the legal status at psychiatric admission of individuals with psychosis or bipolar disorder in a Latin-American cultural setting. Methods: Prospective observational study was conducted in São Paulo, Brazil. We analyzed 169 individuals with bipolar or psychotic disorder in need of hospitalization. Sociodemographic data, data on the psychiatric disorder, information about the hospital stay, and data at time of discharge were collected. Their families were also contacted by telephone and interviews were conducted at 1, 2, 6, and 12 months post-discharge as a follow-up. Results: Eighty-eight patients (52%) had a voluntary admission and 81 (48%) had an involuntary admission (IA). The average length of admission was similar in both groups (17.4 vs. 17.3 days, p = 0.22). It was significantly more common for IA patients to be admitted because of other-directed aggressiveness (47.7 vs. 65.4%, p = 0.02). The percentage of individuals that needed physical restraint during hospital stay among IA patients was also significantly higher (11.4 vs. 25.9%, p = 0.01). Having any religious affiliations was significantly related to an IA status as well (OR = 4–6.48). Conclusion: Our results suggest that cultural factors related to religious affiliations might play an important role in determining psychiatric hospitalization legal status. Religion might possibly influence someone’s judgment and insight about his/her psychiatric disorder. This study restates the importance of dealing with the subject of religion with patients. PMID:25157344

  17. [Psychiatric nursing production in Brazil, 1932-1993].

    PubMed

    Souza, M C; Alencastre, M B

    1999-01-01

    The present research aims at studying the psychiatric nursing bibliographical production in Brazil, from 1932 to 1993. Therefore, the authors searched national journals, annals of the Brazilian Nursing Congresses, Annals of the National Seminars on Nursing Research and Catalogues of the Brazilian Nursing Association--Center of Nursing Studies and Research. In addition, the authors selected publications of the following events: III Meeting of Researchs on Mental Health, II Meeting of Specialists on Psychiatric Nursing, Nursing Undergraduation Golden Jubilee and National Meeting of University Hospitals. After the conclusion of this study, discussions were based on the central themes of the texts as well as on historical development of Psychiatric Nursing in Brazil.

  18. Day to Day

    ERIC Educational Resources Information Center

    Jurecki, Dennis

    2006-01-01

    A clean, healthy and safe school provides students, faculty and staff with an environment conducive to learning and working. However, budget and staff reductions can lead to substandard cleaning practices and unsanitary conditions. Some school facility managers have been making the switch to a day-schedule to reduce security and energy costs, and…

  19. Measurement of Psychiatric Treatment Adherence

    PubMed Central

    Sajatovic, Martha; Velligan, Dawn; Weiden, Peter J.; Valenstein, Marcia; Ogedegbe, Gbenga

    2014-01-01

    Objective Nonadherence to medications for mental disorders substantially limits treatment effectiveness and results in higher rates of relapse, hospitalization, and disability. Accurate measurement of medication adherence is important not only in adherence research, but also in clinical trials in which medications are being evaluated, and in clinical practice where failure to detect nonadherence results in premature medication changes, unnecessary polypharmacy, and greater likelihoods of functional deteriorations and hospitalizations. This is a review of psychiatric treatment adherence methods and measures arising from a meeting on “Methodological Challenges in Psychiatric Treatment Adherence Research” held on September 27-28, 2007 in Bethesda, MD and organized by the National Institute of Mental Health (NIMH). Methods This paper reviews the range of modalities currently available for assessing adherence behavior including pill counts, pharmacy records, technology-assisted monitoring, biological assays, and a range of self-report and interviewer-rated scales. Measures of adherence attitudes are also reviewed. Results Each of the adherence measures described are imperfect estimates of actual medication ingestion but each provides informative estimates of adherence or the attitudinal factors associated with adherence. Measure selection depends on a range of factors including the patient sample, the context in which the measure is being used, and the clinical outcomes expected from various levels of nonadherence. The use of multiple measures of adherence is encouraged to balance the limitations of individual measures. Conclusion While adherence assessment has become increasingly sophisticated in recent years there remains a need for refinement and expansion on currently available methods and measures. PMID:21109048

  20. Day to day with COPD

    MedlinePlus

    ... day; Chronic obstructive airways disease - day to day; Chronic obstructive lung disease - day to day; Chronic bronchitis - day to day; ... strategy for the diagnosis, management, and prevention of chronic ... disease. Updated 2015. www.goldcopd.it/materiale/2015/GOLD_ ...