[Patients of immigrant origin in outpatient psychiatric facilities: a comparison between Turkish, eastern European and German patients].

PubMed

Schouler-Ocak, Meryam; Bretz, H Joachim; Hauth, Iris; Montesinos, Amanda Heredia; Koch, Eckhardt; Driessen, Martin; Heinz, Andreas

2010-11-01

Nationwide representative survey of the use of psychiatric outpatient services in Germany. Every fifth patient of several psychiatric outpatient services was surveyed on one index day (27 (th) of May 2008) with respect to sociodemographic characteristics, ICD-10 diagnoses, difficulties in communication, treatment duration, and number of sickness certificates. Patients with immigrant background comprised 32.5 % of all patients. Compared to German patients, patients with immigrant background received significantly more neurotic, stress-related and somatoform disorders (F4). Turkish patients received significantly more mood (affective) disorders diagnoses (F3), compared to German and Eastern Europe patients. Immigrants had shorter treatment duration and a higher number of sickness certificates. Eastern European patients had a significantly higher education, compared to patients with Turkish background. Patients with immigrant background were younger compared to German patients and had significantly more children. The utilization of outpatient psychiatric services by patients with a migratory background is high. This suggests that immigrants benefit from the multiprofessional team and the low-treshold service offered by outpatient units. © Georg Thieme Verlag KG Stuttgart · New York.

Gender Differences in Psychiatric Diagnoses among Inpatients with and without Intellectual Disabilities

ERIC Educational Resources Information Center

Lunsky, Yona; Bradley, Elspeth A.; Gracey, Carolyn D.; Durbin, Janet; Koegl, Chris

2009-01-01

There are few published studies on the relationship between gender and psychiatric disorders in individuals with intellectual disabilities. Adults (N = 1,971) with and without intellectual disabilities who received inpatient services for psychiatric diagnosis and clinical issues were examined. Among individuals with intellectual disabilities,…

Trajectories and correlates of special education supports for youth with autism spectrum disorder and psychiatric comparisons.

PubMed

Spaulding, Christine J; Lerner, Matthew D; Gadow, Kenneth D

2017-05-01

Relatively little is known about patterns of school-based supportive services for youth with autism spectrum disorder. This study describes these supportive services and their correlates, both cross-sectionally and retrospectively, in a large sample ( N = 283) of 6- to 18- year-old youth. To assess whether special education designation and classroom placement patterns were peculiar to autism spectrum disorder, we also conducted analyses comparing youth with autism spectrum disorder to those with other psychiatric diagnoses ( N = 1088). In higher grades, the relative quantity of three common supportive services received by youth with autism spectrum disorder decreased, while total supportive service quantity remained stable over time. Youth with autism spectrum disorder were more likely to receive a special education designation and were placed in less inclusive classroom settings than youth with other psychiatric diagnoses. These findings suggest that as youth with autism spectrum disorder reach higher grades, changes in service provision occur in terms of both time and quantity.

Popular Musician Responses to Mental Health Treatment.

PubMed

Berg, Lloyd; King, Benjamin; Koenig, Jessica; McRoberts, Roger L

2018-06-01

Popular (i.e., nonclassical) musicians have higher rates of mental health disorders and mental health service utilization than the general population. Little is known, however, about how popular musicians perceive mental health interventions in terms of overall satisfaction and therapeutic benefit. An online client satisfaction survey was sent to all musicians and family members who received mental health services through a nonprofit mental health organization in Austin, Texas, between July 2014 and June 2015 (n=628). 260 individuals (41.4%) responded to the survey, of whom 94% (n=244) were musicians. A majority of musician respondents were male (60%) and white (82%). 87% received counseling, 32% received psychiatric medication treatment, and 8% received addiction recovery services. 97% of musicians (205/211) rated their counselor as 'very good' or 'excellent,' 88% (64/79) rated their psychiatric providers as 'very good' or 'excellent,' and 94% (17/19) rated their addiction recovery specialists as 'very good' or 'excellent' (nonsignificant between all categories, p>0.05). 89% of musicians receiving counseling, 84% receiving psychiatric medication treatment, and 95% receiving addiction recovery services agreed or strongly agreed that their symptoms and overall functioning improved as a result of their treatment (nonsignificant between all categories, p>0.05). Popular musicians express strong provider satisfaction and overall benefit when mental health interventions are accessible, affordable, and delivered by professionals familiar with their concerns. More research is needed to understand the unique psychosocial stresses popular musicians face to inform treatment planning for this high-risk, underserved population.

42 CFR 435.308 - Medically needy coverage of individuals under age 21.

Code of Federal Regulations, 2010 CFR

2010-10-01

...) Individuals receiving active treatment as inpatients in psychiatric facilities or programs, if inpatient psychiatric services for individuals under 21 are provided under the plan. [46 FR 47986, Sept. 30, 1981, as...

Managing Bipolar Youths in a Psychiatric Inpatient Emergency Service

ERIC Educational Resources Information Center

Masi, Gabriele; Mucci, Maria; Pias, Paola; Muratori, Filippo

2011-01-01

Among the youths referred to our Psychiatric Inpatient Emergency Service, we focused on bipolar disorder (BD), to explore predictive elements for the outcome. Fifty-one patients (30 males, 21 females, age range 8-18 years, mean age 14.2 plus or minus 3.1 years) received a diagnosis of BD, according to historical information, prolonged…

Psychiatric symptom typology in a sample of youth receiving substance abuse treatment services: associations with self-reported child maltreatment and sexual risk behaviors.

PubMed

Oshri, Assaf; Tubman, Jonathan G; Jaccard, James

2011-11-01

Latent profile analysis (LPA) was used to classify 394 adolescents undergoing substance use treatment, based on past year psychiatric symptoms. Relations between profile membership and (a) self-reported childhood maltreatment experiences and (b) current sexual risk behavior were examined. LPA generated three psychiatric symptom profiles: Low-, High- Alcohol-, and High- Internalizing Symptoms profiles. Analyses identified significant associations between profile membership and childhood sexual abuse and emotional neglect ratings, as well as co-occurring sex with substance use and unprotected intercourse. Profiles with elevated psychiatric symptom scores (e.g., internalizing problems, alcohol abuse and dependence symptoms) and more severe maltreatment histories reported higher scores for behavioral risk factors for HIV/STI exposure. Heterogeneity in psychiatric symptom patterns among youth receiving substance use treatment services, and prior histories of childhood maltreatment, have significant implications for the design and delivery of HIV/STI prevention programs to this population.

Barriers to Employment for Transition-age Youth with Developmental and Psychiatric Disabilities.

PubMed

Noel, Valerie A; Oulvey, Eugene; Drake, Robert E; Bond, Gary R

2017-05-01

Youth with developmental and psychiatric disabilities encounter significant vocational challenges, even when they receive supported employment services. We examined the barriers to employment for 280 transition-age youth with disabilities enrolled in supported employment in eight community rehabilitation centers. Employment team members identified each youth's top three barriers to employment using a 21-item checklist. Lack of work experience, transportation problems, and program engagement issues represented common barriers for both youth with developmental disabilities (53, 36, and 25%) and youth with psychiatric disabilities (20, 33, and 26%). Additional common barriers among youth with developmental disabilities included cognitive problems (32%) and lack of social skills (23%) and among youth with psychiatric disabilities included poor control of psychiatric symptoms (23%). Despite receiving evidence-based employment services, youth with disabilities encounter many barriers to employment. Awareness of typical barriers for transition-age youth, including those specific to different disability groups, may help employment programs anticipate challenges and develop strategies that avoid these barriers and their effects on employment opportunities.

Ethnic differences in the diagnosis of schizophrenia and mood disorders during admission to an academic safety-net psychiatric hospital.

PubMed

Hamilton, Jane E; Heads, Angela M; Meyer, Thomas D; Desai, Pratikkumar V; Okusaga, Olaoluwa O; Cho, Raymond Y

2018-05-30

U.S. Hispanics, now the single largest minority group in the country, face unique mental health disparities. The current study utilizes Andersen's Behavioral Model of Health Service Use to examine ethnic disparities in receiving a schizophrenia or mood disorder diagnosis at psychiatric hospital admission. Our retrospective cohort study examined electronic health record data at an academic safety-net psychiatric hospital for adult patients (n = 5571) admitted between 2010 and 2013. Logistic regression with block-wise entry of predisposing, enabling and need variables was used to examine ethnic disparities in receiving a schizophrenia diagnosis at admission. The block of need factors was the strongest predictor of receiving a schizophrenia diagnosis compared to predisposing and enabling factors. Compared to non-Hispanic whites, Hispanics and African Americans had a greater likelihood of receiving a schizophrenia diagnosis at admission. Additionally, patients diagnosed with schizophrenia had elevated positive and negative symptoms and were more likely to be male, single/unmarried, homeless, high inpatient service utilizers, involuntarily hospitalized, and to exhibit functional impairment at psychiatric hospital admission. To address elevated positive and negative symptoms of schizophrenia, functional impairment, social withdrawal, and high inpatient service utilization, promising psychosocial interventions should be adapted for racial and ethnic minority populations and utilized as an adjuvant to antipsychotic medication. Copyright © 2018. Published by Elsevier B.V.

Reinforcing integrated psychiatric service attendance in an opioid-agonist program: a randomized and controlled trial.

PubMed

Kidorf, Michael; Brooner, Robert K; Gandotra, Neeraj; Antoine, Denis; King, Van L; Peirce, Jessica; Ghazarian, Sharon

2013-11-01

The benefits of integrating substance abuse and psychiatric care may be limited by poor service utilization. This randomized clinical trial evaluated the efficacy of using contingency management to improve utilization of psychiatric services co-located and integrated within a community-based methadone maintenance treatment program. Opioid-dependent outpatients (n=125) with any current psychiatric disorder were randomly assigned to: (1) reinforced on-site integrated care (ROIC), with vouchers (worth $25.00) contingent on full adherence to each week of scheduled psychiatric services; or (2) standard on-site integrated care (SOIC). All participants received access to the same schedule of psychiatrist and mental health counseling sessions for 12-weeks. ROIC participants attended more overall psychiatric sessions at month 1 (M=7.53 vs. 3.97, p<.001), month 2 (M=6.31 vs. 2.81, p<.001), and month 3 (M=5.71 vs. 2.44, p<.001). Both conditions evidenced reductions in psychiatric distress (p<.001) and similar rates of drug-positive urine samples. No differences in study retention were observed. These findings suggest that contingency management can improve utilization of psychiatric services scheduled within an on-site and integrated treatment model. Delivering evidenced-based mental health counseling, or modifying the contingency plan to include illicit drug use, may be required to facilitate greater changes in psychiatric and substance abuse outcomes. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Drug Treatment Service Utilization and Outcomes for Hispanic and White Methamphetamine Abusers

PubMed Central

Niv, Noosha; Hser, Yih-Ing

2006-01-01

Objective To examine differences in drug treatment service needs, utilization, satisfaction, and outcomes between Hispanic and white methamphetamine (meth) abusers. Data Sources Intake assessments and follow-up interviews of 128 Hispanic and 371 non-Hispanic white meth abusers admitted during 2000–2001 to 43 drug treatment programs in 13 counties across California. Study Design A prospective longitudinal study comparing ethnic differences in problem severity during pre- and posttreatment periods, as well as in services received during treatment. Data Collection/Extraction Methods The Addiction Severity Index (ASI) was administered at both intake and the 9-month follow-up to assess clients' problem severity in a number of domains. Service utilization and satisfaction were assessed 3 months following treatment admission. Principal Findings Hispanics were less educated and reported more employment difficulties than whites. Whites were more likely to be treated in residential programs than Hispanics despite similar severity in drug and alcohol use, legal, medical and family/social problems, and psychiatric status. Significantly more whites than Hispanics received psychiatric services, likely because more of them were treated in residential programs. Whites also reported receiving greater numbers of total services and services addressing alcohol and psychiatric problems. While no ethnic differences were found in treatment satisfaction and several other outcomes, Hispanics demonstrated better family and social outcomes than whites. Conclusions Both Hispanic and white meth abusers improved after treatment, although benefits from treatment can be further enhanced if services underscore different facets of their psychosocial problems. PMID:16899005

Ethnic Disparities in School-Based Behavioral Health Service Use for Children With Psychiatric Disorders.

PubMed

Locke, Jill; Kang-Yi, Christina D; Pellecchia, Melanie; Marcus, Steven; Hadley, Trevor; Mandell, David S

2017-01-01

We examined racial/ethnic disparities in school-based behavioral health service use for children with psychiatric disorders. Medicaid claims data were used to compare the behavioral healthcare service use of 23,601 children aged 5-17 years by psychiatric disorder (autism, attention deficit hyperactivity disorder [ADHD], conduct/oppositional defiant disorder, and "other") and by race/ethnicity (African-American, Hispanic, white, and other). Logistic and generalized linear regression analyses were used. Differences in service use by racial/ethnic group were identified within and across diagnostic groups, both for in-school service use and out-of-school service use. For all disorders, Hispanic children had significantly lower use of in-school services than white children. Among children with ADHD, African-American children were less likely to receive in-school services than white children; however, there were no differences in adjusted annual mean Medicaid expenditures for in-school services by race/ethnicity or psychiatric disorders. Statistically significant differences by race/ethnicity were found for out-of-school service use for children with ADHD and other psychiatric disorders. There were significant differences by race/ethnicity in out-of-school service use for each diagnostic group. Differences in the use of school-based behavioral health services by racial and ethnic groups suggest the need for culturally appropriate outreach and tailoring of services to improve service utilization. © 2016, American School Health Association.

Mental health consultations in a prison population: a descriptive study

PubMed Central

Kjelsberg, Ellen; Hartvig, Paal; Bowitz, Harald; Kuisma, Irene; Norbech, Peder; Rustad, Aase-Bente; Seem, Marthe; Vik, Tom-Gunnar

2006-01-01

Background The psychiatric morbidity among prison inmates is substantially higher than in the general population. We do, however, have insufficient knowledge about the extent of psychiatric treatment provided in our prisons. The aim of the present study was to give a comprehensive description of all non-pharmacological interventions provided by the psychiatric health services to a stratified sample of prison inmates. Methods Six medium/large prisons (n = 928) representing 1/3 of the Norwegian prison population and with female and preventive detention inmates over-sampled, were investigated cross-sectionally. All non-pharmacological psychiatric interventions, excluding pure correctional programs, were recorded. Those receiving interventions were investigated further and compared to the remaining prison population. Results A total of 230 of the 928 inmates (25 %) had some form of psychiatric intervention: 184 (20 %) were in individual psychotherapy, in addition 40 (4 %) received ad hoc interventions during the registration week. Group therapy was infrequent (1 %). The psychotherapies were most often of a supportive (62 %) or behavioural-cognitive (26 %) nature. Dynamic, insight-oriented psychotherapies were infrequent (8 %). Concurrent psychopharmacological treatment was prevalent (52 %). Gender and age did not correlate with psychiatric interventions, whereas prisoner category (remanded, sentenced, or preventive detention) did (p < 0.001). Most inmates had a number of defined problem areas, with substance use, depression, anxiety, and personality disorders most prevalent. Three percent of all inmates were treated for a psychotic disorder. Remand prisoners averaged 14 sessions per week per 100 inmates, while sentenced inmates and those on preventive detention averaged 22 and 25 sessions per week per 100 inmates, respectively. Five out of six psychiatric health services estimated the inmates' psychiatric therapy needs as adequately met, both overall and in the majority of individual cases. Conclusion Our results pertain only to prisons with adequate primary and mental health services and effective diversion from prison of individuals with serious mental disorders. Given these important limitations, we do propose that the service estimates found may serve as a rough guideline to the minimum number of sessions a prison's psychiatric health services should be able to fulfil in order to serve the inmates psychiatric needs. The results rely on the specialist services' own estimates only. Future studies should take other important informants, including the inmates themselves, into consideration. PMID:16759383

Psychiatric disorders among people living with HIV/AIDS in IRAN: Prevalence, severity, service utilization and unmet mental health needs.

PubMed

Shadloo, Behrang; Amin-Esmaeili, Masoumeh; Motevalian, Abbas; Mohraz, Minoo; Sedaghat, Abbas; Gouya, Mohammad Mehdi; Rahimi-Movaghar, Afarin

2018-07-01

HIV and psychiatric disorders are closely correlated and are accompanied by some similar risk factors. The aim of this study was to assess psychiatric comorbidity and health service utilization for mental problems among people living with HIV/AIDS in Iran. A total of 250 cases were randomly selected from a large referral center for HIV treatment and care in Tehran, Iran. Psychiatric disorders in the past 12 months including mood, anxiety, and substance use disorders were assessed through face-to-face interview, using a validated Persian translation of the Composite International Diagnostic Interview (CIDI v2.1). Severity of psychiatric disorders, social support, socio-economic status, service utilization and HIV-related indicators were assessed. Participants consisted of 147 men and 103 women. Psychiatric disorders were found in 50.2% (95% confidence interval: 43.8-56.6) of the participants. Major depressive disorder was the most prevalent diagnosis (32.1%), followed by substance use disorders (17.1%). In bivariate analysis, psychiatric disorders were significantly higher among male gender, single and unemployed individuals and those with lower social support. In multivariate regression analysis, only social support was independently associated with psychiatric disorders. Among those with a psychiatric diagnosis, 41.1% had used a health service for mental problems and 53% had received minimally adequate treatment. The findings of the study highlight the importance of mental health services in the treatment of people living with HIV/AIDS. Copyright © 2018 Elsevier Inc. All rights reserved.

Local inpatient units may increase patients' utilization of outpatient services: a comparative cohort-study in Nordland County, Norway.

PubMed

Myklebust, Lars Henrik; Sørgaard, Knut; Wynn, Rolf

2015-01-01

In the last few decades, there has been a restructuring of the psychiatric services in many countries. The complexity of these systems may represent a challenge to patients that suffer from serious psychiatric disorders. We examined whether local integration of inpatient and outpatient services in contrast to centralized institutions strengthened continuity of care. Two different service-systems were compared. Service-utilization over a 4-year period for 690 inpatients was extracted from the patient registries. The results were controlled for demographic variables, model of service-system, central inpatient admission or local inpatient admission, diagnoses, and duration of inpatient stays. The majority of inpatients in the area with local integration of inpatient and outpatient services used both types of care. In the area that did not have beds locally, many patients that had been hospitalized did not receive outpatient follow-up. Predictors of inpatients' use of outpatient psychiatric care were: Model of service-system (centralized vs decentralized), a diagnosis of affective disorder, central inpatient admission only, and duration of inpatient stays. Psychiatric centers with local inpatient units may positively affect continuity of care for patients with severe psychiatric disorders, probably because of a high functional integration of inpatient and outpatient care.

Local inpatient units may increase patients’ utilization of outpatient services: a comparative cohort-study in Nordland County, Norway

PubMed Central

Myklebust, Lars Henrik; Sørgaard, Knut; Wynn, Rolf

2015-01-01

Objectives In the last few decades, there has been a restructuring of the psychiatric services in many countries. The complexity of these systems may represent a challenge to patients that suffer from serious psychiatric disorders. We examined whether local integration of inpatient and outpatient services in contrast to centralized institutions strengthened continuity of care. Methods Two different service-systems were compared. Service-utilization over a 4-year period for 690 inpatients was extracted from the patient registries. The results were controlled for demographic variables, model of service-system, central inpatient admission or local inpatient admission, diagnoses, and duration of inpatient stays. Results The majority of inpatients in the area with local integration of inpatient and outpatient services used both types of care. In the area that did not have beds locally, many patients that had been hospitalized did not receive outpatient follow-up. Predictors of inpatients’ use of outpatient psychiatric care were: Model of service-system (centralized vs decentralized), a diagnosis of affective disorder, central inpatient admission only, and duration of inpatient stays. Conclusion Psychiatric centers with local inpatient units may positively affect continuity of care for patients with severe psychiatric disorders, probably because of a high functional integration of inpatient and outpatient care. PMID:26604843

[Characteristics of calls by psychiatric patients to an emergency telephone helpline].

PubMed

Gilat, I; Gil, Z E

1996-05-15

The role of the Israeli emergency telephone helpline, ERAN, was investigated by comparative analysis of calls received from 464 patients being treated psychiatrically, with calls received from 3,292 nonpatients during 1994. Findings reveal different patterns for helping relations in the 2 groups: Those being treated psychiatrically on a regular basis called ERAN more frequently, expected emotional support rather than direct help, mainly presented mental problems, and suicidal thoughts were much more prevalent among them. Those under no psychiatric treatment often called only once and presented a wider spectrum of expectations and problems. These differences indicate that the interrelations between the para-professional ERAN service and professional agents are complementary for mental patients and substitutional for other callers.

Comparing post-deployment mental health services utilization in soldiers deployed to Balkan, Iraq and Afghanistan.

PubMed

Madsen, T; Sadowa Vedtofte, M; Nordentoft, M; Ravnborg Nissen, L; Bo Andersen, S

2017-06-01

Insight on how different missions have impacted rates of mental health service (MHS) utilization is unexplored. We compared postdeployment MHS utilization in a national cohort of first-time deployed to missions in Balkan, Iraq, and Afghanistan respectively. A prospective national cohort study of 13 246 first-time deployed in the period 1996 through 2012 to missions in Balkan area, Iraq, or Afghanistan respectively. Soldiers 'MHS utilization was also compared with a 5:1 sex-, age-, and calendar year-matched never-deployed background population. Postdeployment utilization of MHS was retrieved from national coverage registers. Using Cox survival analyses, participants were followed and compared with regard to receiving three different types of psychiatric services: (i) admission to psychiatric hospital, (ii) psychiatric outpatient contact, and (iii) prescriptions of psychotropics. Utilizing of psychiatric outpatient services and psychotropics was significantly higher in first-time deployed to Iraq and Afghanistan compared with deployed to Balkan. However, the rate of postdeployment admission to psychiatric hospital did not differ between missions. Postdeployment rates of psychiatric admission and psychiatric outpatient treatment were significantly higher in Afghanistan-deployed personnel compared with the background population. Utilization of MHS differed significantly between mission areas and was highest after the latest mission to Afghanistan. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Characteristics of Children with Autism Spectrum Disorders Who Received Services through Community Mental Health Centers

ERIC Educational Resources Information Center

Bryson, Stephanie A.; Corrigan, Susan K.; McDonald, Thomas P.; Holmes, Cheryl

2008-01-01

Despite the presence of significant psychiatric comorbidity among children with autism spectrum disorders (ASDs), little research exists on those who receive community-based mental health services. This project examined one year (2004) of data from the database maintained by 26 community mental health centers (CMHCs) in the Midwestern US state of…

Are long-term psychiatric patients causing more crisis consultations outside office hours in mental health care?

PubMed

Dekker, J; Theunissen, J; Van, R; Kikkert, M; van der Post, L; Zoeteman, J; Peen, J

2013-09-01

As well as an improvement in community services, the de-institutionalization of patients receiving long-term psychiatric care can lead to marginally staffed mental health services, more homelessness, rising admission rates and more people in prison cells. It is assumed that an imbalance between community and hospital care for chronic patients puts pressure on crisis services. In this study, the central question is whether patients receiving long-term psychiatric care in Amsterdam do indeed put pressure on the city's emergency mental health services. We compare the pressure exerted by this group with the pressure resulting from the use of these services by all registered patients. Data were taken from the client registration systems of three mental health organizations in Amsterdam in the period from 2000 to 2004. Inclusion criteria for long-term psychiatric patients were age above 19 years and uninterrupted receipt of mental health care for a minimum of two successive years. Annually, 6%-8% of all non-long-term patients experienced a crisis outside office hours in the period under investigation; this was 4%-6% for long-term patients. The non-long-term patients accounted for 83% of crisis contacts outside office hours over the entire study period, with long-term patients accounting for 17%. The assumption that crises are more prevalent in long-term patients in the community seems to be an example of stigmatization rather than an observation based on fact.

Effects of mandatory screening labs in directing the disposition of the apparently healthy psychiatric patient in the emergency department.

PubMed

Kagel, Karyn E; Smith, Meghan; Latyshenko, Ilya V; Mitchell, Christopher; Kagel, Andrew

2017-01-01

To determine whether mandatory psychiatric admission laboratory tests yield results that change the disposition of a patient with primary psychiatric complaint from admission to a psychiatric service to admission to a medical service. This was a single center retrospective cohort chart review study approved by the facility Institutional Review Board in which we used a records database maintained by the emergency department's social workers to access the records of every patient that presented to our emergency department with a psychiatric chief complaint between the dates of December 1, 2011, and December 1, 2013. We focused on those that were admitted to either a psychiatric service or a medical service after a thorough evaluation by the department of social work and an emergency provider. We applied our inclusion and exclusion criteria and reviewed the results of the mandatory psychiatric laboratory tests (complete blood count, comprehensive metabolic panel, thyroid stimulating hormone, acetaminophen, aspirin, blood alcohol level, urinalysis, urine pregnancy test, urine drug screen) required for admission. Our independent variables were the compulsory psychiatric admission laboratory tests and our dependent variable was the admission to a medical service. Of 5,606 laboratory tests that were ordered and produced results for the 682 patients enrolled in our study, 51 results were considered clinically significant abnormal results, or results requiring treatment prior to psychiatric service admission, by the 2 reviewing emergency physicians. Only one of 682 psychiatric patients received a final disposition to a medical service based upon abnormal laboratory studies. That patient presented without any medical complaints but a chief complaint of "suicidal ideation," and was found to have diabetic ketoacidosis. Based on our data, the probability that an abnormal laboratory test will result in a change in disposition is 1/682=0.1% (95% CI: 0.0% to 0.9%). Patients presenting to the emergency department with a psychiatric chief complaint and no physical complaints, abnormal vital signs, or abnormal physical exam findings have less than 1% probability that an abnormal laboratory study will change their disposition from a psychiatric admission to a medical admission.

Support after perinatal death: a study of support and counselling after perinatal bereavement.

PubMed Central

Forrest, G C; Standish, E; Baum, J D

1982-01-01

After an earlier study into the practical aspects of the management of perinatal death, a counselling service was introduced for parents whose baby had died in the perinatal period. The service was monitored, and the parents who received the service were compared with a group that did not. Fifty families were allocated randomly either to the counselling (supported) group or to the contrast group, who received routine hospital care. Assessment was carried out at six and 14 months after the death, using a semi-structured interview and two self-rating scales (the general health questionnaire and the Leeds scales). Two of 16 mothers in the supported group showed psychiatric disorder at six months, compared with 10 of 19 in the contrast group (p less than 0.01, Fisher's exact test). There was no significant difference between the two groups at 14 months, when 80% of all the women studied had recovered psychiatric symptoms. Socially isolated women and those who marital relations lacked intimacy had a higher incidence of psychiatric symptoms at six months. Early pregnancy (within six months) was associated with a higher incidence of psychiatric symptoms in the unsupported group. The duration of bereavement reaction after perinatal death was appreciably shortened by support and counselling. PMID:6814610

The Workforce Shortage of Child and Adolescent Psychiatrists: Is It Time for a Different Approach?

PubMed

Findling, Robert L; Stepanova, Ekaterina

2018-05-01

Psychiatric disorders affect a large number of children around the world. Recent data have reported that approximately 10% to 13% of children have a serious emotional disturbance with significant functional impairment, suggesting that at least 1 in 10 children require mental health services. 1,2 Approximately half the adults with mental illness received their diagnosis before 15 years of age 3 and close to three fourths of mental health disorders start by the mid-20s. 4 Mental illnesses are associated with a large disease burden because these conditions lead to increases in morbidity, mortality, and financial costs. For example, in high-income countries such as the United States, 3 of the leading illnesses associated with pediatric disease burden are psychiatric (depression, bipolar disorder, and schizophrenia) and psychiatric illness in children and adolescents is a key risk factor for completed suicide. 5 In the United States, suicide is the second leading cause of death in people 15 to 24 years of age, 6 with rural areas having particularly high suicide rates. 7 What is even more disconcerting is the fact that most youngsters who might benefit from psychiatric or behavioral health treatment do not receive it. For example, only 45% of adolescents with mental illness received psychiatric services in 2013. This number is even smaller for children and adolescents with internalizing disorders and for minorities. 8 . Copyright © 2018 American Academy of Child and Adolescent Psychiatry. Published by Elsevier Inc. All rights reserved.

Association of Bullying Behavior at 8 Years of Age and Use of Specialized Services for Psychiatric Disorders by 29 Years of Age.

PubMed

Sourander, Andre; Gyllenberg, David; Brunstein Klomek, Anat; Sillanmäki, Lauri; Ilola, Anna-Marja; Kumpulainen, Kirsti

2016-02-01

Bullying and being exposed to bullying among children is prevalent, especially among children with psychiatric symptoms, and constitutes a major concern worldwide. Whether childhood bullying or exposure to bullying in the absence of childhood psychiatric symptoms is associated with psychiatric outcomes in adulthood remains unclear. To study the associations between bullying behavior at 8 years of age and adult psychiatric outcomes by 29 years of age. Nationwide birth cohort study of 5034 Finnish children with complete information about childhood bullying behavior was followed up from 8 to 29 years of age. Follow-up was completed on December 31, 2009, and data were analyzed from January 15, 2013, to February 15, 2015. Information about bullying, exposure to bullying, and psychiatric symptoms were obtained from parents, teachers, and child self-reports when children were 8 years of age. Use of specialized services for psychiatric disorders from 16 to 29 years of age was obtained from a nationwide hospital register, including outpatient and inpatient treatment. Among the 5034 study participants, 4540 (90.2%) did not engage in bullying behavior; of these, 520 (11.5%) had received a psychiatric diagnosis at follow-up; 33 of 166 (19.9%) who engaged in frequent bullying, 58 of 251 (23.1%) frequently exposed to bullying, and 24 of 77 (31.2%) who both frequently engaged in and were frequently exposed to bullying had received psychiatric diagnoses at follow-up. When analyses were adjusted by sex, family factors, and child psychiatric symptoms at 8 years of age, we found independent associations of treatment of any psychiatric disorder with frequent exposure to bullying (hazard ratio [HR], 1.9; 95% CI, 1.4-2.5) and being a bully and exposed to bullying (HR, 2.1; 95% CI, 1.3-3.4). Exposure to bullying was specifically associated with depression (HR, 1.9; 95% CI, 1.2-2.9). Bullying was associated with psychiatric outcomes only in the presence of psychiatric problems at 8 years of age. Participants who were bullies and exposed to bullying at 8 years of age had a high risk for several psychiatric disorders requiring treatment in adulthood. However, the associations with specific psychiatric disorders did not remain significant after controlling for concurrent psychiatric symptoms. Exposure to bullying, even in the absence of childhood psychiatric symptoms, is associated with severe adulthood psychiatric outcomes that require treatment in specialized services. Early intervention among those involved in bullying can prevent long-term consequences.

Ethnic matching of clients and clinicians and use of mental health services by ethnic minority clients.

PubMed

Ziguras, Stephen; Klimidis, Steven; Lewis, James; Stuart, Geoff

2003-04-01

Research in the United States has indicated that matching clients from a minority group with clinicians from the same ethnic background increases use of community mental health services and reduces use of emergency services. This study assessed the effects of matching clients from a non-English-speaking background with bilingual, bicultural clinicians in a mental health system in Australia that emphasizes community-based psychiatric case management. In an overall sample of 2,935 clients served in the western region of Melbourne from 1997 to 1999, ethnic minority clients from a non-English-speaking background who received services from a bilingual, bicultural case manager were compared with ethnic minority clients who did not receive such services and with clients from an English-speaking background. The clients' engagement with three types of services-community care teams, psychiatric crisis teams, and psychiatric inpatient services-was assessed. Compared with ethnic minority clients who were not matched with a bilingual clinician, those who were matched generally had a longer duration and greater frequency of contact with community care teams and a shorter duration and lower frequency of contact with crisis teams. Clients born in Vietnam who were matched with a bilingual clinician had a shorter annual mean length of hospital stay and a lower annual mean frequency of hospital admission than Australian-born clients. The benefits of matching clients with psychiatric case managers on the basis of ethnic background include a lower level of need for crisis intervention and, for clients from some ethnic groups, fewer inpatient interventions. These Australian results support findings of the effectiveness of client-clinician ethnic matching in the United States.

Mathematics Instruction in US Psychiatric Schools for Secondary Students with Emotional/Behavioural Disorders or Learning Disabilities

ERIC Educational Resources Information Center

Maccini, Paula; Gagnon, Joseph Calvin; Mulcahy, Candace; Wright, Kenneth

2013-01-01

Students served in alternative and segregated settings tend to receive educational services that are not on par with their public school peers. To develop a better understanding of the problem, the authors conducted a national study of secondary psychiatric schools in the United States. Specifically, the authors administered a survey to…

Delirium tremens and alcohol withdrawal nationally in the Veterans Health Administration.

PubMed

Moore, David Thomas; Fuehrlein, Brian Scott; Rosenheck, Robert Alan

2017-10-01

Alcohol withdrawal-especially delirium tremens (DT)-is a potentially life-threatening condition. While short-term treatment regimens and factors that predispose to more severe symptomatology have been extensively studied, little attention has been paid to the clinical epidemiology and long-term care of the chronic medical, addictive, psychiatric, and psychosocial problems faced by these patients. National Veterans Health Administration data from fiscal year 2012 were examined to identify veterans diagnosed with DT; with withdrawal but not DT (WNDT); and with Alcohol Use Disorder (AUD) but neither DT nor WNDT. They were compared on sociodemographic characteristics, psychiatric and medical co-morbidities, and health service and psychotropic medication use, first with bivariate analyses and then multiple logistic regression. Among the 345,297 veterans diagnosed with AUD, 2,341 (0.7%) were diagnosed with DT and 6,738 (2.0%) with WNDT. Veterans diagnosed with either WNDT or DT were more likely to have been homeless, had more comorbid medical and psychiatric disorders, were more likely to be diagnosed with drug use disorders, utilized more health services, received more psychotropic medications, and were more likely to receive naltrexone. They were more likely to receive specialized legal, housing, vocational, and psychosocial rehabilitation services, as well as intensive case management. Adults with WNDT and DT suffer from multiple chronic conditions and long-term service models are needed to coordinate the work of multiple specialists and to assure continuity of care. This national study identifies sociodemographic characteristics, comorbidities, and service utilization patterns associated with WNDT and DT.(Am J Addict 2017;26:722-730). © 2017 American Academy of Addiction Psychiatry.

Community psychiatric nurse caseloads and the 'worried well': misspent time vital work?

PubMed

Bowers, L

1997-11-01

Community psychiatric nurses (CPNs) in the United Kingdom are being repeatedly urged to focus their attention upon those with serious and enduring psychotic illnesses, and to withdraw from working with the 'worried well' in the primary health care setting. In view of this pressure, it is important to discover the nature of community psychiatric nurses' non-psychotic caseloads. The aim of this study was to describe these cases, what precipitated their referral, what problems they suffered from, what effects these problems had upon their lives and what kinds of therapeutic interventions they were receiving. A random sample was drawn of non-psychotic CPN patients. The community psychiatric nurses then received a structured interview about the history, care and treatment of these patients. These patients did not, in general, suffer from minor, self-limiting conditions. They typically had had 5 years of contact with psychiatric services, and their psychiatric symptoms blighted their occupational, social and personal lives. Their condition caused significant carer burden, and there was frequently a risk of suicide. The CPNs case-managed a complex combination of interventions for these patients, of which psychotherapeutic methods were only one part. The findings show that community psychiatric nurses have a valid role to play in the care of those with non-psychotic mental disorders, and should continue to receive the opportunity, and appropriate training, to do so.

Insertion of Foreign Bodies (polyembolokoilamania): Underpinnings and Management Strategies

PubMed Central

Unruh, Brandon T.; Nejad, Shamim H.; Stern, Thomas W.

2012-01-01

LESSONS LEARNED AT THE INTERFACE OF MEDICINE AND PSYCHIATRY The Psychiatric Consultation Service at Massachusetts General Hospital sees medical and surgical inpatients with comorbid psychiatric symptoms and conditions. Such consultations require the integration of medical and psychiatric knowledge. During their twice-weekly rounds, Dr Stern and other members of the Consultation Service discuss the diagnosis and management of conditions confronted. These discussions have given rise to rounds reports that will prove useful for clinicians practicing at the interface of medicine and psychiatry. Dr Unruh is an attending psychiatrist at McLean Hospital, Belmont, Massachusetts, and an instructor in psychiatry at Harvard Medical School, Boston, Massachusetts. Dr Nejad is an instructor in psychiatry at Harvard Medical School, Boston, Massachusetts, an attending physician on the Psychiatric Consultation Service at Massachusetts General Hospital, Boston, and the director of the Burns and Trauma Psychiatric Consultation Service at Massachusetts General Hospital, Boston. Mr Stern is a research assistant in the Department of Psychiatry at Massachusetts General Hospital, Boston. Dr Stern is chief of the Psychiatric Consultation Service at Massachusetts General Hospital, Boston, and a professor of psychiatry at Harvard Medical School, Boston, Massachusetts. Dr Stern is an employee of the Academy of Psychosomatic Medicine, has served on the speaker's board of Reed Elsevier, is a stock shareholder in WiFiMD (Tablet PC), and has received royalties from Mosby/Elsevier and McGraw Hill. Drs Unruh and Nejad and Mr Stern report no financial or other affiliations relevant to the subject of this article. PMID:22690353

Children of mothers diagnosed with serious mental illness: patterns and predictors of service use.

PubMed

Mowbray, Carol T; Lewandowski, Lisa; Bybee, Deborah; Oyserman, Daphna

2004-09-01

Children who have a parent diagnosed with a mental illness are at risk of psychiatric and behavioral problems; yet, these children do not necessarily receive needed services. Research has investigated correlates of child mental health service use, but not for these high-risk children. This study is part of an NIMH-funded, longitudinal investigation and describes child problems, service use, and predictors of service use for 506 children of 252 mothers diagnosed with serious mental illness. Mothers are primarily poor, minority women from urban areas. A multilevel-model approach is used to examine service use for multiple siblings in a family. More than one third of children had received services (from school or mental health agencies) in their lifetimes. Service use was predicted by child demographic characteristics (being male, non-African American, and older), social context variables (more negative life events, less financial satisfaction, and more parenting dissatisfaction), and maternal psychiatric variables (positively by high levels of case management receipt and affective diagnoses, negatively by maternal substance abuse history). In a subsample of "target children," mothers' rating of child behavior problems additionally predicted service use. Implications of results for research and intervention are discussed.

Disability income, cocaine use, and repeated hospitalization among schizophrenic cocaine abusers--a government-sponsored revolving door?

PubMed

Shaner, A; Eckman, T A; Roberts, L J; Wilkins, J N; Tucker, D E; Tsuang, J W; Mintz, J

1995-09-21

Many patients with serious mental illness are addicted to drugs and alcohol. This comorbidity creates additional problems for the patients and for the clinicians, health care systems, and social-service agencies that provide services to this population. One problem is that disability income, which many people with serious mental illness receive to pay for basic needs, may facilitate drug abuse. In this study, we assessed the temporal patterns of cocaine use, psychiatric symptoms, and psychiatric hospitalization in a sample of schizophrenic patients receiving disability income. We evaluated 105 male patients with schizophrenia and cocaine dependence at the time of their admission to the hospital. They had severe mental illness and a long-term dependence on cocaine, with repeated admissions to psychiatric hospitals; many were homeless. The severity of psychiatric symptoms and urinary concentrations of the cocaine metabolite benzoylecgonine were evaluated weekly for 15 weeks. Cocaine use, psychiatric symptoms, and hospital admissions all peaked during the first week of the month, shortly after the arrival of the disability payment, on the first day. The average patient spent nearly half his total income on illegal drugs. Among cocaine-abusing schizophrenic persons, the cyclic pattern of drug use strongly suggests that it is influenced by the monthly receipt of disability payments. The consequences of this cycle include the depletion of funds needed for housing and food, exacerbation of psychiatric symptoms, more frequent psychiatric hospitalization, and a high rate of homelessness. The troubling irony is that income intended to compensate for the disabling effects of severe mental illness may have the opposite effect.

[Schizotypical Disorder or Schizophrenia? Assessment of Penal Responsibility in a Patricide Case].

PubMed

Cutrim, Ruy Justo C; Forte Stuchi, Luísa; Martins Valença, Alexandre

2013-09-01

Patricide is the murder of one of the parents. We report a case of a man who had committed two homicides, at different times, one of them being considered a parricide. He was referred for forensic psychiatric evaluation and later evaluated in a psychiatric assistance service. Psychiatric interview was carried out and the final psychiatric diagnosis was established based on the DSM-IV-TR criteria and retrospective analysis of forensic and clinical records. The court appointed forensic experts concluded that the patient suffered from schizotypical disorder, presenting cognitive and volitive impairment. He was found not guilty by reason of insanity. Later, in a second assessment, being in a psychiatric assistance service, the patient received a diagnosis of paranoid schizophrenia. The determination of criminal responsibility is essential to the proper disposition of convicted persons in any system of criminal law that protects human rights. Copyright © 2013 Asociación Colombiana de Psiquiatría. Publicado por Elsevier España. All rights reserved.

Payment incentives for community-based psychiatric care in Ontario, Canada

PubMed Central

Rudoler, David; de Oliveira, Claire; Cheng, Joyce; Kurdyak, Paul

2017-01-01

BACKGROUND: In September 2011, the government of Ontario implemented payment incentives to encourage the delivery of community-based psychiatric care to patients after discharge from a psychiatric hospital admission and to those with a recent suicide attempt. We evaluated whether these incentives affected supply of psychiatric services and access to care. METHODS: We used administrative data to capture monthly observations for all psychiatrists who practised in Ontario between September 2009 and August 2014. We conducted interrupted time-series analyses of psychiatrist-level and patient-level data to evaluate whether the incentives affected the quantity of eligible outpatient services delivered and the likelihood of receiving follow-up care. RESULTS: Among 1921 psychiatrists evaluated, implementation of the incentive payments was not associated with increased provision of follow-up visits after discharge from a psychiatric hospital admission (mean change in visits per month per psychiatrist 0.0099, 95% confidence interval [CI] −0.0989 to 0.1206; change in trend 0.0032, 95% CI −0.0035 to 0.0095) or after a suicide attempt (mean change −0.0910, 95% CI −0.1885 to 0.0026; change in trend 0.0102, 95% CI 0.0045 to 0.0159). There was also no change in the probability that patients received follow-up care after discharge (change in level −0.0079, 95% CI −0.0223 to 0.0061; change in trend 0.0007, 95% CI −0.0003 to 0.0016) or after a suicide attempt (change in level 0.0074, 95% CI −0.0094 to 0.0366; change in trend 0.0006, 95% CI −0.0007 to 0.0022). INTERPRETATION: Our results suggest that implementation of the incentives did not increase access to follow-up care for patients after discharge from a psychiatric hospital admission or after a suicide attempt, and the incentives had no effect on supply of psychiatric services. Further research to guide design and implementation of more effective incentives is warranted. PMID:29229712

Follow-up study of female delinquent adolescents in a detention centre: effectiveness of psychiatric intervention as a mental health service.

PubMed

Ariga, Michio; Uehara, Toru; Takeuchi, Kazuo; Ishige, Yoko; Nakano, Reiko; Mikuni, Masahiko

2010-01-01

of previous studies suggest that many female offenders have co-morbid psychiatric disorders, which require mental health services. However, few longitudinal studies examined subjects during incarceration or detention. This study compares depressive symptoms, abnormal eating behaviour and impulsivity before release from a detention centre and after incarceration, thereby indicating the effectiveness of psychiatric intervention in a Japanese detention centre. Of 64 young women, 36 were followed up. Self-report measures were used to assess depression, eating behaviour and impulsivity after incarceration and one month before release. s: Of the 36 participants, nine were diagnosed using the MINI-kids as needing mental health services. Those who received psychiatric intervention were diagnosed as having major depression and/or post-traumatic stress disorder. Significant main effects of intervention and effects of time were shown in the DSD. The EAT-26 score demonstrated the significance of the effects of time and interaction. In the BIS-11 scores, neither intervention nor time showed significant effects. Results of this study showed that the time course and psychiatric intervention contributed to recovery of depression and therapeutic intervention. The time course might reduce eating problems. Psychiatric intervention might be necessary for female juvenile detainees, which presents an important issue for future studies.

Receipt of Prescription Opioids in a National Sample of Pregnant Veterans Receiving Veterans Health Administration Care.

PubMed

Kroll-Desrosiers, Aimee R; Skanderson, Melissa; Bastian, Lori A; Brandt, Cynthia A; Haskell, Sally; Kerns, Robert D; Mattocks, Kristin M

2016-01-01

A growing number of reproductive-age women veterans are returning from Operations Enduring Freedom, Iraqi Freedom, and New Dawn (OEF/OIF/OND). In 2010, 42% of women veterans receiving Veterans Health Administration (VHA) services were aged 18 to 45. Prescription opioid use has increased among all veterans over the past decade; however, exposure among pregnant veterans has not been examined. We identified 2,331 women who delivered babies within the VHA system between 2001 and 2010. Delivery, opioid prescribing history, and demographic and health-related variables were obtained from a national database of veterans receiving VHA services. Receipt of an opioid prescription was defined as any filled VHA prescription for opioids in the 280-day pregnancy window before delivery. We developed a multivariable logistic regression model adjusted for sociodemographic, service-related, psychiatric diagnosis, and physical health variables to examine the odds of filling an opioid prescription during the pregnancy window. Ten percent of pregnant veterans received VHA prescription opioids during their pregnancy window. Significant factors associated with opioid prescriptions included presence of any psychiatric diagnosis (adjusted odds ratio [aOR], 1.67; 95% CI, 1.24-2.26), diagnosis of back problems (aOR, 2.94; 95% CI, 1.92-4.49), or other nontraumatic joint disorders (aOR, 2.20; 95% CI, 1.36-3.58). This study suggests that a substantial proportion of women veterans received VHA prescriptions for opioids during pregnancy. Providers should be aware of the potential risks of prescription opioid use during pregnancy, assess for potential undertreatment of psychiatric diagnoses, and consider alternate pain management strategies when possible. Published by Elsevier Inc.

Missed opportunities: mental disorder in children of parents with depression

PubMed Central

Potter, Robert; Mars, Becky; Eyre, Olga; Legge, Sophie; Ford, Tamsin; Sellers, Ruth; Craddock, Nicholas; Rice, Frances; Collishaw, Stephan; Thapar, Anita; Thapar, Ajay K

2012-01-01

Background Emerging evidence suggests that early intervention and prevention programmes for mental health problems in the offspring of parents with depression are important. Such programmes are difficult to implement if children with psychiatric disorder are not identified and are not accessing services, even if their parents are known to primary care. Aim To investigate service use in children of parents who have recurrent depression, and factors that influence such contact. Design and setting A total of 333 families were recruited, mainly through primary health care, in which at least one parent had received treatment for recurrent depression and had a child aged 9–17 years. Method Psychiatric assessments of parents and children were completed using research diagnostic interviews. The service-use interview recorded current (in the 3 months prior to interview) and lifetime contact with health, educational, and social services due to concerns about the child’s emotions or behaviour. Results Only 37% of children who met criteria for psychiatric disorder were in contact with any service at the time of interview. A third, who were suicidal or self-harming and had a psychiatric disorder at that time, were not in contact with any service. Lack of parental worry predicted lower service use, with higher rates in children with comorbidity and suicidality. Conclusion Most children with a psychiatric disorder in this high-risk sample were not in contact with services. Improving ease of access to services, increasing parental and professional awareness that mental health problems can cluster in families, and improving links between adult and child services may help early detection and intervention strategies for the offspring of parents with depression. PMID:22781997

Frequency and Correlates of Service Access among Youth with Autism Transitioning to Adulthood

PubMed Central

Taylor, Julie Lounds; Henninger, Natalie A.

2014-01-01

This study examined service receipt and unmet service needs among youth with autism spectrum disorders (ASD) in their last year of high school, as well as the youth (intellectual disability, race/ethnicity, autism severity, comorbid psychiatric diagnoses, behavior problems, adaptive behavior) and family (income, parental health, parental depressive symptoms, parental anxiety) correlates of service access. Thirty-nine families of youth with ASD participated. Data were collected via parental interview/questionnaire and youth psychological evaluation. Results suggested that this sample was underserved relative to a nationally-representative cohort. Those with a comorbid psychiatric diagnosis and lower levels of adaptive behavior received more services. Greater unmet needs were reported for youth who were racial/ethnic minorities, who had more behavior problems, and whose parents had greater anxiety. PMID:25081594

Services provided by volunteer psychiatrists after 9/11 at the New York City family assistance center: September 12-November 20, 2001.

PubMed

Pandya, Anand; Katz, Craig L; Smith, Rebecca; Ng, Anthony T; Tafoya, Michael; Holmes, Anastasia; North, Carol S

2010-05-01

To characterize the experience of volunteer disaster psychiatrists who provided pro bono psychiatric services to 9/11 survivors in New York City, from September 12, 2001 to November 20, 2001. Disaster Psychiatry Outreach (DPO) is a non-profit organization founded in 1998 to provide volunteer psychiatric care to people affected by disasters and to promote education and research in support of this mission. Data for this study were collected from one-page clinical encounter forms completed by 268 DPO psychiatrists for 2 months after 9/11 concerning 848 patients served by the DPO 9/11 response program at the New York City Family Assistance Center. In this endeavor, 268 psychiatrist volunteers evaluated 848 individuals and provided appropriate interventions. The most commonly recorded clinical impressions indicated stress-related and adjustment disorders, but other conditions such as bereavement, major depression, and substance abuse/dependence were also observed. Free samples were available for one sedative and one anxiolytic agent; not surprisingly, these were the most commonly prescribed medications. Nearly half of those evaluated received psychotropic medications. In the acute aftermath of the attacks of September 11, 2001, volunteer psychiatrists were able to provide services in a disaster response setting, in which they were co-located with other disaster responders. These services included psychiatric assessment, provision of medication, psychological first aid, and referrals for ongoing care. Although systematic diagnoses could not be confirmed, the fact that most patients were perceived to have a psychiatric diagnosis and a substantial proportion received psychotropic medication suggests potential specific roles for psychiatrists that are unique and different from roles of other mental health professionals in the early post-disaster setting. In addition to further characterizing post-disaster mental health needs and patterns of service provision, future research should focus on the short- and long-term effects of psychiatric interventions, such as providing acute psychotropic medication services and assessing the effectiveness of traditional acute post-disaster interventions including crisis counseling and psychological first aid.

Extended mental health service utilization among survivors of the Oklahoma City bombing.

PubMed

Tucker, Phebe; Pfefferbaum, Betty; Jeon-Slaughter, Haekyung; Garton, Theresa S; North, Carol S

2014-04-01

The study assessed survivors of Oklahoma City's 1995 bombing seven years postdisaster to identify long-term mental health service use. Psychiatric disorders and disaster-related variables were assessed for 99 survivors at seven years postdisaster with the Diagnostic Interview Schedule for DSM-IV and its Disaster Supplement. Of the 99 survivors, 86% received services during the seven years. Use was associated with female sex, injury or hospitalization, and posttraumatic stress disorder (PTSD) or major depression. Informal interventions were usually initiated in the first six months. Treatment by psychiatrists, other professionals, and family doctors increased after the first month. Half the survivors with PTSD or depression received treatment from a psychiatrist. Only 15% of survivors took psychotropic medications. Although 33% received treatment for more than one year, only 7% were receiving services at seven years. Although service needs decreased over time, results support provision of diverse services adapted to changing needs.

A follow-up study of adolescent attempted suicide in Israel.

PubMed

Farbstein, Ilana; Dycian, Anat; Gothelf, Doron; King, Robert A; Cohen, Donald J; Kron, Shmuel; Apter, Alan

2002-11-01

(1) To compare the outcome of adolescent subjects who have made a suicide attempt with the outcome of matched controls, using their psychological and psychometric screening tests for military service at age 16.5 years. Their subsequent performance during military service between ages 18 and 21 was also evaluated. (2) To compare the prognosis of those attempters who received intensive psychiatric inpatient evaluation in a general hospital with the prognosis of those who received emergency room treatment only. The computerized military records of 216 adolescents, who had been treated between 1987 and 1988 for attempted suicide in a general hospital emergency room, prior to their induction into the army, were evaluated. They were rated on the following tests: cognitive/educational performance and psychosocial adaptation, psychiatric and psychological health diagnoses, and performance during their military service between 1989 and 1992. Although the female attempters had slightly more problems in the military than the controls, their overall prognosis was surprisingly good. The male suicide attempters did very poorly in their subsequent military service. There was no long-term advantage in having had a psychiatric evaluation performed in a hospital over a brief emergency room evaluation. Most differences between attempters and controls were in service performance, rather than in cognitive and psychometric tests. There may be marked differences between the sexes in the significance of attempted suicide and in the indications for intervention. The policy of mandatory general hospitalization for suicide attempters may need reevaluation.

A record-based analysis of 803 patients treated for depression in psychiatric care.

PubMed

Rytsälä, H J; Melartin, T K; Leskelä, U S; Lestelä-Mielonen, P S; Sokero, T P; Isometsä, E T

2001-09-01

New antidepressants emerged and became widely used during the 1990s. The present study investigated quality-of-care problems in the treatment of depression in a current psychiatric setting. We investigated the treatment received for depression by all 803 inpatients or outpatients with a clinical diagnosis of ICD-10 depressive episode or recurrent depressive disorder in 1996 in the Peijas Medical Care District, which provides psychiatric services for citizens of Vantaa, a city in southern Finland. Most patients (84%) in the sample were found to have received antidepressants, generally in adequate, albeit low, doses. Inadequate antidepressant treatment was common only with tricyclic antidepressants. Most patients received a single antidepressant for extended periods; only 22% had 2 or more antidepressant trials. During the treatment period, disability pension was granted to 19% of those not already pensioned, two thirds (67%) of whom had received only 1 antidepressant trial prior to being granted a pension. The present study supports the emerging perception of improved quality of pharmacotherapy in psychiatric settings, with the exception of treatment with tricyclic antidepressants. Problems of quality of care now appear to be related to the suboptimal intensity and monitoring of the treatment provided. which may eventually result in considerable costs to society due to permanent disability.

Temporal and Spatial Patterns in Utilization of Mental Health Services During and After Hurricane Sandy: Emergency Department and Inpatient Hospitalizations in New York City.

PubMed

He, Fangtao Tony; Lundy De La Cruz, Nneka; Olson, Donald; Lim, Sungwoo; Levanon Seligson, Amber; Hall, Gerod; Jessup, Jillian; Gwynn, Charon

2016-06-01

Hurricane Sandy made landfall on October 29, 2012, causing a coastal storm surge and extensive flooding, which led to the closure of several health care facilities in New York City (NYC) and prolonged interruptions in service delivery. The impact on mental health-related emergency department (ED) and inpatient hospital service utilization was studied. Data came from the New York Statewide Planning and Research Cooperative System. We obtained mental health-related data among NYC residents from 2010 to 2013. Patients were grouped into 5 geographic areas, including service areas of closed hospitals, the Hurricane Sandy evaluation zone, and all of NYC. The Farrington method was used to detect increases in ED visits and hospitalizations for the post-Sandy period. Open hospitals experienced a substantial increase in psychiatric ED visits from patients living in the service areas of closed hospitals. This surge in psychiatric ED visits persisted for 4 to 6 months after Hurricane Sandy. However, the increase in psychiatric hospitalizations was observed for 1 to 3 months. Several NYC hospitals received a substantially larger number of ED patients from service areas of closed hospitals after Hurricane Sandy, unlike other hospitals that experienced a decrease. Because of potential surges in the number of psychiatric ED visits, resource allocation to hospitals should be considered. (Disaster Med Public Health Preparedness. 2016;10:512-517).

Some Evidence of Race Bias in the Diagnosis and Treatment of the Juvenile Offender.

ERIC Educational Resources Information Center

Lewis, Dorothy Otnow; And Others

1979-01-01

Clinical and epidemiological evidence is presented indicating that many more Black delinquent children and their families fail to receive needed psychiatric and medical services than do White delinquents. (Author)

Gender-specific mental health care needs of women veterans treated for psychiatric disorders in a Veterans Administration Women's Health Clinic.

PubMed

Miller, Laura J; Ghadiali, Nafisa Y

2015-04-01

This pilot study aims to ascertain the prevalence of self-reported premenstrual, perinatal, and perimenopausal influences on mental health, and of gynecologic conditions that could interact with psychiatric conditions, among women veterans receiving psychiatric care within a Veterans Administration (VA) Women's Health Clinic (WHC). Participants included all women veterans (N=68) who received psychiatric evaluations within a VA WHC over a 5-month period. This setting encompasses colocated and coordinated primary care, gynecologic and mental health services. Evaluations included a Women's Mental Health Questionnaire, a psychiatric interview, and medical record review. Deidentified data were extracted from a clinical data repository for this descriptive study. High proportions of study participants reported that their emotional problems intensified premenstrually (42.6%), during pregnancy (33.3%), in the postpartum period (33.3%), or during perimenopause (18.2%). Unintended pregnancy (70.0% of pregnancies) and pregnancy loss (63.5% of women who had been pregnant) were prominent sex-linked stressors. Dyspareunia (22.1% of participants) and pelvic pain (17.6% of participants) were frequent comorbidities. Among women veterans receiving psychiatric care within a VA WHC, there are high rates of self-reported premenstrual, perinatal, and perimenopausal influences on mental health. This population also has substantial comorbidity of psychiatric disorders with dyspareunia and pelvic pain. This underscores the importance of recognizing and addressing women veterans' sex-specific care needs, including interactions among reproductive cycle phases, gynecologic pain, and psychiatric symptoms. The findings support the need for greater awareness of the sex-specific mental health needs of women veterans, and for more definitive studies to further characterize these needs.

Preliminary Outcomes from an Integrated Pediatric Mental Health Outpatient Clinic.

PubMed

Maslow, Gary R; Banny, Adrienne; Pollock, McLean; Stefureac, Kristen; Rosa, Kendra; Walter, Barbara Keith; Hobbs Knutson, Katherine; Lucas, Joseph; Heilbron, Nicole

2017-10-01

An estimated 1 in 5 children in the United States meet criteria for a diagnosable mental disorder, yet fewer than 20% receive mental health services. Unmet need for psychiatric treatment may contribute to patterns of increasing use of the emergency department. This article describes an integrated pediatric evaluation center designed to prevent the need for treatment in emergency settings by increasing access to timely and appropriate care for emergent and critical mental health needs. Preliminary results showed that the center provided rapid access to assessment and treatment services for children and adolescents presenting with a wide range of psychiatric concerns. Copyright © 2017 Elsevier Inc. All rights reserved.

Contact with child and adolescent psychiatric services among self-harming and suicidal adolescents in the general population: a cross sectional study.

PubMed

Tørmoen, Anita J; Rossow, Ingeborg; Mork, Erlend; Mehlum, Lars

2014-01-01

Studies have shown that adolescents with a history of both suicide attempts and non-suicidal self-harm report more mental health problems and other psychosocial problems than adolescents who report only one or none of these types of self-harm. The current study aimed to examine the use of child and adolescent psychiatric services by adolescents with both suicide attempts and non-suicidal self-harm, compared to other adolescents, and to assess the psychosocial variables that characterize adolescents with both suicide attempts and non-suicidal self-harm who report contact. Data on lifetime self-harm, contact with child and adolescent psychiatric services, and various psychosocial risk factors were collected in a cross-sectional sample (response rate = 92.7%) of 11,440 adolescents aged 14-17 years who participated in a school survey in Oslo, Norway. Adolescents who reported any self-harm were more likely than other adolescents to have used child and adolescent psychiatric services, with a particularly elevated likelihood among those with both suicide attempts and non-suicidal self-harm (OR = 9.3). This finding remained significant even when controlling for psychosocial variables. In adolescents with both suicide attempts and non-suicidal self-harm, symptoms of depression, eating problems, and the use of illicit drugs were associated with a higher likelihood of contact with child and adolescent psychiatric services, whereas a non-Western immigrant background was associated with a lower likelihood. In this study, adolescents who reported self-harm were significantly more likely than other adolescents to have used child and adolescent psychiatric services, and adolescents who reported a history of both suicide attempts and non-suicidal self-harm were more likely to have used such services, even after controlling for other psychosocial risk factors. In this high-risk subsample, various psychosocial problems increased the probability of contact with child and adolescent psychiatric services, naturally reflecting the core tasks of the services, confirming that they represents an important area for interventions that aim to reduce self-harming behaviour. Such interventions should include systematic screening for early recognition of self-harming behaviours, and treatment programmes tailored to the needs of teenagers with a positive screen. Possible barriers to receive mental health services for adolescents with immigrant backgrounds should be further explored.

Contact with child and adolescent psychiatric services among self-harming and suicidal adolescents in the general population: a cross sectional study

PubMed Central

2014-01-01

Background Studies have shown that adolescents with a history of both suicide attempts and non-suicidal self-harm report more mental health problems and other psychosocial problems than adolescents who report only one or none of these types of self-harm. The current study aimed to examine the use of child and adolescent psychiatric services by adolescents with both suicide attempts and non-suicidal self-harm, compared to other adolescents, and to assess the psychosocial variables that characterize adolescents with both suicide attempts and non-suicidal self-harm who report contact. Methods Data on lifetime self-harm, contact with child and adolescent psychiatric services, and various psychosocial risk factors were collected in a cross-sectional sample (response rate = 92.7%) of 11,440 adolescents aged 14–17 years who participated in a school survey in Oslo, Norway. Results Adolescents who reported any self-harm were more likely than other adolescents to have used child and adolescent psychiatric services, with a particularly elevated likelihood among those with both suicide attempts and non-suicidal self-harm (OR = 9.3). This finding remained significant even when controlling for psychosocial variables. In adolescents with both suicide attempts and non–suicidal self-harm, symptoms of depression, eating problems, and the use of illicit drugs were associated with a higher likelihood of contact with child and adolescent psychiatric services, whereas a non-Western immigrant background was associated with a lower likelihood. Conclusions In this study, adolescents who reported self-harm were significantly more likely than other adolescents to have used child and adolescent psychiatric services, and adolescents who reported a history of both suicide attempts and non-suicidal self-harm were more likely to have used such services, even after controlling for other psychosocial risk factors. In this high-risk subsample, various psychosocial problems increased the probability of contact with child and adolescent psychiatric services, naturally reflecting the core tasks of the services, confirming that they represents an important area for interventions that aim to reduce self-harming behaviour. Such interventions should include systematic screening for early recognition of self-harming behaviours, and treatment programmes tailored to the needs of teenagers with a positive screen. Possible barriers to receive mental health services for adolescents with immigrant backgrounds should be further explored. PMID:24742154

[An emergency team working closely with the patient].

PubMed

Selma, Toufik; Chermak, Mustapha; Limani, Mohammed; Rochard, Jacques; Wendlandt, Jérôme; Hernandez, Angélique

2015-01-01

ERIC 77 is a rapid response team for emergency psychiatric situations. This cross-sector service based at Marne-la-Vallée general hospital represents a supplementary network in psychiatric patient care. The analysis of the professionals receiving calls as well as the link with the sector are critical in determining the success of patient care. Each risk is measured in order to provide adapted and personalised care. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

Barriers and Challenges in Seeking Psychiatric Intervention in a General Hospital, by the Collaborative Child Response Unit, (A Multidisciplinary Team Approach to Handling Child Abuse) A Qualitative Analysis

PubMed Central

Subramaniyan, Vyjayanthi Kanugodu Srinivasa; Mital, Anukant; Rao, Chandrika; Chandra, Girish

2017-01-01

Child abuse is a serious criminal act against children in our country and punishable according to protection of children from sexual offenses act 2012. No one agency has the ability to respond completely to the abuse. Hence a multidisciplinary team approach was developed in India. Aim is to narrate the collaborative effort among the multiple disciplines in a general hospital to deliver child protection services and explore the barriers to integrate psychiatric services. Methodology: Members of the team were recruited from different disciplines and trained by experts. A mission statement, protocol to assess the victims and provide treatment was formulated as an algorithm. The barriers to psychiatric treatment among the stakeholders were analyzed using framework method of qualitative analysis. Results (After 20 months) the unit received 27 referrals in 20 months, 24 females, and 3 males. Age of the victims was between 8 months and 17 years. Two cases found to be physically abused. Penetrative sexual abuse was found in 23 cases, pregnant victims were 4. Most referrals were by police, trafficking found in 6 cases. Discussion: It was possible to provide multidisciplinary care to the victims and families. Recurrent themes of barriers to psychiatric treatment were stigma, victim blaming; focus on termination of pregnancy, minimization of abuse in males by stakeholders. Conclusion is collaboration needs more effort to integrate psychiatric services but can minimize the reduplication of services. PMID:28250553

Influence of psychiatric morbidity and sociodemographic determinants on use of service in a catchment area in the city of São Paulo, Brazil.

PubMed

Andrade, Laura Helena; Viana, Maria Carmen; Tófoli, Luis Fernando Farah; Wang, Yuan-Pang

2008-01-01

Recent population-based studies in Latin American and the Caribbean (LAC) countries brought evidence of the growing burden of mental illness in this region. The objective of this study is to examine determinants of health service utilization by individuals with psychiatric disorders in a defined area in the city of São Paulo, Brazil. Data were derived from São Paulo Catchment Area Study (SP-ECA), a cross-sectional household prevalence survey, based on a representative adult sample (N=1,464) living in two defined boroughs. The psychiatric diagnosis was assessed through the CIDI 1.1 interview, yielding ICD-10 diagnoses. The past-month use of health services--for general medical (GM) care and mental health (MH) care sectors--was investigated in their relationship with sociodemographic features, insurance coverage, GM conditions, and psychiatric morbidity. Nearly one-third (32.2%) of the total sample used health services in the last month: 29.0% attended GM care and 7.8% used MH care. Logistic regression models showed that being female, older than 60 years, having private insurance coverage, and presence of psychiatric morbidity increased the level GM care seeking in the total sample. For those with 12-month psychiatric disorders, the determinants for GM sector use were female gender, age 45-59 years old, and private insurance coverage, whereas separated, divorced, or widowed women had the highest odds (OR 9.9; 95% CI: 2.7-36.5) for using MH service. Low-income people were less likely to seek MH services. The major contribution of this article is to underscore the impact of MH on health care systems, in a LAC country where service use information is scarce. The main finding is that inequalities in the access to MH care occurred, with low-income people having less likelihood of receiving treatment for their mental disorder. Access to health service in this catchment area reflected the great degree of deregulation and lack of integration. Additional efforts should address the barriers to the utilization of MH services in Brazil, including social inequities in the access to care.

Recent and lifetime utilization of health care services by children and adolescent suicide victims: a case-control study.

PubMed

Renaud, Johanne; Berlim, Marcelo T; Séguin, Monique; McGirr, Alexander; Tousignant, Michel; Turecki, Gustavo

2009-10-01

In the present paper we describe a case-control study on the utilization of health care services prior to suicide (across different time periods) among children and adolescents aged 11 to 18 years in the Province of Quebec, Canada and matched healthy controls. Utilization of services (i.e., contact with general practitioners, mental health professionals, psychiatrists and/or youth protection groups) was examined at different time periods in 55 child and adolescent suicide victims and 54 matched community controls using proxy-based interviews and questionnaires. In addition, we examined the rates of detection of psychopathology by health care professionals, the use of psychotropic medications and the subjects' compliance with treatment. Although more than 90% of child and adolescent suicide completers in our sample suffered from mental disorders, a significant proportion of them were left without appropriate healthcare support (including psychiatric consultation) in the period preceding their suicide. Also, 20% of suicide completers and no control subject made prior suicide attempts. More specifically, over two-thirds of suicide completers had no treatment contact within the month prior to the completion, while only 12.7% (n=7) of them were in contact with psychiatric services during that same period. Moreover, 56.4% (n=31) of the suicide completers had not been diagnosed as having a mental disorder at the time of their death, and 54.5% of the subjects' that received treatment (12 out of 22) were considered poorly compliant or not compliant at all according to their medical/psychosocial records. Finally, we also found that females seemed to have more psychiatric and mental health service contacts in the past month, that subjects with depressive and anxious disorders received more psychiatric and general mental health services in the past year, and that past month hospitalization was more often associated with alcohol abuse and psychosis. Relatively small sample size, and cross-sectional design. Our findings indicate the need for an overall increase in the rates of healthcare services delivered to young subjects at risk for suicide, as well as better training of health professionals in detecting and treating youth psychopathology.

Co-Occurring Disorders: A Challenge for Mexican Community-Based Residential Care Facilities for Substance Use.

PubMed

Marín-Navarrete, Rodrigo; Medina-Mora, María Elena; Horigian, Viviana E; Salloum, Ihsan M; Villalobos-Gallegos, Luis; Fernández-Mondragón, José

2016-01-01

In Mexico, specialized treatment services for people with co-occurring disorders are limited within public health services, while private options are deemed too costly. More than 2,000 community-based residential care facilities have risen as an alternative and are the main source of treatment for individuals with substance use disorders; however, suboptimal practices within such facilities are common. Information on the clinical characteristics of patients receiving care in these facilities is scarce and capacity to provide high-quality care for co-occurring disorders is unknown. The aims of this study were to examine the prevalence of co-occurring disorders in patients receiving treatment for substance use in these community-based residential centers and to assess whether the presence of co-occurring disorders is associated with higher severity of substance use, psychiatric symptomatology, and other health risks. This study was conducted with 601 patients receiving treatment for substance use disorders at 30 facilities located in five Mexican states, recruited in 2013 and 2014. Patients were assessed with self-report measures on substance use, service utilization, suicidality, HIV risk behaviors, psychiatric symptomatology, and psychiatric disorder diagnostic criteria. The prevalence of any co-occurring disorder in this sample was 62.6%. Antisocial personality disorder was the most prevalent (43.8%), followed by major depressive disorder (30.9%). The presence of a co-occurring disorder was associated with higher severity of psychiatric symptoms (aB = .496, SE = .050, p < .05); more days of substance use (aB = .219, SE = .019, p < .05); current suicidal ideation (aOR = 5.07, 95% CI [2.58, 11.17]; p < .05), plans (aOR = 5.17 95% CI [2.44, 12.73]; p < .05), and attempts (aOR = 6.43 95% CI [1.83, 40.78]; p < .05); more sexual risk behaviors; and more contact with professional services (aOR = 1.77, 95% CI [1.26, 2.49], p < .05). Co-occurring disorders are highly prevalent in community-based residential centers in Mexico and are associated with significantly increased probability of other health risks. This highlights the need to develop care standards for this population and the importance of clinical research in these settings.

Migrants referring to the Bologna Transcultural Psychiatric Team: reasons for drop-out.

PubMed

Tarricone, Ilaria; Atti, Anna Rita; Braca, Mauro; Pompei, Graziano; Morri, Michela; Poggi, Francesca; Melega, Saverio; Stivanello, Elisa; Tonti, Lorenza; Nolet, Maria; Berardi, Domenico

2011-11-01

Recent immigrants face various difficulties in adjusting to western countries and show a high prevalence of mental disorders. Access to a culturally appropriate community mental health centre (CMHC) is crucial for immigrants (Bhui et al., 2007). The Bologna West Transcultural Psychiatric Team (BoTPT, Tarricone et al., 2009) is one of the first projects in Italy that prioritizes cultural competence care. This paper aims to evaluate the effectiveness of this service and to describe what characteristics of patient and psychiatric intervention are related to 'drop-out'. All migrants who consecutively attended the BoTPT between 1 July 1999 and 30 June 2008 were included and evaluated at first contact and again six months later. After six months we followed up 162 patients; 32 (17.9%) of these had interrupted treatment. Non-Asian origin, a recent history of migration and not receiving social intervention were the strongest predictors of drop-out cases. Psychiatric consultation services to migrants could be made more effective by enhancing: (a) cultural competence, through cultural mediator involvement; and (b) social support from the first psychiatric contact. These two characteristics of psychiatric consultation could be developed from resources ordinarily present in the context of a CMHC and could then become a cost-effective strategy for addressing mental health needs among first-generation immigrants.

Job satisfaction in psychiatric nursing.

PubMed

Ward, M; Cowman, S

2007-08-01

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

Psychiatric disorders in patients who lost family members to cancer and asked for medical help: descriptive analysis of outpatient services for bereaved families at Japanese cancer center hospital.

PubMed

Ishida, Mayumi; Onishi, Hideki; Wada, Mei; Tada, Yukio; Ito, Hiroshi; Narabayashi, Masaru; Sasaki, Yasutsuna; Nomura, Shinobu; Uchitomi, Yosuke

2011-03-01

There have been no previous studies about consultation of the bereaved who have lost a loved one to cancer and ask for medical help. The aim of this study was to investigate their basic characteristics and their psychiatric disorders. A retrospective study using clinical and background data obtained over 30 months (from April 2007 to September 2009) was conducted at outpatient services for bereaved families at the Department of Psycho-Oncology at Saitama Medical University International Medical Center, Japan. During the period of investigation, 51 patients underwent consultation. The patients were frequently female (P < 0.0001) and the spouse of the deceased. Regarding the psychiatric diagnoses, major depression was the most common (39%), followed by adjustment disorders (28%). This study revealed basic characteristics and psychiatric disorders of the bereaved who asked for medical help. Most of the patients were women (86.3%) and 86.3% of them received a psychiatric diagnosis. This information is important for both physicians and psychologists since the bereaved who have lost a loved one to cancer often ask for medical help in clinical settings.

Risk for Suicide among Medicaid Beneficiaries

ERIC Educational Resources Information Center

Becker, Marion; Brown, Lisa; Ochshorn, Ezra; Diamond, Ronald

2009-01-01

Demographic, diagnostic, and service expenditure characteristics of Florida Medicaid enrollees who died by suicide were investigated. Among persons receiving Medicaid and Supplemental Security Income (SSI), findings indicate the most powerful predictors of suicide were involuntary psychiatric examination, mental health hospitalization, and high…

Caregiver-Teacher Concordance of Challenging Behaviors in Children with Autism Spectrum Disorder Served in Community Mental Health Settings

PubMed Central

Chlebowski, Colby; Brookman-Frazee, Lauren

2018-01-01

Children with autism spectrum disorder (ASD) exhibit high rates of challenging behaviors that impair functioning and represent the primary presenting problem in mental health (MH) services. Obtaining symptom reports from multiple informants is critical for treatment planning. This study evaluated caregiver-teacher concordance of ratings of the intensity of challenging behaviors in children with ASD receiving MH services, and identified child clinical factors associated with concordance. This sample included 141 children (M = 9.07 years), their caregivers, and teachers. Caregiver-teacher concordance of challenging behaviors was low and impacted by the degree and type of child psychiatric comorbidity. Findings support need for increased attention to the range of psychiatric problems children with ASD present to tailor treatment recommendations and service delivery. PMID:28343342

Patterns of mental health service utilization.

PubMed

Howard, K I; Cornille, T A; Lyons, J S; Vessey, J T; Lueger, R J; Saunders, S M

1996-08-01

How many and which individuals, with which psychiatric disorders, receive (and do not receive) mental health services from which professionals in what settings? This question falls within the purview of mental health services research, which is a multidisciplinary field that brings together the methodologies of epidemiology, econometrics, and clinical research. First, in this article, we present an explication of what is known about those individuals in need of psychotherapy and how they access services. Next, we describe the numbers, professional affiliations, and service sites of professionals who are engaged in the practice of psychotherapy. We summarize our current knowledge about the actual utilization of psychotherapy services relative to the needs of patients and the professional background of therapists. Finally, we identify aspects of psychotherapy service utilization that are, as yet, unaddressed.

Two-year outcome of team-based intensive case management for patients with schizophrenia.

PubMed

Aberg-Wistedt, A; Cressell, T; Lidberg, Y; Liljenberg, B; Osby, U

1995-12-01

Two-year outcomes of patients with schizophrenic disorders who were assigned to an intensive, team-based case management program and patients who received standard psychiatric services were assessed. The case management model featured increased staff contact time with patients, rehabilitation plans based on patients' expressed needs, and patients' attendance at team meetings where their rehabilitation plan was discussed. Forty patients were randomly assigned to either the case management group or the control group that received standard services. Patients' use of emergency and inpatient services, their quality of life, the size of their social networks, and their relatives' burden of care were assessed at assignment to the study groups and at two-year follow-up. Patients in the case management group had significantly fewer emergency visits compared with the two years before the study, and their relatives reported significantly reduced burden of care associated with relationships with psychiatric services over the two-year period. The size of patients' social networks increased for the case management group and decreased for the control group. A team-based intensive case management model is an effective intervention in the rehabilitation of patients with chronic schizophrenia.

Psychiatric stigma in the military.

PubMed

Porter, T L; Johnson, W B

1994-09-01

There is potential for the stigma of mental health care to directly affect an active duty member's career. The authors are aware of cases in which fear of adverse career consequences has led service members to avoid needed mental health care. In order to investigate the legitimacy of this fear, the authors surveyed 252 USN and USMC commanding and executive officers concerning their attitudes about service members who had received mental health and other services; 138 responded. Overall the responses were neutral and there were relatively few negative evaluations of service members who had received services. Military health care providers should take an active role in diminishing the stigma of mental illness, and in allaying fears of adverse career consequences for seeking care.

The mental health care gap among children and adolescents: data from an epidemiological survey from four Brazilian regions.

PubMed

Paula, Cristiane S; Bordin, Isabel A S; Mari, Jair Jesus; Velasque, Luciane; Rohde, Luis A; Coutinho, Evandro S F

2014-01-01

Worldwide, a minority of disordered children/adolescents receives mental health assistance. In order to improve service access, it is important to investigate factors that influence the process leading to receiving care. Data on frequency and barriers for mental health service use (MHSU) among Brazilian children/adolescents are extremely scarce and are needed to guide public policy. To establish the frequency of MHSU among 6-to-16-year-old with psychiatric disorders from four Brazilian regions; and to identify structural/psychosocial/demographic barriers associated with child/adolescent MHSU. Multicenter cross-sectional-study involving four towns from four out of five Brazilian regions. In each town, a representative sample of elementary public school students was randomly selected (sample: 1,721). Child/adolescent MHSU was defined as being seen by a psychologist/psychiatrist/neurologist in the previous 12 months. Standardized instruments measured: (1) children/adolescent characteristics [(1.1) Schedule for Affective Disorders and Schizophrenia for School-Age Children (K-SADS-PL)-psychiatric disorders; (1.2) Ten Questions Screen-neurodevelopment problems; (1.3) two subtests of WISC-III-estimated IQ; (1.4) Academic Performance Test-school performance)], (2) factors related to mothers/main caregivers (Self-Reporting Questionnaire-anxiety/depression), (3) family (Brazilian Research-Companies-Association's Questionnaire-SES). Only 19.8% of children/adolescents with psychiatric disorder have used mental health services in the previous 12 months. Multiple logistic regression modeling identified five factors associated with lower rates of MHSU (female gender, adequate school performance, mother/main caregiver living with a partner, lower SES, residing in deprived Brazilian regions) regardless of the presence of any psychiatric disorders/neurodevelopmental problems. Only a small proportion of children/adolescents with psychiatric disorders had been seen by a mental health specialist in the previous 12 months. Structural/psychosocial/demographic factors were associated with uneven access to service for certain groups of children/adolescents. These results call attention to the urgent need to implement programs to help reduce this large unmet mental health need; inequalities must be considered by policy makers when planning strategies to address barriers for care.

Parents' mental health and psychiatric expertise in child welfare family rehabilitation.

PubMed

Riihimäki, Kirsi

2015-02-01

Parents' mental health disorders are not well known within child welfare services. First, to assess the mental health disorders and treatment needs of parents participating in the child welfare-centred family rehabilitation; Second, to evaluate the work of psychiatric nurses and the effectiveness of consultations by psychiatrists in such cases. During 2010, a total of 141 parents participated in child welfare-centred family rehabilitation. The primary psychiatric disorders of parents not currently receiving psychiatric care were assessed, as was the appropriate treatment for them. The majority of parents in child welfare-centred family rehabilitation suffered from severe mental health disorders, often unrecognized and untreated. As much as 93% of parents were referred to mental health or substance abuse treatment, almost half of them to secondary care. The work of psychiatric nurses and consultations by psychiatrists were found to be useful. Most parents suffered from severe unrecognized and untreated mental health disorders. There is a high demand for adult-psychiatric expertise in child welfare.

Post-inpatient attrition from care "as usual" in veterans with multiple psychiatric admissions.

PubMed

Bowersox, Nicholas W; Saunders, Stephen M; Berger, Bertrand

2013-12-01

Disengagement from outpatient care following psychiatric hospitalization is common in high-utilizing psychiatric patients and contributes to intensive care utilization. To investigate variables related to treatment attrition, a range of demographic, diagnostic, cognitive, social, and behavioral variables were collected from 233 veterans receiving inpatient psychiatric services who were then monitored over the following 2 years. During the follow-up period, 88.0 % (n = 202) of patients disengaged from post-inpatient care. Attrition was associated with male gender, younger age, increased expectations of stigma, less short-term participation in group therapy, and poorer medication adherence. Of those who left care, earlier attrition was predicted by fewer prior-year inpatient psychiatric days, fewer lifetime psychiatric hospitalizations, increased perceived treatment support from family, and less short-term attendance at psychiatrist appointments. Survival analyses were used to analyze the rate of attrition of the entire sample as well as the sample split by short-term group therapy attendance. Implications are discussed.

Electroconvulsive therapy practice in Ukraine.

PubMed

Olekseev, Aleksey; Ungvari, Gabor S; Gazdag, Gábor

2014-09-01

Patterns of electroconvulsive therapy (ECT) use have recently been extensively surveyed in Central-Eastern Europe. However, data from post-USSR countries are limited. This study aimed to survey ECT practice in Ukraine. All psychiatric services in Ukraine were identified and contacted to obtain information on the use of ECT in 2011 using a 22-item questionnaire. Of the 146 psychiatric inpatient facilities, only 5 confirmed that they performed ECT in 2011. Three other services also performed ECT but refused to provide further information. In the only private psychiatric institute where ECT was offered, 14.28% of inpatients received this treatment in 2011, whereas the corresponding figure in the 6 public psychiatric facilities was a mere 0.4%. Three centers used unmodified ECT, and only 2 centers had equipment that monitored electroencephalogram. In 7 services, in line with international recommendations, affective disorders were the first indications for ECT in Ukraine, whereas uncommon indications such as anorexia or Parkinsonism were also reported. This was the first survey of ECT practice conducted in Ukraine. The provision of ECT in only 8 centers is clearly insufficient for a large country such as Ukraine, which is reflected in the low rate of inpatients treated with ECT. The very limited availability of this effective treatment modality should be addressed by the Ukrainian health authorities.

Prescription of Psychiatric Medications and Polypharmacy in the LAMS Cohort

PubMed Central

Kowatch, Robert A.; Youngstrom, Eric A.; Horwitz, Sarah; Demeter, Christine; Fristad, Mary A.; Birmaher, Boris; Axelson, David; Ryan, Neal; Frazier, Thomas W.; Arnold, L. Eugene; Young, Andrea S.; Gill, MaryKay; Findling, Robert L.

2014-01-01

Objective This study evaluated demographic and clinical correlates and predictors of polypharmacy at baseline assessment in the Longitudinal Assessment of Manic Symptoms (LAMS) sample, a cohort of children age six to 12 years at their first outpatient mental health visit at university-affiliated clinics. Methods Use of medications in four classes (mood stabilizers, antidepressants, antipsychotics, and stimulants) was assessed, and the Service Assessment for Children and Adolescents classified lifetime and current use of various services. Analyses examined correlates of the number of medications prescribed and odds of polypharmacy, defined as use of two or more concurrent medications. Results In the total sample, 201 of 698 participants (29%) were prescribed two or more medications. These participants had lower Children's Global Assessment Scale scores, more comorbid disorders, and higher baseline parent-reported mood symptoms than those prescribed no or one medication. White youths were three times as likely as nonwhite youths to be receiving two or more psychotropics, even after adjustment for other demographic and clinical characteristics. Of 262 participants (38% of sample) not being treated with medications, 252 (96%) had a diagnosis of at least one psychiatric disorder (74% had two or more). Conclusions Findings suggest that patients with greater severity and comorbidity were more likely to receive two or more medications. However, 38% of these children with serious disorders were not receiving psychotropic medication at the time of this assessment. Results counter findings suggesting overtreatment with medications of children with psychiatric disorders in the community. PMID:23852186

Mental Health Service Use Among Lesbian, Gay, and Bisexual Older Adults.

PubMed

Stanley, Ian H; Duong, Jeffrey

2015-07-01

Empirical efforts to measure use of mental health services among lesbian, gay, and bisexual (LGB) older adults have been notably lacking. Thus this study assessed associations between sexual orientation and mental health service use among older adults and determined the mediating role of nonspecific psychological distress, excessive alcohol use, and self-perceived poor general medical health. Data from the 2011 New York City Community Health Survey were analyzed. The analytic sample comprised 5,138 adults ages 50 and over. Logistic regression modeling was used to examine associations between sexual orientation (LGB versus heterosexual) and past-year mental health service use (counseling or medication), adjusting for sociodemographic and clinical characteristics. Mediation analyses using bootstrapping were conducted. Among LGB older adults, 23.9% reported receiving counseling, and 23.4% reported taking psychiatric medication in the past year. LGB respondents were significantly more likely than heterosexuals to have received counseling (adjusted odds ratio [AOR]=2.16, 95% confidence interval [CI]=1.49-3.13) and psychiatric medication (AOR=1.97, CI=1.36-2.86). Psychological distress, excessive alcohol use, and self-perceived poor general medical health did not mediate the association between sexual orientation and mental health service use. LGB older adults were more likely than heterosexuals to utilize mental health services, and this association was not explained by indicators of general medical, mental, or behavioral health.

Psychiatric comorbidity in autism spectrum disorder: Correspondence between mental health clinician report and structured parent interview.

PubMed

Stadnick, Nicole; Chlebowski, Colby; Baker-Ericzén, Mary; Dyson, Margaret; Garland, Ann; Brookman-Frazee, Lauren

2017-10-01

Publicly funded mental health services are critical in caring for children with autism spectrum disorder. Accurate identification of psychiatric comorbidity is necessary for effective mental health treatment. Little is known about psychiatric diagnosis for this population in routine mental health care. This study (1) examined correspondence between psychiatric diagnoses reported by mental health clinicians and those derived from a structured diagnostic interview and (2) identified predictors of agreement between clinician-reported and diagnostic interview-derived diagnoses in a sample of 197 children aged 4-14 years with autism spectrum disorder receiving mental health services. Data were drawn from a randomized effectiveness trial conducted in publicly funded mental health services. Non-autism spectrum disorder diagnoses were assessed using an adapted version of the Mini-International Neuropsychiatric Interview, parent version. Cohen's kappa was calculated to examine agreement between Mini-International Neuropsychiatric Interview, parent version and clinician-reported diagnoses of comorbid conditions. Children met criteria for an average of 2.83 (standard deviation = 1.92) Mini-International Neuropsychiatric Interview, parent version diagnoses. Agreement was poor across all diagnostic categories (κ values: 0.06-0.18). Logistic regression identified child gender and clinical characteristics as significant predictors of agreement for specific diagnoses. Results underscore the need for training mental health clinicians in targeted assessment of specific psychiatric disorders and prioritizing treatment development and testing for specific diagnoses to improve care for children with autism spectrum disorder served in publicly funded mental health settings.

Predictors of Stimulant Abuse Treatment Outcomes in Severely Mentally Ill Outpatients

PubMed Central

Angelo, Frank N.; McDonell, Michael G.; Lewin, Michael R.; Srebnik, Debra; Lowe, Jessica; Roll, John; Ries, Richard

2012-01-01

Background Severe mental illness is often exclusionary criteria for studies examining factors that influence addiction treatment outcome. Therefore, little is known about predictors of treatment response of individuals receiving psychosocial treatments for addictions who suffer from co-occurring severe mental illness. Methods The impact of demographic, substance abuse severity, psychiatric severity, and service utilization variables on in-treatment performance (i.e., longest duration of abstinence) in a 12-week contingency management (CM) intervention for stimulant abuse in 96 severely mentally ill adults was investigated. A 4-step linear regression was used to identify independent predictors of in-treatment abstinence. Results This model accounted for 37.4% of variance in the longest duration of abstinence outcome. Lower levels of stimulant use (i.e., stimulant-negative urine test) and psychiatric severity (i.e., lower levels of psychiatric distress), as well as higher rates of outpatient treatment utilization at study entry were independently associated with longer duration of drug abstinence. Conclusion These data suggest that individuals with low levels of stimulant use and psychiatric severity, as well as those actively engaged in services are most likely to succeed in a typical CM intervention. For others, modifications to CM interventions, such as increasing the value of reinforcement or adding CM to evidence based psychiatric interventions may improve treatment outcomes. PMID:23273776

Predictors of mental health service utilization in the 12 months before imprisonment: analysis of results from a national prisons survey.

PubMed

Farrell, Michael; Boys, Annabel; Singleton, Nicola; Meltzer, Howard; Brugha, Traolach; Bebbington, Paul; Jenkins, Rachel; Coid, Jeremy; Lewis, Glyn; Marsden, John

2006-01-01

To describe the self-reported history of health service utilization and help-seeking to those who are drug-dependent in the period of time prior to imprisonment. A cross-section survey of 3142 sentenced or remand prisoners in English prisons completed private, face-to-face interviews with trained Office for National Statistics staff covering a full structured psychiatric assessment interview. Specific questions about service utilization prior to imprisonment were included, as were questions on patterns of drug use and dependence prior to imprisonment. Receipt of any form of help was demographically most strongly associated with being older, white and female. Women were about twice as likely as men to report having received help for mental or emotional problems. Older age was also consistently associated with greater levels of reporting having received help, for both genders but only for use of general practitioners. Being black was strongly associated with reduced likelihood of receiving help and this was maintained after adjusting for other sociodemographic variables. Opioid dependence alone or opioid dependence with stimulant dependence, psychiatric disorder alone and probable psychosis were all most predictive of service use in the 12 months prior to imprisonment. In the year prior to imprisonment, the majority of mental health needs of these individual prisoners were not able to access help prior to imprisonment. Future strategies should aim for better health access before, during and after imprisonment.

Collaboration between primary care and psychiatric services: does it help family physicians?

PubMed

Kisely, Stephen; Duerden, Debbie; Shaddick, Susan; Jayabarathan, Ajantha

2006-07-01

To compare family physicians' reports of their experiences managing patients with psychiatric disorders in settings with and without access to collaborative mental health services. Survey using a questionnaire adapted from a similar study in Australia. Family physicians were asked about their knowledge, skills, and degree of comfort in managing the following psychiatric disorders derived from the primary care version of the 10th edition of the International Classification of Diseases: psychosis, depression, anxiety, childhood disorders, and stress-related disorders. We also compared the 2 groups of physicians regarding their satisfaction with mental health services in general. The Capital District Health Authority (CDHA) in Nova Scotia. All family physicians practising in the CDHA. Self-reported knowledge, skills, and degree of comfort in managing psychiatric problems; satisfaction with mental health services, adjusted for family physicians' demographics; and stated interest in mental health. We received 101 responses (37 from physicians with access to collaborative care and 64 from physicians without access) from 7 communities in the CDHA. Family physicians who had access to collaborative care reported significantly greater knowledge in the areas of psychosis, alcohol or substance use, and childhood behavioural problems; and better skills in managing psychosis, alcohol or substance use, childhood depression or anxiety, childhood behavioural disorders, and relationship problems. Their comfort levels in managing relationship problems and childhood behavioural disorders were also significantly higher. Family physicians with access to collaborative care were significantly more satisfied with mental health services, over and above shared care. All these differences remained significant after controlling for sex, level of interest in mental health, and years in practice. Family physicians with access to collaborative care reported greater knowledge, better skills, and more comfort in managing psychiatric disorders and greater satisfaction with mental health services. Further work is needed to establish why this is so and to determine any effect on patient outcomes, such as symptoms, quality of life, and psychosocial functioning.

Use of medical services and treatment for panic disorder with agoraphobia and for social phobia.

PubMed Central

Swinson, R P; Cox, B J; Woszczyna, C B

1992-01-01

OBJECTIVE: To examine the medical services and treatment for anxiety disorders reported by patients who had either panic disorder with agoraphobia or else social phobia. DESIGN: Archival research of consecutive records of psychiatric interviews conducted between January 1990 and December 1991. The records were examined by a trained research assistant who had had no contact with the patients. PATIENTS: One hundred patients who had panic disorder with agoraphobia and twenty-eight patients who had social phobia. SETTING: An anxiety disorders clinic in a university-affiliated psychiatric institute. OUTCOME MEASURES: Variables related to the use of medical services included history of hospitalization, emergency department visits and referrals to specialists. Variables related to treatment included types of medication received, whether behaviour therapy was received and types of health care professionals seen. RESULTS: Almost 30% of the patients with panic disorder and more than 20% of those with social phobia had a history of a major depressive episode at some time in their lives; 30% and 25% respectively had a current nonpsychiatric medical diagnosis. In the past year nearly one-third of both patient groups had seen three or more different health care professionals and almost one-fifth of those with panic disorder had gone to a general hospital emergency department. Of the patients with panic disorder 9% had previously been assessed by a cardiologist and 17% by a neurologist. At least two-thirds of each group had received benzodiazepines, often for use as needed. Although most of the patients in both groups had been seen by mental health professionals such as psychiatrists, few had received optimal treatment. Of those with panic disorder, only 15% had received the tricyclic antidepressant imipramine, 13% alprazolam and 11% cognitive-behavioural therapy. Only 4% of the patients with social phobia had received cognitive-behavioural therapy. CONCLUSIONS: Both groups of patients, and particularly those with panic disorder, are frequent users of medical services. Although most have had contact with mental health professionals, few have received appropriate treatment. Benzodiazepines appear to be overprescribed, whereas forms of treatment that have been shown to reduce the use of medical services, such as cognitive-behavioural therapy, are infrequently given. PMID:1525731

Pre-surgical Psychological and Neuroendocrine Predictors of Psychiatric Morbidity Following Major Vascular Surgery: A Prospective Longitudinal Study

PubMed Central

King, Anthony P.; Abelson, James L.; Gholami, Bardia; Upchurch, Gilbert R.; Henke, Peter; Graham, Linda; Liberzon, Israel

2015-01-01

Objective Major life stressors, including major surgeries, are often followed by psychiatric symptoms and disorders. Prior retrospective work found abdominal-aortic aneurysm (AAA) repair is followed by increased psychiatric morbidity, which may adversely influence physical and functional recovery. Identifying risk factors prior to surgery, such as dysregulation in stress response systems, might be useful to improving preventative intervention. Methods Two hundred and sixteen patients receiving open AAA or aortofemoral bypass (AFB) surgeries, endovascular AAA repair (EVAR), or nonsurgical AAA treatment were recruited from two vascular surgery services. Psychiatric symptoms and salivary cortisol measures (waking, 4 pm, and 11 pm, before and after low-dose dexamethasone) were obtained at intake and 3 and 9 month followups. Results Following open surgeries, 18% of patients had new psychiatric disorders, compared to 4% of patients receiving EVAR or nonsurgical treatment (odds ratio = 6.0, 95% CI 1.6 - 22.1, p=.007). Having a history of major depression predicted onset of new disorders in surgical patients. Pre-surgical cortisol levels were associated with both baseline (r=.23, p<.05) and 9 month (r=.32, p<.01) psychiatric symptoms (cortisol B=1.0, SE=0.48, p<.05 in repeated measures mixed model). Conclusion Open AAA repair surgery is prospectively linked to development of psychiatric morbidity, and history of depression elevates risk. Cortisol measures prior to surgery are associated with current and future psychological functioning, suggesting potential neurobiological mechanisms that may contribute to vulnerability. These results can help identify surgical patients at risk, and point to potential targets for risk reduction interventions. PMID:26461854

Discordance in Diagnoses and Treatment of Psychiatric Disorders in Children and Adolescents with 22q11.2 Deletion Syndrome

PubMed Central

Young, Andrea S.; Shashi, Vandana; Schoch, Kelly; Kwapil, Thomas; Hooper, Stephen R.

2011-01-01

This study examines the rate of utilization of mental health services in children and adolescents with 22q11DS relative to their remarkably high rate of psychiatric disorders and behavior problems. Seventy-two children and adolescents with 22q11DS were participants; their parents completed the Diagnostic Interview Schedule for Children (DISC) and the Child Behavior Checklist (CBCL). The results indicated that 22q11DS children and adolescents have higher rates of psychopathology than the general pediatric population, with ADHD and anxiety disorders being the most common. However, among youth with 22q11DS, those with psychopathology are often no more likely to receive either pharmacological or non-pharmacological mental health care than those without a given psychiatric diagnosis. Thus, although psychopathology is fairly common in this sample, many children with 22q11DS may not be receiving needed psychiatric care. These results have significant implications for these children and their families, as well as for the health care providers who treat them. In particular, the results may suggest a need for careful screening of psychiatric disorders that are likely to affect this population as well, as making appropriate treatment recommendations to remedy childhood mental health problems. Since these children face an extraordinarily high risk of psychoses in late adolescence/adulthood, treatment of childhood psychopathology could be crucial in mitigating the risk/consequences of major psychiatric illnesses in later life. PMID:21743818

42 CFR 441.182 - Maintenance of effort: Computation.

Code of Federal Regulations, 2010 CFR

2010-10-01

... SERVICES Inpatient Psychiatric Services for Individuals Under Age 21 in Psychiatric Facilities or Programs § 441.182 Maintenance of effort: Computation. (a) For expenditures for inpatient psychiatric services... total State Medicaid expenditures in the current quarter for inpatient psychiatric services and...

Evaluation of a primary care counselling service in Dorset.

PubMed Central

Baker, R; Allen, H; Gibson, S; Newth, J; Baker, E

1998-01-01

BACKGROUND: Research into the effectiveness of counselling in primary care is rare. This study attempts to provide a thorough evaluation of the effects of a new counselling service introduced throughout Dorset. AIM: To evaluate the impact of counselling on client symptomatology, self-esteem, and quality of life. The effect of counselling on drug prescribing, referrals to other mental health professionals, and client and general practitioner (GP) satisfaction were also assessed. METHOD: All new clients referred for counselling were asked to complete and return questionnaires before and after counselling. A total of 385 clients took part in the study. The first and second assessments were compared statistically. Clients were ascribed a psychiatric diagnosis using a simplified version of DSM-IIIR (Diagnostic and Statistical Manual of the American Psychiatric Association). GPs' views of the service were determined using a specially designed questionnaire. Drug data were obtained from the Prescription Pricing Authority and referral statistics from Dorset HealthCare National Health Service (NHS) Trust. RESULTS: The number of psychiatric symptoms and their severity were significantly reduced by counselling. There were no significant differences in the prescription of anxiolytic/hypnotic and anti-depressant medication between matched practices with and without counsellors. The presence of a counsellor did not affect the rate of referral to other mental health professionals. Clients and GPs valued the service highly. CONCLUSIONS: The Psychology Managed Counselling Service is an effective method of running a counselling service and is well received by both clients and GPs. Counselled clients improved significantly on several measures. PMID:9624745

Pre-injury depression and anxiety in patients with orthopedic trauma and their treatment.

PubMed

Haupt, Edward; Vincent, Heather K; Harris, Andrew; Vasilopoulos, Terrie; Guenther, Robert; Sharififar, Sharareh; Hagen, Jennifer E

2018-03-27

Depressive symptoms have a known negative impact on outcomes following musculoskeletal injury. This study determined the pre-injury prevalence of psychiatric diagnoses of depression and anxiety, medication lapses and psychiatric consult services among patients admitted for orthopaedic trauma. This is a retrospective study of data from our Level-1 trauma center. Patients admitted to the orthopaedic trauma service during 2010-2015 were included (N = 4053). Demographics, Injury Severity Scores (ISS), mental health diagnoses, psychotropic medications, medication type and delay, psychiatric consultation use, intensive care unit (ICU) stay and total hospital length of stay (LOS) were abstracted from medical records and the institutional trauma registry. The 12-month prevalence of a major depressive episode is 6.6%-8.6% in adults in the United States. In our database, only 152/4053 (3.8%) of the patients had documented medical history of depression (80%) or anxiety (30%), and these patients had a 32% longer LOS (p < 0.016). Nearly two-thirds of patients who used psychotropic medications prior to injury experienced a delay in receiving these medications in the hospital (median = 1.0 day, range 0-14 days). Sixteen percent of patients also received a new psychotropic medication while hospitalized: an antipsychotic (8/16 patients, to treat delirium), an anxiolytic (3/16 patients for acute anxiety), or an antidepressant (1/16). Among patients with depression or anxiety, 16.7% received a psychiatric consult. Patients with psychiatric consults had higher ISS, were more likely to have longer ICU LOS and had longer hospital LOS than those without consults (all p < 0.05). The prevalence of depression and anxiety is grossly under-reported in our registry compared to national prevalence data. Patients with pre-existing disease had longer LOS and a higher rate of extended ICU care. Further studies are needed to characterize the true prevalence of disease in this patient population and its effect on patient outcomes after traumatic orthopaedic injury. Copyright © 2018 Elsevier Ltd. All rights reserved.

Characteristics, management, and depression outcomes of primary care patients who endorse thoughts of death or suicide on the PHQ-9.

PubMed

Bauer, Amy M; Chan, Ya-Fen; Huang, Hsiang; Vannoy, Steven; Unützer, Jürgen

2013-03-01

With increasing emphasis on integrating behavioral health services, primary care providers play an important role in managing patients with suicidal thoughts. To evaluate whether Patient Health Questionnaire-9 (PHQ-9) Item 9 scores are associated with patient characteristics, management, and depression outcomes in a primary care-based mental health program. Observational analysis of data collected from a patient registry. Eleven thousand fifteen adults enrolled in the Mental Health Integration Program (MHIP). MHIP provides integrated mental health services for safety-net populations in over 100 community health centers across Washington State. Key elements of the team-based model include: a disease registry; integrated care management; and organized psychiatric case review. The independent variable, suicidal ideation (SI), was assessed by PHQ-9 Item 9. Depression severity was assessed with the PHQ-8. Outcomes included four indicators of depression treatment process (care manager contact, psychiatric case review, psychotropic medications, and specialty mental health referral), and two indicators of depression outcomes (50 % reduction in PHQ-9 score and PHQ-9 score < 10). SI was common (45.2 %) at baseline, with significantly higher rates among men and patients with greater psychopathology. Few patients with SI (5.4 %) lacked substantial current depressive symptoms. After adjusting for age, gender, and severity of psychopathology, patients with SI received follow-up earlier (care manager contact HR = 1.05, p < 0.001; psychiatric review HR = 1.02, p < 0.05), and were more likely to receive psychotropic medications (OR = 1.11, p = 0.001) and specialty referral (OR = 1.23, p < 0.001), yet were less likely to achieve a PHQ-9 score < 10 (HR = 0.87, p < 0.001). Suicidal thoughts are common among safety-net patients referred by primary care providers for behavioral health care. Scores on Item 9 of the PHQ-9 are easily obtainable in primary care, may help providers initiate conversations about suicidality, and serve as useful markers of psychiatric complexity and treatment-resistance. Patients with positive scores should receive timely and comprehensive psychiatric evaluation and follow-up.

Use of psychotropic medications in São Paulo Metropolitan Area, Brazil: pattern of healthcare provision to general population.

PubMed

Campanha, Angela Maria; Siu, Erica Rosanna; Milhorança, Igor André; Viana, Maria Carmen; Wang, Yuan-Pang; Andrade, Laura Helena

2015-11-01

We estimate the proportion of psychotropic medication use (PMU) among adults in São Paulo Metropolitan Area, Brazil. We investigated whether socio-demographic factors, comorbidity, and disease severity influence PMU among individuals with psychiatric disorders. Data are from the São Paulo Megacity Mental Health Survey, a cross-sectional, population-based study, the Brazilian branch of the World Mental Health Survey Initiative. Trained lay interviewers face-to-face assessed psychiatric disorders and PMU through the Composite International Diagnostic Interview. Respondents were asked about use of healthcare service and prescribed medications for mental disorders in the previous year. Information on PMU was collected for 2935 adult residents in the area and among those with disorders who received treatment. Around 6% of respondents reported PMU in the past year: hypnotics or sedatives were used by 3.7% and antidepressants by 3.5%. Among individuals with 12-month disorders, only 14% reported past year PMU. Gender, age, education, income, occupational status, comorbidity, and severity were significant predictors for PMU. Among those with 12-month DSM-IV disorders who obtained treatment in healthcare settings, almost 40% received medication only. Among those treated in specialty mental health service, around 23% received combination of medication and psychotherapy. Our study has pointed out that the recent trend of access to mental healthcare in Brazil depicts unmet needs, characterized by a low prevalence of PMU among individuals with psychiatric disorders. Policies that improve appropriate access to prescribed drugs for those most in need are urgent public health priority. Copyright © 2015 John Wiley & Sons, Ltd.

Integration of DSM-III and ICD-8 to be used in a consultation-liaison psychiatric service. Preliminary experiences.

PubMed

Poulsen, D L; Zierau, F; Eplov, L; Jepsen, P W; Kastrup, M; Kijne, B; Rasmussen, S; Stubgaard, M; Bech, P

1987-01-01

In 1983 a total of 405 patients received psychiatric supervision in somatic departments in the general hospital. At this supervision, these patients were registered by means of a five-axial diagnostic coding according to the DMS III principle, and this was combined with a quantitative global assessment of the severity of the condition. Reliability testing was undertaken by five supervising physicians with a total of 15 patients. The total number of supervisions constituted one supervision per somatic bed per annum. Women were overrepresented, and medical departments made the greatest use of psychiatric supervision. Reactive conditions dominated parallel with a high relative incidence of alcohol-related conditions. In patients with diagnoses of psychoses, only slight to moderate psychiatric symptoms were encountered. This held true also for personality deviations. 50% of the patients had experienced significant psychosocial stress, but 10% of these were diagnosed as having non-reactive psychoses, 52% of the patients had moderate to pronounced disturbances of social function. Half of the patients supervised in this manner could be investigated or treated in the referring departments. Approximately half of the patients in whom referral to private psychiatric specialists was made did not keep these appointments. Reliability testing in the material shows the employability of the diagnostic armamentarium. All in all, the investigation suggests that extension of the liaison psychiatric service in somatic departments would result in a relative increase in the number of patients who could be treated in the referring department and an increase in the number of psychiatric conditions diagnosed. Establishment of a psychiatric outpatient clinic in the somatic environment appears to be indicated.

An examination of the services provided by Psychiatric Consultation Liaison Nurses in a general hospital.

PubMed

Johnston, M L; Cowman, S

2008-08-01

The political, professional and economic context in which mental health care is delivered has witnessed significant changes in recent times. The movement of psychiatric patients from institutions to community settings has seen the emphasis of the loci of care delivery shifting with increasing numbers presenting to general hospitals. The speciality of the Psychiatric Consultation Liaison Nurse (PCLN) has emerged as a bridge between mental health and general hospital services. A descriptive, non-experimental research approach was employed to establish patient profiles and to provide an overview of the depth of service provision. This design was selected as the most appropriate because of the limited information on the PCLN in an Irish setting and secondly, as the study was limited to one rural geographical location. A questionnaire was utilized to collate the details of patients who had received a mental health assessment. The findings presented here are the profiles of patients assessed by the PCLN during the 3-month study period. The results add further credence to the existing evaluative studies in presenting the characteristics of patients within the Irish context and further contribute to the unique body of evidence that defines the mental health nurse in an advancing role.

42 CFR 440.160 - Inpatient psychiatric services for individuals under age 21.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 4 2010-10-01 2010-10-01 false Inpatient psychiatric services for individuals... Definitions § 440.160 Inpatient psychiatric services for individuals under age 21. “Inpatient psychiatric... physician; (b) Are provided by— (1) A psychiatric hospital that undergoes a State survey to determine...

A Pilot Initiative to Deliver Community-based Psychiatric Services in Rural Haiti After the 2010 Earthquake.

PubMed

Grelotti, David J; Lee, Amy C; Fils-Aimé, Joseph Reginald; Jean, Jacques Solon; Therosmé, Tatiana; Petit-Homme, Handy; Oswald, Catherine M; Raviola, Giuseppe; Eustache, Eddy

2015-01-01

Worldwide, there is a gap between the burden of mental distress and disorder and access to mental health care. This gap is particularly large in low- and middle-income countries (LMICs). After the 2010 earthquake in Haiti, the international health care organizations Partners in Health and Zanmi Lasante worked to expand local mental health services in rural Haiti. The aims of this study are to describe clinical characteristics of the patients served during a pilot project to deliver community-based psychiatric services in rural Haiti and to show how this experience complements the Mental Health Gap Action Programme ("mhGAP"), a tool developed by the World Health Organization to support mental health care delivery by nonspecialists in LMICs. The pilot was conducted in March 2011. A visiting psychiatrist traveled to rural Haiti and paired with local clinicians to evaluate patients and to support quality improvement practices in psychiatric care. Patients received a standard neuropsychiatric evaluation. mhGAP was an important clinical reference. To assess the experience, we conducted a retrospective chart review of outpatient encounters. Sixty-five patients presented with a wide range of common psychiatric, neurologic, and general medical conditions. Forty-nine of these patients (75%) reported primary problems subsumed by an mhGAP module. Fifteen patients (23%) reported headache as their chief complain, a condition that is not currently covered by mhGAP. Surprisingly, only 3 patients (5%), reported earthquake-related distress. Our clinical data reinforce the need for provision of standard psychiatric and neurologic services in LMICs. Such services ought to accompany interventions targeted specifically at disaster-related problems. Clinical situations falling outside existing mhGAP modules inspired the development of supplemental treatment protocols. These observations informed coordinated efforts at Zanmi Lasante to build a sustainable, integrated mental health system in Haiti that may be relevant to other resource-limited settings. Copyright © 2015 The Authors. Published by Elsevier Inc. All rights reserved.

Use of general medical services among Medicaid patients with severe and persistent mental illness.

PubMed

Salsberry, Pamela J; Chipps, Esther; Kennedy, Carol

2005-04-01

The aim of this study was to examine patterns of use of general medical services among persons with a severe and persistent mental illness enrolled in Medicaid from 1996 to 1998. A total of 669 persons with a severe and persistent mental illness were identified by using statewide clinical criteria. A three-year database of Medicaid claims was developed to examine service use. The main outcome measures were use of outpatient services for a general medical problem, use of dental and vision services, and use of screening tests for women. Service use was examined by primary psychiatric diagnosis (schizophrenic, affective, paranoid, and anxiety disorders), and analyses controlled for the presence of a chronic medical condition, age, race, and sex. This study found high levels of service use for outpatient services but very low levels for primary and preventive services. Although 78 percent of persons with a schizophrenic disorder had an office-based visit during the three-year period, all persons with an anxiety disorder had such a visit. Sixty-nine percent of persons with a schizophrenic disorder had at least one emergency department visit, whereas 83 percent of those with an anxiety disorder had such a visit. Dental and vision visits and the use of mammograms and pap tests followed the same pattern; persons with a schizophrenic disorder had fewer visits and had less overall use than the other diagnostic groups. The use patterns across the four groups were significantly different in outpatient service use, dental and vision service use, and screening tests for women. Compared with persons with a schizophrenic disorder, those with an anxiety disorder were more likely to have had an office-based visit and to have received vision services, those with a paranoid disorder were more likely to have used dental services or received a mammogram, and those with an affective disorder were more likely to have had a pap test. Although this group of Medicaid patients with severe and persistent mental illness had access to providers, they received an unacceptably low level of preventive care. Use of health services for general medical problems differed somewhat by primary psychiatric illness.

The Efficacy of Interpersonal Psychotherapy-Adolescent Skill Training (IPT-AST) in Preventing Depression: A Mixed Methods Approach

ERIC Educational Resources Information Center

Kerner, Sarah Shankman

2015-01-01

Adolescent depression is a prevalent and debilitating disorder that is associated with social and academic impairment, suicidality, comorbid psychiatric disorders, and high-risk behaviors (Horowitz, Garber, Ciesla, Young, & Mufson, 2007). Yet many adolescents experiencing depressive symptoms do not receive adequate services, and those that do…

24 CFR 882.803 - Project eligibility and other requirements.

Code of Federal Regulations, 2012 CFR

2012-04-01

... receiving Federal funding for rental assistance or operating costs under other HUD programs. (3) Nursing... providing continual psychiatric, medical, or nursing services are not eligible for assistance under this.... 3601-19), E.O. 11063 (as amended by E.O. 12259; 3 CFR, 1959-1963 Comp., p. 652 and 3 CFR, 1980 Comp., p...

24 CFR 882.803 - Project eligibility and other requirements.

Code of Federal Regulations, 2014 CFR

2014-04-01

... receiving Federal funding for rental assistance or operating costs under other HUD programs. (3) Nursing... providing continual psychiatric, medical, or nursing services are not eligible for assistance under this.... 3601-19), E.O. 11063 (as amended by E.O. 12259; 3 CFR, 1959-1963 Comp., p. 652 and 3 CFR, 1980 Comp., p...

24 CFR 882.803 - Project eligibility and other requirements.

Code of Federal Regulations, 2013 CFR

2013-04-01

... receiving Federal funding for rental assistance or operating costs under other HUD programs. (3) Nursing... providing continual psychiatric, medical, or nursing services are not eligible for assistance under this.... 3601-19), E.O. 11063 (as amended by E.O. 12259; 3 CFR, 1959-1963 Comp., p. 652 and 3 CFR, 1980 Comp., p...

24 CFR 882.803 - Project eligibility and other requirements.

Code of Federal Regulations, 2011 CFR

2011-04-01

... receiving Federal funding for rental assistance or operating costs under other HUD programs. (3) Nursing... providing continual psychiatric, medical, or nursing services are not eligible for assistance under this.... 3601-19), E.O. 11063 (as amended by E.O. 12259; 3 CFR, 1959-1963 Comp., p. 652 and 3 CFR, 1980 Comp., p...

Psychiatric Consultation and Substance Use Disorders

PubMed Central

Specker, Sheila; Meller, William H.; Thurber, Steven

2009-01-01

Background A substantial number of patients in general hospitals will evince substance abuse problems but a majority is unlikely to be adequately identified in the referral-consultation process. This failure may preclude patients from receiving effective interventions for substance use disorders. Objectives 1. To evaluate all referred patients for possible substance use disorders. 2. To ascertain the degree of convergence between patients referred for chemical problems and the corresponding DSM diagnosis. 3. To compare demographic data for substance abusing patients and referrals not so classified. 4. To evaluate conditions concomitant with substance use disorders. Method Consecutive one-year referrals (524) to consultation-liaison psychiatric services were scrutinized for chemically-related problems by psychiatric consultants. Results Of the referrals, 176 met criteria for substance use disorders (SUD) (57% alcohol; 25% other drugs; 18% both alcohol and other drugs). Persons diagnosed with SUD tended to be younger, male, non-Caucasian, unmarried, and unemployed. They were more likely to be depressed, have liver and other gastrointestinal problems, and to have experienced traumatic events; they also tended to have current financial difficulties. Most were referred for SUD evaluation by personnel in general medicine and family practice. Following psychiatric consultation, SUD designated patients were referred mainly to substance abuse treatment programs. The only variable related to recommended inpatient versus outpatient services for individuals with SUD was the Global Assessment of Functioning Axis (GAF) with persons having lower estimated functioning more likely to be referred for inpatient interventions. Conclusions These data are similar to the results of past studies in this area. Unlike previous investigations in the domain of consultative-liaison psychiatry, financial stressors and specific consultant recommendations were included in data gathering. Although the results are encouraging in that individuals with SUD were identified and potentially sent for appropriate treatment, the likelihood is that many patients with SUD remain unrecognized and do not receive necessary consultative and treatment services. PMID:24357934

Psychiatric consultation and substance use disorders.

PubMed

Specker, Sheila; Meller, William H; Thurber, Steven

2009-01-01

A substantial number of patients in general hospitals will evince substance abuse problems but a majority is unlikely to be adequately identified in the referral-consultation process. This failure may preclude patients from receiving effective interventions for substance use disorders. 1. To evaluate all referred patients for possible substance use disorders. 2. To ascertain the degree of convergence between patients referred for chemical problems and the corresponding DSM diagnosis. 3. To compare demographic data for substance abusing patients and referrals not so classified. 4. To evaluate conditions concomitant with substance use disorders. Consecutive one-year referrals (524) to consultation-liaison psychiatric services were scrutinized for chemically-related problems by psychiatric consultants. Of the referrals, 176 met criteria for substance use disorders (SUD) (57% alcohol; 25% other drugs; 18% both alcohol and other drugs). Persons diagnosed with SUD tended to be younger, male, non-Caucasian, unmarried, and unemployed. They were more likely to be depressed, have liver and other gastrointestinal problems, and to have experienced traumatic events; they also tended to have current financial difficulties. Most were referred for SUD evaluation by personnel in general medicine and family practice. Following psychiatric consultation, SUD designated patients were referred mainly to substance abuse treatment programs. The only variable related to recommended inpatient versus outpatient services for individuals with SUD was the Global Assessment of Functioning Axis (GAF) with persons having lower estimated functioning more likely to be referred for inpatient interventions. These data are similar to the results of past studies in this area. Unlike previous investigations in the domain of consultative-liaison psychiatry, financial stressors and specific consultant recommendations were included in data gathering. Although the results are encouraging in that individuals with SUD were identified and potentially sent for appropriate treatment, the likelihood is that many patients with SUD remain unrecognized and do not receive necessary consultative and treatment services.

Rates of mental disorder in people convicted of homicide. National clinical survey.

PubMed

Shaw, Jenny; Hunt, Isabelle M; Flynn, Sandra; Meehan, Janet; Robinson, Jo; Bickley, Harriet; Parsons, Rebecca; McCann, Kerry; Burns, James; Amos, Tim; Kapur, Navneet; Appleby, Louis

2006-02-01

Previous studies of people convicted of homicide have used different definitions of mental disorder. To estimate the rate of mental disorder in people convicted of homicide; to examine the relationship between definitions, verdict and outcome in court. A national clinical survey of people convicted of homicide (n=1594) in England and Wales (1996-1999). Rates of mental disorder were estimated based on: lifetime diagnosis, mental illness at the time of the offence, contact with psychiatric services, diminished responsibility verdict and hospital disposal. Of the 1594,545 (34%) had a mental disorder: most had not attended psychiatric services; 85 (5%) had schizophrenia (lifetime); 164 (10%) had symptoms of mental illness at the time of the offence; 149 (9%) received a diminished responsibility verdict and 111 (7%) a hospital disposal - both were associated with severe mental illness and symptoms of psychosis. The findings suggest an association between schizophrenia and conviction for homicide. Most perpetrators with a history of mental disorder were not acutely ill or under mental healthcare at the time of the offence. Some perpetrators receive prison sentences despite having severe mental illness.

Time utilisation trends of supported employment services by persons with mental disability in South Africa.

PubMed

Van Niekerk, Lana; Coetzee, Zelda; Engelbrecht, Madri; Hajwani, Zerina; Terreblanche, Santie

2015-01-01

This paper reports on the second phase of a two-phased study that was undertaken to determine the feasibility of supported employment (SE) as a strategy with which to facilitate the employment of persons with disability in competitive work contexts. The study population comprised people with mental disabilities receiving SE in the Western Cape Province, South Africa. To describe the components of SE utilised by persons with mental disability (i.e. psychiatric or intellectual disability) in terms of type and time utilisation patterns over 12 months. Criterion sampling, a form of purposive sampling, was used to identify 29 study participants - 19 with intellectual disability and 10 with psychiatric disability. Data collection commenced for each participant when a work placement had been identified and preparation for such ensued. Data was collected prospectively for a period of 12 months. SE service components utilised by participants were captured using a data capture sheet that was developed for this purpose. Time utilisation indicated a steep downwards trend for both cohorts. The decrease in utilisation of SE service components over a period of one year was more pronounced in the psychiatric disability (PD) cohort, who utilized almost half the total SE services in the first month. SE services can be considered as a viable option for return to work in resource-constrained environments. Providers of SE services will need to modify approaches in order to meet contextual realities.

42 CFR 441.152 - Certification of need for services.

Code of Federal Regulations, 2010 CFR

2010-10-01

... SERVICES Inpatient Psychiatric Services for Individuals Under Age 21 in Psychiatric Facilities or Programs...) Proper treatment of the recipient's psychiatric condition requires services on an inpatient basis under...

Psychiatric service use and psychiatric disorders in adults with intellectual disability.

PubMed

Bhaumik, S; Tyrer, F C; McGrother, C; Ganghadaran, S K

2008-11-01

UK policies aim to facilitate access to general psychiatric services for adults with intellectual disability (ID). If this is to be achieved, it is important to have a clear idea of the characteristics and proportion of people with ID who currently access specialist psychiatric services and the nature and extent of psychiatric disorders in this population. A cross-sectional study was carried out on all adults with ID using specialist services in Leicestershire and Rutland, UK, between 2001 and 2006. Characteristics of individuals seen by psychiatric services and the nature and prevalence of psychiatric disorders were investigated. Of 2711 adults identified, 1244 (45.9%) accessed specialist psychiatric services at least once during the study period. Individuals attending psychiatric services were more likely to be older and to live in residential settings; they were less likely to be south Asian or to have mild/moderate ID. The prevalence of psychiatric disorders among the total study population was 33.8%; the most common disorders were behaviour disorder (19.8%) and autistic spectrum disorders (8.8%). Epilepsy was highly prevalent (60.8%) among those attending psychiatric services without a mental health diagnosis. Behaviour disorders and autistic spectrum disorders were more common in men and in adults with severe/profound ID, whereas schizophrenia and organic disorders were more common in women and in adults with mild/moderate ID. Depression was also more common in women with ID. Psychiatric disorders and specialist health problems are common among adults with ID and the profile of psychiatric disorders differs from that found in general psychiatry. Close collaboration between general and specialist service providers is needed if the current move towards use of general psychiatric services in this population is to be achieved. The measures should include a clear care pathway for people with ID and mental health problems to facilitate the smooth transfer of patients between specialist and generic mental health services and arrangements for joint working where input from both services is required. The commissioning framework for such processes should be in place with appropriate pooling of resources.

Facilitated Psychiatric Advance Directives: A Randomized Trial of an Intervention to Foster Advance Treatment Planning Among Persons with Severe Mental Illness

PubMed Central

Swanson, Jeffrey W.; Swartz, Marvin S.; Elbogen, Eric B.; Van Dorn, Richard A.; Ferron, Joelle; Wagner, H. Ryan; McCauley, Barbara J.; Kim, Mimi

2013-01-01

Objective Studies show a high potential demand for psychiatric advance directives but low completion rates. The authors conducted a randomized study of a structured, manualized intervention to facilitate completion of psychiatric advance directives. Method A total of 469 patients with severe mental illness were randomly assigned to a facilitated psychiatric advance directive session or a control group that received written information about psychiatric advance directives and referral to resources in the public mental health system. Completion of an advance directive, its structure and content, and its short-term effects on working alliance and treatment satisfaction were recorded. Results Sixty-one percent of participants in the facilitated session completed an advance directive or authorized a proxy decision maker, compared with only 3% of control group participants. Psychiatrists rated the advance directives as highly consistent with standards of community practice. Most participants used the advance directive to refuse some medications and to express preferences for admission to specific hospitals and not others, although none used an advance directive to refuse all treatment. At 1-month follow-up, participants in the facilitated session had a greater working alliance with their clinicians and were more likely than those in the control group to report receiving the mental health services they believed they needed. Conclusions The facilitation session is an effective method of helping patients complete psychiatric advance directives and ensuring that the documents contain useful information about patients’ treatment preferences. Achieving the promise of psychiatric advance directives may require system-level policies to embed facilitation of these instruments in usual-care care settings. PMID:17074946

Mental health services then and now.

PubMed

Mechanic, David

2007-01-01

Over the past twenty-five years, psychiatric services have shifted from hospital to community. Managed care reinforces this trend. Mental illness is better understood and less stigmatized, and services are more commonly used. But many in need do not receive care consistent with evidence-based standards, or at all. Challenges are greatest for people with serious and persistent mental illnesses who depend on generic health and welfare programs and integrated services. Evidence-based rehabilitative care is often unavailable. Failures in community care lead to arrest; jail diversion and treatment are required. Despite progress, implementing an effective, patient-centered care system remains a formidable challenge.

Patient ethnicity and three psychiatric intensive care units compared: the Tompkins Acute Ward Study.

PubMed

Bowers, L; Simpson, A; Nijman, H; Hall, C

2008-04-01

Psychiatric care units provide care to disturbed patients in a context of higher security and staffing levels. Although such units are numerous, few systematic comparisons have been made, and there are indications that ethnic minority groups may be over-represented. The aim of this study was to compare the rates of adverse incidents and patterns of usage of three psychiatric intensive care units. The study used a triangulation or multi-method design, bringing together data from official statistics, local audit and interviews conducted with staff. Intensive care patients were more likely to be young, male and suffering a psychotic disorder, as compared with general acute ward patients. Caribbean patients were twice as likely, and Asian patients half as likely, to receive intensive care (age, gender and diagnosis controlled). There were large differences in service levels, staffing, team functioning and adverse incidents between the three units. Various aspects of physical security were important in preventing absconds. More evaluative research is required in order to define effective service levels, and to explore the nature of the interaction between ethnicity and inpatient care provision during acute illness.

World Psychiatry and the WPA task force to promote dissemination of psychiatric research conducted in low and middle income countries.

PubMed

Maj, Mario

2010-01-01

World Psychiatry, the official journal of the World Psychiatric Association (WPA), is now published in five languages (English, Spanish, Chinese, Russian and French) and reaches more than 33,000 psychiatrists in 121 countries. It received recently its first impact factor, 3.896. The publication of the journal has two objectives. The first is to reach as many psychiatrists of the various countries of the world as possible, disseminating information on recent significant clinical, service and research developments in a language that can be assimilated by the vast majority of them. The second is to give voice to psychiatrists of all regions of the world, encouraging submission of research papers, commentaries and reports on innovative service modalities. Related to this second objective has been the establishment by the WPA of a task force aiming to promote dissemination of psychiatric research conducted in low and middle income countries. Among the objectives of this task force is to advise and support the editors of high quality journals produced in those countries in their efforts to achieve indexation.

Integration initiatives for forensic services

PubMed Central

ARBOLEDA-FLÓREZ, JULIO

2003-01-01

Poorly implemented mental health reform policies are often given as reasons for the growth in demands for forensic psychiatric services and the steady increase of mental patients in prison systems. However, in this paper, additional reasons are advanced to explain the growth of forensic psychiatry, such as an expansion in the types of "psychiatric defences" in courts of law; public concerns about violent behaviour attributed to the mentally ill; the community management of paraphilias, especially pedophilia; the development of risk assessment methodologies and the halo of super-specialization. The net result of these developments is that patients who receive a label of "forensic" enter into a mental health ghetto with little connectivity or integration with the general mental health system. The forensic label increases the stigma and decreases opportunities for reintegration and full social recovery. The paper provides guidelines to reverse these trends. PMID:16946932

[Differences between patients in consultation psychiatry and psychiatric inpatients].

PubMed

Unterecker, Stefan; Maloney, Julia; Pfuhlmann, Bruno; Deckert, Jürgen; Warrings, Bodo

2014-05-01

To optimize psychiatric consultation service epidemiological information is needed. We compared data on gender, age and diagnoses of patients in the consultation service to psychiatric inpatients. In psychiatric consultation service patients are older (56.6 vs. 44.9 years, p < 0.05) and males are older than females (58.8 vs. 54.4 years, p < 0.05). For male patients, the psychiatric consultation service is contacted more often in cases of organic disorders, for females in adjustment disorders (p < 0.05). The diagnostic spectrum in psychiatric consultation service is different for males and females with relevance for diagnostic and therapeutic procedures. © Georg Thieme Verlag KG Stuttgart · New York.

The Role of Academic Psychiatry Faculty in the Treatment and Subsequent Evaluation and Promotion of Medical Students: An Ethical Conundrum

ERIC Educational Resources Information Center

Kavan, Michael G.; Malin, Paula Jo; Wilson, Daniel R.

2008-01-01

Objectives: This article explores ethical and practical issues associated with the Liaison Committee on Medical Education (LCME) provision that states health professionals who provide psychiatric/psychological care to medical students must have no involvement in the academic evaluation or promotion of students receiving those services. Method: The…

Youth Characteristics Associated with Intensity of Service Use in a School-Based Mental Health Intervention

ERIC Educational Resources Information Center

Burnett-Zeigler, Inger; Lyons, John S.

2012-01-01

Several epidemiological studies have reported that large numbers of children and adolescents suffer from diagnosable psychiatric conditions, however most of them do not receive treatment. The schools are a key setting where youth with mental health problems are identified and linked to treatment. In this study we examine the demographic and…

Perspectives of Young Emerging Adults with Serious Mental Health Conditions on Vocational Peer Mentors

ERIC Educational Resources Information Center

Klodnick, Vanessa V.; Sabella, Kathryn; Brenner, Christopher J.; Krzos, Izabela M.; Ellison, Marsha L.; Kaiser, Susan M.; Davis, Maryann; Fagan, Marc A.

2015-01-01

For early emerging adults with serious mental health conditions, vocational services with peer mentors are a promising adaptation of adult system evidence-based practices. Peer mentors were added to the Individual Placement and Support model of supported employment for 17- to 20-year-olds receiving residential and psychiatric care. To explore the…

42 CFR 424.14 - Requirements for inpatient services of inpatient psychiatric facilities.

Code of Federal Regulations, 2010 CFR

2010-10-01

... psychiatric facilities. 424.14 Section 424.14 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES... Certification and Plan Requirements § 424.14 Requirements for inpatient services of inpatient psychiatric... requirements differ from those for other hospitals because the care furnished in psychiatric hospitals is often...

Ethnic differences in psychosocial service use among non-Latina white and Latina breast cancer survivors.

PubMed

Costas-Muñiz, Rosario; Hunter-Hernández, Migda; Garduño-Ortega, Olga; Morales-Cruz, Jennifer; Gany, Francesca

2017-01-01

This study examined the use of psychosocial services (i.e., social work, psychiatric, psychological, and spiritual/pastoral services) among Latina and Non-Latina white breast cancer survivors. Survivors who received treatment in a Comprehensive Cancer Center in New York completed a mailed questionnaire about interest in help for distress, and psychosocial service use. Descriptive and non-parametric statistics were used to explore ethnic differences in use of, and interest in, psychosocial services. Thirty-three percent of breast cancer survivors reported needing mental health or psychosocial services after their cancer diagnosis (33% Latinas, 34% whites); 34% of survivors discussed with their oncologist or cancer care provider their emotional problems or needs after the diagnosis (30% Latinas, 36% whites). Only 40% of the survivors who reported needing services received a referral for psychosocial services (42% Latinas, 39% whites). Sixty-six percent of survivors who reported needing services had contact with a counselor or mental health professional (psychiatrist, psychologist, or social worker) after their diagnosis (57% Latinas, 71% whites), and 61% of those needing services reported receiving psychosocial services (53% Latinas, 67% whites). Whites were significantly more likely than Latinas to have contact with a social worker (33% vs. 17%, respectively) and to receive psychotropic medication (15% vs. 0%, respectively). However, Latinas were significantly more likely to receive spiritual counseling than whites (11% vs. 3%, respectively). Our study revealed gaps for both groups; however, the gaps differed by group. It is crucial to study and address potential differences in the psychosocial services availability, acceptability, and help-seeking behaviors of ethnically diverse cancer patients and survivors.

Patterns of inpatient care for immigrants in Switzerland: a case control study.

PubMed

Lay, Barbara; Lauber, Christoph; Nordt, Carlos; Rössler, Wulf

2006-03-01

Migration has become a major political and social concern in West European societies. A case-control method was used to analyse the utilisation of inpatient mental health services by immigrants from a catchment area in Switzerland over a 7-year period. Compared to natives, immigrants had fewer psychiatric hospitalisations, but more emergency and compulsory admissions. During inpatient treatment, they received less psycho-, ergo- and physiotherapy. Other therapies as well as compulsory measures were at comparable rates, as was the frequency of irregular discharge. They spent shorter periods as inpatients and the rate of psychiatric readmissions was significantly lower. Comparison of different countries of origin revealed that only patients from West and North Europe were comparable to natives regarding type of referral, inpatient treatment, and longitudinal measures of service utilisation. Even after accounting for effects of social class, immigrants from South Europe, former Yugoslavia, Turkey, East Europe and more distant countries spent significantly shorter time in inpatient treatment, compared to Swiss control patients. Results of this study clearly point to an underutilisation of inpatient facilities among immigrants with mental disorders, and to disadvantages in psychiatric inpatient care. This, however, does not pertain to all foreign patients to the same extent: inequalities of mental health service use are particularly pronounced in immigrants from more distant countries.

Evaluation of a cognitive remediation intervention for college students with psychiatric conditions.

PubMed

Mullen, Michelle G; Thompson, Judy L; Murphy, Ann A; Malenczak, Derek; Giacobbe, Giovanna; Karyczak, Sean; Holloway, Katherine E; Twamley, Elizabeth W; Silverstein, Steven M; Gill, Kenneth J

2017-03-01

Given the poor educational outcomes associated with psychiatric conditions, we developed Focused Academic Strength Training (FAST), a 12-week strategy-focused cognitive remediation intervention designed to improve academic functioning among college students with psychiatric conditions. Here we report initial results from a randomized controlled trial of FAST. Seventy-two college students with mood, anxiety, and/or psychotic disorders were randomized to receive FAST or services as usual and were assessed at baseline and 4 months (posttreatment). Repeated-measures analyses of variance indicated FAST-associated improvements in self-reported cognitive strategy use (p < .001), self-efficacy (p = .001), and academic difficulties (p = .025). There were no significant treatment-related improvements in neuropsychological performance. FAST may lead to an increase in self-efficacy and cognitive strategy use, as well as a reduction in academic difficulties among students with psychiatric conditions. Future analyses with follow-up data through 12 months will address the potential of FAST to improve academic functioning among this population. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

Short Text Messages to Encourage Adherence to Medication and Follow-up for People With Psychosis (Mobile.Net): Randomized Controlled Trial in Finland

PubMed Central

Kannisto, Kati Anneli; Vahlberg, Tero; Hätönen, Heli; Adams, Clive E

2017-01-01

Background A text messaging service (short message service [SMS]) has the potential to target large groups of people with long-term illnesses such as serious mental disorders, who may have difficulty with treatment adherence. Robust research on the impact of mobile technology interventions for these patients remains scarce. Objective The main objective of our study was to investigate the impact of individually tailored short text messages on the rate of psychiatric hospital readmissions, health care service use, and clinical outcomes. In addition, we analyzed treatment costs. Methods Between September 2011 and November 2012, we randomly assigned 1139 people to a tailored text message intervention (n=569) or usual care (n=570). Participants received semiautomated text messages for up to 12 months or usual care. The primary outcome, based on routinely collected health register data, was patient readmission into a psychiatric hospital during a 12-month follow-up period. Secondary outcomes were related to other service use, coercion, medication, adverse events, satisfaction, social functioning, quality of life, and economic factors (cost analysis). Results There was 98.24% (1119/1139) follow-up at 12 months. Tailored mobile telephone text messages did not reduce the rate of hospital admissions (242/563, 43.0% of the SMS group vs 216/556, 38.8% of the control group; relative risk 1.11; 95% CI 0.92-1.33; P=.28), time between hospitalizations (mean difference 7.0 days 95% CI –8.0 to 24.0; P=.37), time spent in a psychiatric hospital during the year (mean difference 2.0 days 95% CI –2.0 to 7.0; P=.35), or other service outcomes. People who received text messages were less disabled, based on Global Assessment Scale scores at the time of their readmission, than those who did not receive text messages (odds ratio 0.68; 95% CI 0.47-0.97; P=.04). The costs of treatment were higher for people in the SMS group than in the control group (mean €10,103 vs €9210, respectively, P<.001). Conclusions High-grade routinely collected data can provide clear outcomes for pragmatic randomized trials. SMS messaging tailored with the input of each individual patient did not decrease the rate of psychiatric hospital visits after the 12 months of follow-up. Although there may have been other, more subtle effects, the results of these were not evident in outcomes of agreed importance to clinicians, policymakers, and patients and their families. Trial Registration International Standard Randomized Controlled Trial Number (ISRCTN): 27704027; http://www.isrctn.com/ISRCTN27704027 (Archived by WebCite at http://www.webcitation.org/6rVzZrbuz). PMID:28701292

Provision of mental health care in general practice in Italy.

PubMed Central

Tansella, M; Bellantuono, C

1991-01-01

The main features of the psychiatric system and of the general practice system in Italy since the psychiatric reform and the introduction of a national health service are briefly described. Research conducted in Italy confirms that a large proportion of patients seen by general practitioners have psychological disorders and that only some of those patients whose psychological problems are identified by general practitioners are referred to specialist psychiatric care. Thus, the need to identify the best model of collaboration between psychiatric services and general practice services is becoming increasingly urgent. The chances of improving links between the two services and of developing a satisfactory liaison model are probably greater in countries such as Italy where psychiatric services are highly decentralized and community-based, than in countries where the psychiatric services are hospital-based. PMID:1807308

Determinants of the cost of health services used by veterans with HIV.

PubMed

Barnett, Paul G; Chow, Adam; Joyce, Vilija R; Bayoumi, Ahmed M; Griffin, Susan C; Nosyk, Bohdan; Holodniy, Mark; Brown, Sheldon T; Sculpher, Mark; Anis, Aslam H; Owens, Douglas K

2011-09-01

The effect of adherence, treatment failure, and comorbidities on the cost of HIV care is not well understood. To characterize the cost of HIV care including combination antiretroviral treatment (ART). Observational study of administrative data. Total 1896 randomly selected HIV-infected patients and 288 trial participants with multidrug-resistant HIV seen at the US Veterans Health Administration (VHA). Comorbidities, cost, pharmacy, and laboratory data. Many HIV-infected patients (24.5%) of the random sample did not receive ART. Outpatient pharmacy accounted for 62.8% of the costs of patients highly adherent with ART, 32.2% of the cost of those with lower adherence, and 6.2% of the cost of those not receiving ART. Compared with patients not receiving ART, high adherence was associated with lower hospital cost, but no greater total cost. Individuals with a low CD4 count (<50 cells/mm) incurred 1.9 times the cost of patients with counts >500. Most patients had medical, psychiatric, or substance abuse comorbidities. These conditions were associated with greater cost. Trial participants were less likely to have psychiatric and substance abuse comorbidities than the random sample of VHA patients with HIV. Patients receiving combination ART had higher medication costs but lower acute hospital cost. Poor control of HIV was associated with higher cost. The cost of psychiatric, substance abuse, rehabilitation, and long-term care and medications other than ART, often overlooked in HIV studies, was substantial.

Attention Deficit Hyperactivity Disorder in Childhood: Healthcare Use in a Danish Birth Cohort during the First 12 Years of Life.

PubMed

Laugesen, Britt; Mohr-Jensen, Christina; Boldsen, Søren Kjærgaard; Jørgensen, Rikke; Sørensen, Erik Elgaard; Grønkjær, Mette; Rasmussen, Philippa; Lauritsen, Marlene Briciet

2018-06-01

To compare the mean number of medical and psychiatric hospital-based services in children with and without attention deficit hyperactivity disorder (ADHD) and to assess the effect of ADHD on hospital-based service use, including child-, parental-, and socioeconomic-related risk factors. A Danish birth cohort was followed through 12 years, and children with ADHD were identified using Danish nationwide registries. Poisson regression analyses were used to assess the association of ADHD with service use and to adjust for a comprehensive set of explanatory variables. Children diagnosed with ADHD used more medical and psychiatric hospital-based healthcare than those without ADHD. In children with ADHD, intellectual disability and parental psychiatric disorder were associated with increased medical and psychiatric service use. Low birth weight and low gestational age were associated with increased medical service use. Psychiatric comorbidity and having a divorced or single parent were associated with increased psychiatric service use. ADHD independently affected medical and psychiatric hospital-based service use even when adjusting for a comprehensive set of explanatory variables. However, the pattern of medical and psychiatric hospital-based service use is complex and cannot exclusively be explained by the child-, parental-, and socioeconomic-related variables examined in this study. Copyright © 2018 Elsevier Inc. All rights reserved.

The effects of simultaneous exercise and psychotherapy on depressive symptoms in inpatient, psychiatric older adults.

PubMed

Jacquart, Son D; Marshak, Helen H; Dos Santos, Hildemar; Luu, Sen M; Berk, Lee S; McMahon, Paul T; Riggs, Matt

2014-01-01

Depression is the leading cause of early death, affecting 15% of Americans older than 65 y and costing $43 billion each year. The current mental health service system for seniors, particularly for the population hospitalized in acute inpatient psychiatric units, is fragmented because of poor funding and a shift to a transitory health care paradigm, leading to inadequate treatment modalities, questionable quality of care, and lack of research demonstrating the superiority of a particular treatment. These issues are likely to lead to a public health crisis in the coming years. To investigate the effectiveness of combining exercise and psychotherapy in improving acute depressive symptoms among older adults who were receiving treatment in an inpatient psychiatric unit. Based on rolling admissions, inpatients were randomly assigned to 1 of 3 treatment groups. The study was blinded and controlled. This study took place in inpatient psychiatric units at the Loma Linda University's Behavioral Medicine Center (LLUBMC) in Redlands, California. Participants were 78 inpatients, aged 50-89 y. Participants in the simultaneous exercise and psychotherapy (STEP) group (n = 26) took part in exercise and received psychotherapy for 30 min per session, whereas those in the TALK group (n = 26) received individual psychotherapy for 30 min per session. Participants in the control group (n = 26) served as a comparison group, receiving standard therapy. The effects of the interventions were determined by assessing differences from baseline to postintervention in the symptomatology of all 3 groups. The research team also administered the Behavioral and Symptom Identification Scale (BASIS-32) and the Geriatric Depression Scale (GDS) pre- and postintervention. At posttest, the STEP group (M = 4.24, SE = 0.62) had a better response than the TALK group (M = 11.34, SE = 0.62, P < .001), which in turn showed greater improvement than the control group (M = 14.84, SE = 0.62, P < .001). Overall, these results indicate that patients' posttreatment depression scores were significantly lower in those receiving the STEP treatment compared with those receiving individual psychotherapy only or standard care. A short-term exercise program consisting of 30 min of walking in conjunction with individual psychotherapy was an effective intervention for depression among older adults in inpatient psychiatric units.

Psychiatric Service Use and Psychiatric Disorders in Adults with Intellectual Disability

ERIC Educational Resources Information Center

Bhaumik, S.; Tyrer, F. C.; McGrother, C.; Ganghadaran, S. K.

2008-01-01

Background: UK policies aim to facilitate access to general psychiatric services for adults with intellectual disability (ID). If this is to be achieved, it is important to have a clear idea of the characteristics and proportion of people with ID who currently access specialist psychiatric services and the nature and extent of psychiatric…

Prevalence of burnout among public health nurses in charge of mental health services and emergency care systems in Japan.

PubMed

Imai, Hirohisa; Nakao, Hiroyuki; Nakagi, Yoshihiko; Niwata, Satoko; Sugioka, Yoshihiko; Itoh, Toshihiro; Yoshida, Takahiko

2006-11-01

The Community Health Act came into effect in 1997 in Japan. This act altered the work system for public health nurses (PHNs) in public health centers (PHCs) nationwide from region-specific to service-specific work. Such major changes to working environment in the new system seem to be exposing PHNs to various types of stress. The present study examined whether prevalence of burnout is higher among PHNs in charge of mental health services (psychiatric PHNs) than among PHNs in charge of other services (non-psychiatric PHNs), and whether attributes of emergency mental health care systems in communities are associated with increased prevalence of burnout. A questionnaire including the Pines burnout scale for measuring burnout was mailed to 525 psychiatric PHNs and 525 non-psychiatric PHNs. The 785 respondents included in the final analysis comprised 396 psychiatric PHNs and 389 non-psychiatric PHNs. Prevalence of burnout was significantly higher for psychiatric PHNs (59.2%) than for non-psychiatric PHNs (51.5%). When prevalence of burnout in each group was analyzed in relation to question responses regarding emergency service and patient referral systems, prevalence of burnout for psychiatric PHNs displayed significant correlations to frequency of cases requiring overtime emergency services, difficulties referring patients, and a feeling of "restriction". Prevalence of burnout is high among psychiatric PHNs, and inadequate emergency mental health service systems contribute to burnout among these nurses. Countermeasures for preventing such burnout should be taken as soon as possible.

Expanding the Role of the School Psychologist in the Delivery of School-Based Mental Health Services

ERIC Educational Resources Information Center

Eklund, Katie; Vaillancourt, Kelly; Pedley, Trisha

2013-01-01

Approximately 20% of children in the United States experience significant mental, emotional, or behavioral symptoms that would qualify them for a psychiatric diagnosis (Burns et al., 1995; Costello et al., 2003). Unfortunately, only 15%-30% of these children receive any type of help or support (Ringel & Sturm, 2001; United States Public Health…

Race-ethnicity and gender differences in VA health care service utilization among U.S. veterans of recent conflicts.

PubMed

Koo, Kelly H; Madden, Erin; Maguen, Shira

2015-05-01

The purpose of this study was to compare health care utilization patterns by race-ethnicity and gender among veterans returning from Iraq and Afghanistan. A retrospective analysis was conducted with records from U.S. service members and veterans returning from Iraq and Afghanistan who enrolled in health care through the Veterans Health Administration, who received a psychiatric diagnosis, and who had used primary or mental health outpatient care between October 7, 2001, and December 31, 2012 (N=309,050). Racial-ethnic minority groups were first collapsed together and compared with whites and then separated by racial-ethnic group. Gender was also tested as a moderator of utilization. Although rates of mental health outpatient care, primary care, and emergency service utilization were relatively similar for racial-ethnic minority groups and whites, minority groups were admitted to psychiatric inpatient care at lower rates than whites. When veterans were separately categorized by specific racial-ethnic groups, some differences in utilization rates emerged; most notably, only black and Hispanic men were admitted less frequently to psychiatric inpatient care, and male and female Asian/Pacific Islander veterans used emergency services less, than their white counterparts. Gender moderated the association between race-ethnicity and mental health outpatient use, such that American Indian and Hispanic women used mental health outpatient services less than white women, but American Indian and Hispanic men showed the opposite pattern. Furthermore, black men were more likely than white men to use mental health outpatient services, but there was no difference between these women. Although service utilization rates between minority groups and whites were similar when minority groups were combined, examination of utilization by racial-ethnic groups and by men and women separately yielded more robust findings.

Misdiagnosis versus missed diagnosis: diagnosing autism spectrum disorder in adolescents.

PubMed

Aggarwal, Shilpa; Angus, Beth

2015-04-01

The diagnosis of children with autism spectrum disorders (ASDs) is sometimes delayed until adolescence. This study tries to identify the symptoms in clients that initiated a referral to an autism team of an early intervention service providing psychiatric care for young people between the ages of 15 and 25 and who subsequently receive a new diagnosis of autism. Thirty-one ASD assessments were carried out during a period of 3 years in an early intervention service in Australia. An attempt to identify the common presenting symptoms and trends in the referrals for ASD assessment within the service was made. Most common presentation of adolescents getting referred for ASD assessment was with depressive symptoms followed by mixed anxiety and depression and primary psychotic symptoms. There was a significant gender difference, with a higher number of males getting referred for ASD assessment. ASDs can go undetected during childhood and these clients can sometimes present during adolescence to mental health services for a psychiatric comorbidity. Regular training opportunities for clinicians dealing with them could improve the chances of ASDs being picked up during their episode of care at an early intervention service, thus optimizing their management. © The Royal Australian and New Zealand College of Psychiatrists 2015.

Current issues in Scandinavian acute psychiatric wards.

PubMed

Ruud, Torleif; Lindefors, Nils; Lindhardt, Anne

2006-01-01

The aim of the paper is to provide an overview of some of the most important issues faced by acute inpatient facilities in three Scandinavian countries, including reflections and critical remarks for discussion in this field. Information was drawn from scientific articles and official reports published in recent years, as well as the authors' own knowledge of acute facilities in their home countries. Acute inpatient facilities, including General Hospital Psychiatric Units (GHPUs), in all Scandinavian countries have several issues and problems in common, which include the organisation and capacity of acute services, the assessment of dangerousness and suicidality, the use of coercion and efforts to reduce coercion, the need to define and improve the quality of acute services, and the necessity to improve collaboration and continuity between acute services and other services. Although the emphasis some of these issues receive can vary across the three countries, Scandinavian mental health professionals (and policy makers) have begun to systematically share their experiences in developing a growing spirit of collaboration. Despite the role of welfare state and the deployment of substantial resources in Scandinavian countries, mental health practitioners are struggling to implement best practices in acute wards, to develop differentiated forms of acute services, and to reach the right balance and coordination between acute services and other services.

A Multisite Study of the Prevalence of HIV With Rapid Testing in Mental Health Settings

PubMed Central

Blank, Michael B.; Himelhoch, Seth S.; Balaji, Alexandra B.; Metzger, David S.; Dixon, Lisa B.; Rose, Charles E.; Oraka, Emeka; Davis-Vogel, Annet; Thompson, William W.; Heffelfinger, James D.

2014-01-01

Objectives. We estimated HIV prevalence and risk factors among persons receiving mental health treatment in Philadelphia, Pennsylvania, and Baltimore, Maryland, January 2009 to August 2011. Methods. We used a multisite, cross-sectional design stratified by clinical setting. We tested 1061 individuals for HIV in university-based inpatient psychiatric units (n = 287), intensive case-management programs (n = 273), and community mental health centers (n = 501). Results. Fifty-one individuals (4.8%) were HIV-infected. Confirmed positive HIV tests were 5.9% (95% confidence interval [CI] = 3.7%, 9.4%) for inpatient units, 5.1% (95% CI = 3.1%, 8.5%) for intensive case-management programs, and 4.0% (95% CI = 2.6%, 6.1%) for community mental health centers. Characteristics associated with HIV included Black race, homosexual or bisexual identity, and HCV infection. Conclusions. HIV prevalence for individuals receiving mental health services was about 4 times as high as in the general population. We found a positive association between psychiatric symptom severity and HIV infection, indicating that engaging persons with mental illness in appropriate mental health treatment may be important to HIV prevention. These findings reinforce recommendations for routine HIV testing in all clinical settings to ensure that HIV-infected persons receiving mental health services are identified and referred to timely infectious disease care. PMID:24524493

Regional supply of outreach service and length of stay in psychiatric hospital among patients with schizophrenia: National case mix data analysis in Japan.

PubMed

Niimura, Junko; Nakanishi, Miharu; Yamasaki, Syudo; Nishida, Atsushi

2017-12-01

Several clinical trials have demonstrated that linkage to an outreach service can prevent prolonged length of stay of patients at psychiatric hospitals. However, there has been no investigation of the association between length of stay in psychiatric hospital and regional supply of outreach services using national case mix data. The aim of this study was to clarify the relationship between length of stay in psychiatric hospital and regional supply of outreach services. We used data from the National Patient Survey in Japan, a nationally representative cross-sectional survey of inpatient care conducted every three years from 1996 to 2014. Data from 42,268 patients with schizophrenia who had been admitted to psychiatric hospitals were analyzed. After controlling for patient and regional characteristics, patients in regions with fewer number of visits for psychiatric nursing care at home had significantly longer length of stay in psychiatric hospitals. This finding implies that enhancement of the regional supply of outreach services would prevent prolonged length of stay in psychiatric hospitals. Copyright © 2017 Elsevier B.V. All rights reserved.

Factors affecting employment outcomes for people with disabilities who received Disability Employment Services in Taiwan.

PubMed

Jang, Yuh; Wang, Yun-Tung; Lin, Meng-Hsiu

2014-03-01

One of the most important rehabilitation goals is to return people with disabilities to paid employment. The purposes of this study were (1) to explore employment status and (2) to identify factors that may affect the employment outcomes of people with disabilities who received Disability Employment Services (DES). A retrospective study was conducted on clients who commenced and closed DES between January 2008 and December 2010 in a metropolitan city in Taiwan, using the files from the National Vocational Rehabilitation Services Documentary System. Sixty-nine percent (1,684 out of 2,452) of the clients in this study were engaged in paid employment after receiving DES. Logistic regression analyses indicated that clients with no psychiatric disability or mild impairment and with useful vocational qualifications, typical work experience, more post-employment services, and less pre-employment services were associated with a higher rate of successful employment outcomes. This study provides empirical evidence of the association between person- and DES-related factors and the employment outcomes of people with disabilities. Future improvements in health, school-to-work transition services, and vocational rehabilitation for people with disabilities should place more emphasis on providing work-based work experience, professional vocational training, access to college/professional education, career exploration, effective supported employment services, and other post-employment services.

Hemoperfusion in the treatment of acute clozapine intoxication in China.

PubMed

He, Jia-Li; Xiang, Yu-Tao; Li, Wen-Biao; Cai, Zhuo-Ji; Ungvari, Gabor Sandor

2007-12-01

No systematic study has focused on the characteristics and outcome of acute clozapine intoxication, although clozapine is the most widely used antipsychotic agent in China. The study reported herein examined the features of clozapine intoxication and the therapeutic effect of hemoperfusion (HP). In a retrospective chart review, the notes of 47 patients who attempted suicide by ingesting large amounts of clozapine and were treated at the only psychiatric emergency service in Beijing were analyzed. Of the 20 unconscious patients with plasma clozapine concentrations of more than 2000 ng/mL, 14 received a combination of HP and symptomatic treatment, whereas the other 6 and the remaining 27 patients received only symptomatic treatment. Patients' psychiatric conditions and both plasma clozapine and norclozapine concentrations were closely monitored and registered. One patient died of pulmonary edema and subsequent heart failure, but the rest of the patients recovered without any sequelae. Patients who received HP regained consciousness significantly faster than their counterparts with the same level of clozapine plasma concentration (>2000 ng/mL) who did not receive HP. A combination of HP and symptomatic treatment is the best therapeutic option when plasma clozapine concentration is high.

The Role of Psychiatric Diagnoses for Outcome After Hip and Knee Arthroplasty.

PubMed

Gylvin, Silas H; Jørgensen, Christoffer C; Fink-Jensen, Anders; Gislason, Gunnar H; Kehlet, Henrik

2017-12-01

Surgical patients receiving psychopharmacologic treatment have been associated with adverse outcomes in total hip and knee arthroplasty (THA and TKA). The purpose of this study was to investigate whether a specific high-risk group of patients receiving psychopharmacologic treatment could be identified based upon a nationwide psychiatric diagnosis register. From 7 different orthopedic centers, 8288 THA and TKA patients were included from January 2010 to November 2012 of which 943 (11.4%) received psychopharmacologic treatment. Patients receiving preoperative psychopharmacologic treatment were divided into 2 groups based on the presence or absence of a psychiatric diagnosis in a nationwide administrative database and analyzed with respect to length of hospital stay (LOS >4 days) and 30- and 90-day readmissions using multivariable logistic regression models. A total of 191 patients receiving psychopharmacologic treatment were registered with a psychiatric diagnosis while 752 patients received psychopharmacologic treatment without a registered psychiatric diagnosis. No significantly increased risk was found in patients with a preoperative registered psychiatric diagnosis compared to patients without, with regard to LOS >4 days (odds ratio [OR], 1.19; P = .51), 30-day readmission (OR, 0.56; P = .086), or 90-day readmission (OR, 0.81; P = .446), respectively. However, both groups had an increased risk of LOS >4 days and readmissions compared to a control population without psychopharmacologic treatment or any registered psychiatric diagnoses. No further risk was found for psychopharmacologically treated THA/TKA patients with an additional hospital-related psychiatric diagnosis compared to patients without, suggesting that the psychopharmacologic treatment per se is an outcome risk factor independent of severity of the psychiatric disorder. Copyright © 2017 Elsevier Inc. All rights reserved.

Psychiatric inpatient services in general hospitals.

PubMed

HUME, P B; RUDIN, E

1960-10-01

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

Integrated EAP/Managed Behavioral Health Plan Utilization by Persons with Substance Use Disorders

PubMed Central

Levy Merrick, Elizabeth S.; Hodgkin, Dominic; Hiatt, Deirdre; Horgan, Constance M.; Greenfield, Shelly F.; McCann, Bernard

2011-01-01

New federal parity and health reform legislation, promising increased behavioral health care access and a focus on prevention, has heightened interest in employee assistance programs (EAPs). This study investigated service utilization by persons with a primary substance use disorder (SUD) diagnosis in a managed behavioral healthcare organization's integrated EAP/managed behavioral health care product (N=1,158). In 2004, 25.0% of clients used the EAP first for new treatment episodes. After initial EAP utilization, 44.4% received no additional formal services through the plan and 40.4% received regular outpatient services. Overall, outpatient care, intensive outpatient/day treatment, and inpatient/residential detoxification were most common. About half of clients had co-occurring psychiatric diagnoses. Mental health service utilization was extensive. Findings suggest that for service users with primary SUD diagnoses in an integrated EAP/MBHC product, the EAP benefit plays a key role at the front end of treatment and is often only one component of treatment episodes. PMID:21185684

Integrated employee assistance program/managed behavioral health plan utilization by persons with substance use disorders.

PubMed

Merrick, Elizabeth S Levy; Hodgkin, Dominic; Hiatt, Deirdre; Horgan, Constance M; Greenfield, Shelly F; McCann, Bernard

2011-04-01

New federal parity and health reform legislation, promising increased behavioral health care access and a focus on prevention, has heightened interest in employee assistance programs (EAPs). This study investigated service utilization by persons with a primary substance use disorder (SUD) diagnosis in a managed behavioral health care (MBHC) organization's integrated EAP/MBHC product (N = 1,158). In 2004, 25.0% of clients used the EAP first for new treatment episodes. After initial EAP utilization, 44.4% received no additional formal services through the plan, and 40.4% received regular outpatient services. Overall, outpatient care, intensive outpatient/day treatment, and inpatient/residential detoxification were most common. About half of the clients had co-occurring psychiatric diagnoses. Mental health service utilization was extensive. Findings suggest that for service users with primary SUD diagnoses in an integrated EAP/MBHC product, the EAP benefit plays a key role at the front end of treatment and is often only one component of treatment episodes. Copyright © 2011 Elsevier Inc. All rights reserved.

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…

The effects of housing stability on service use among homeless adults with mental illness in a randomized controlled trial of housing first.

PubMed

Kerman, Nick; Sylvestre, John; Aubry, Tim; Distasio, Jino

2018-03-20

Housing First is an effective intervention to stably house and alter service use patterns in a large proportion of homeless people with mental illness. However, it is unknown whether there are differences in the patterns of service use over time among those who do or do not become stably housed and what effect, if any, Housing First has on these differing service use patterns. This study explored changes in the service use of people with mental illness who received Housing First compared to standard care, and how patterns of use differed among people who did and did not become stably housed. The study design was a multi-site randomized controlled trial of Housing First, a supported housing intervention. 2039 participants (Housing First: n = 1131; standard care: n = 908) were included in this study. Outcome variables include nine types of self-reported service use over 24 months. Linear mixed models examined what effects the intervention and housing stability had on service use. Participants who achieved housing stability, across the two groups, had decreased use of inpatient psychiatric hospitals and increased use of food banks. Within the Housing First group, unstably housed participants spent more time in prison over the study period. The Housing First and standard care groups both had decreased use of emergency departments and homeless shelters. The temporal service use changes that occurred as homeless people with mental illness became stably housed are similar for those receiving Housing First or standard care, with the exception of time in prison. Service use patterns, particularly with regard to psychiatric hospitalizations and time in prison, may signify persons who are at-risk of recurrent homelessness. Housing support teams should be alert to the impacts of stay-based services, such as hospitalizations and incarcerations, on housing stability and offer an increased level of support to tenants during critical periods, such as discharges. ISRCTN. ISRCTN42520374 . Registered 18 August 2009.

Lessons from the Deployment of the SPIRIT App to Support Collaborative Care for Rural Patients with Complex Psychiatric Conditions

PubMed Central

Bauer, Amy M.; Hodsdon, Sarah; Hunter, Suzanne; Choi, Youlim; Bechtel, Jared; Fortney, John C.

2017-01-01

We report the design and deployment of a mobile health system for patients receiving primary care-based mental health services (Collaborative Care) for post-traumatic stress disorder and/or bipolar disorder in rural health centers. Here we describe the clinical model, our participatory approach to designing and deploying the mobile system, and describe the final system. We focus on the integration of the system into providers’ clinical workflow and patient registry system. We present lessons learned about the technical and training requirements for integration into practice that can inform future efforts to incorporate health technologies to improve care for patients with psychiatric conditions. PMID:29075683

The role of the nurse practitioner in psychiatric/mental health nursing: exploring consumer satisfaction.

PubMed

Wortans, J; Happell, B; Johnstone, H

2006-02-01

There is a substantial body of literature pertaining to the role of the nurse practitioner. Research directed towards consumer satisfaction suggests that the care provided by nurse practitioners is perceived as at least equal to that provided by a medical practitioner. However, there is a paucity of literature examining the nurse practitioner role in the psychiatric/mental health field. An evaluation of a Nurse Practitioner demonstration model has recently been undertaken in the Crisis, Assessment and Treatment Team in Victoria, Australia. This article presents the findings of a qualitative, exploratory study. Individual interviews were conducted with consumers (n = 7) who had received care and treatment provided by the nurse practitioner candidate. Data analysis revealed two main themes: the quality of the service provided, and the unique role of the nurse. The findings supported the available literature in articulating the specific aspects of the nurse practitioner role that are favourably perceived by consumers of services. This study contributes to the limited body of knowledge in the psychiatric/mental health nursing field and specifically emphasizes the importance of the relationship between nurse practitioner and consumer in facilitating the provision of effective care and treatment.

42 CFR 441.151 - General requirements.

Code of Federal Regulations, 2010 CFR

2010-10-01

... Inpatient Psychiatric Services for Individuals Under Age 21 in Psychiatric Facilities or Programs § 441.151 General requirements. (a) Inpatient psychiatric services for individuals under age 21 must be: (1) Provided under the direction of a physician; (2) Provided by— (i) A psychiatric hospital that undergoes a...

Mental disorder and clinical care in people convicted of homicide: national clinical survey

PubMed Central

Shaw, Jenny; Appleby, Louis; Amos, Tim; McDonnell, Ros; Harris, Catherine; McCann, Kerry; Kiernan, Katy; Davies, Sue; Bickley, Harriet; Parsons, Rebecca

1999-01-01

Objectives To estimate the rate of mental disorder in those convicted of homicide and to examine the social and clinical characteristics of those with a history of contact with psychiatric services. Design National clinical survey. Setting England and Wales. Subjects Eighteen month sample of people convicted of homicide. Main outcome measures Offence related and clinical information collected from psychiatric court reports on people convicted of homicide. Detailed clinical data collected on those with a history of contact with psychiatric services. Results 718 homicides were reported to the inquiry between April 1996 and November 1997. Of the 500 cases for whom psychiatric reports were retrieved, 220 (44%; 95% confidence interval 40% to 48%) had a lifetime history of mental disorder, while 71 (14%; 11% to 17%) had symptoms of mental illness at the time of the homicide. Of the total sample, 102 (14%; 12% to 17%) were confirmed to have been in contact with mental health services at some time, 58 (8%; 6% to 10%) in the year before the homicide. The commonest diagnosis was personality disorder (20 cases, 22%; 13% to 30%). Alcohol and drug misuse were also common. Only 15 subjects (18%; 10% to 26%) were receiving intensive community care, and 60 (63%; 53% to 73%) were out of contact at the time of the homicide. Conclusions There are substantial rates of mental disorder in people convicted of homicide. Most do not have severe mental illness or a history of contact with mental health services. Inquiry findings suggest that preventing loss of contact with services and improving the clinical management of patients with both mental illness and substance misuse may reduce risk, but clinical trials are needed to examine the effectiveness of such interventions. Key messagesPeople convicted of homicide have substantial rates of mental disorderMost do not have severe mental illness or a history of contact with mental health servicesMental health services need to prevent loss of contact with patientsThe clinical management of patients with both mental illness and substance misuse needs to be improved PMID:10231252

Does Integrated Behavioral Health Care Reduce Mental Health Disparities for Latinos? Initial Findings

PubMed Central

Bridges, Ana J.; Andrews, Arthur R.; Villalobos, Bianca T.; Pastrana, Freddie A.; Cavell, Timothy A.; Gomez, Debbie

2014-01-01

Integrated behavioral health care (IBHC) is a model of mental health care service delivery that seeks to reduce stigma and service utilization barriers by embedding mental health professionals into the primary care team. This study explored whether IBHC service referrals, utilization, and outcomes were comparable for Latinos and non-Latino White primary care patients. Data for the current study were collected from 793 consecutive patients (63.8% Latino; M age = 29.02 years [SD = 17.96]; 35.1% under 18 years; 65.3% women; 54.3% uninsured) seen for behavioral health services in 2 primary care clinics during a 10.5 month period. The most common presenting concerns were depression (21.6%), anxiety (18.5%), adjustment disorder (13.0%), and externalizing behavior problems (9.8%). Results revealed that while Latino patients had significantly lower self-reported psychiatric distress, significantly higher clinician-assigned global assessment of functioning scores, and fewer received a psychiatric diagnosis at their initial visit compared to non-Latino White patients, both groups had comparable utilization rates, comparable and clinically significant improvements in symptoms (Cohen’s d values > .50), and expressed high satisfaction with integrated behavioral services. These data provide preliminary evidence suggesting integration of behavioral health services into primary care clinics may help reduce mental health disparities for Latinos. PMID:25309845

Identification and treatment of patients with nicotine problems in routine clinical psychiatry practice.

PubMed

Montoya, Ivan D; Herbeck, Diane M; Svikis, Dace S; Pincus, Harold Alan

2005-01-01

The aim of this study is to assess the rates of nicotine problems diagnosed by psychiatrists, the characteristics of psychiatric patients who smoke, and the services provided to them in routine psychiatric practice. Data were obtained by asking psychiatrists participating in the American Psychiatric Institute for Psychiatric Research and Education's Practice Research Network to complete a self-administered questionnaire to provide detailed sociodemographic, clinical, and health plan information on three of their patients seen during routine clinical practice. A total of 615 psychiatrists provided information on 1,843 patients, of which 280 (16.6%) were reported to have a current nicotine problem. Of these, 9.1% were reported to receive treatment for nicotine dependence. Patients with nicotine problems were significantly more likely to be males, divorced or separated, disabled, and uninsured, and have fewer years of education. They also had significantly more co-morbid psychiatric disorders, particularly schizophrenia or alcohol/substance use disorders; a lower Global Assessment Functioning score; and poorer treatment compliance than their counterparts. The results suggest a very low rate of identification and treatment of nicotine problems among patients treated by psychiatrists, even though psychiatric patients who smoke seem to have more clinical and psychosocial stressors and more severe psychiatric problems than those who do not smoke. Programs should be developed to raise the awareness and ability of psychiatrists to diagnose and treat patients with nicotine problems, with a particular emphasis on the increased medical and psychosocial needs of psychiatric patients who smoke.

Cognitive Predictors of Work Among Social Security Disability Insurance Beneficiaries With Psychiatric Disorders Enrolled in IPS Supported Employment.

PubMed

McGurk, Susan R; Drake, Robert E; Xie, Haiyi; Riley, Jarnee; Milfort, Roline; Hale, Thomas W; Frey, William

2018-01-13

Impaired cognitive functioning is a significant predictor of work dysfunction in schizophrenia. Less is known, however about relationships of cognition and work in people with less severe disorders with relatively normal cognitive functioning. This secondary analysis evaluated cognitive predictors of work in Social Security Disability Insurance (SSDI) beneficiaries with a recent work history who were randomized to receive mental health services, supported employment, and freedom from work disincentives over a 2-year study period in the Mental Health Treatment Study. Of the 1045 participants randomized to the treatment package, 945 (90.4%) received a cognitive assessment at study entry. Competitive work activity was evaluated using a computer-assisted timeline follow-back calendar at baseline and quarterly for 24 months. Mood disorders were the most common psychiatric diagnoses (64.9%), followed by schizophrenia or schizoaffective disorder (35.1%). Tobit regression analyses predicting the average number of hours worked per week, controlling for demographic characteristics, diagnosis, and work history indicated that the cognitive composite score (P < .01) and verbal learning subscale scores (P < .001) were associated with fewer hours of weekly work over the study period. Cognitive functioning predicted work over 2 years in SSDI beneficiaries with mood or schizophrenia-spectrum disorders who were receiving supported employment and mental health interventions, despite a relative absence of cognitive impairment in the study participants. The findings suggest cognitive functioning contributes to competitive work outcomes in persons with psychiatric disorders who have relatively unimpaired cognitive abilities, even under optimal conditions of treatment and vocational support. © The Author(s) 2017. Published by Oxford University Press on behalf of the Maryland Psychiatric Research Center. All rights reserved. For permissions, please email: journals.permissions@oup.com.

. . . On foster care International Society of Psychiatric-Mental Health Nurses.

PubMed

Galehouse, Pam; Herrick, Charlotte; Raphel, Sally

2010-02-01

Mental health problems are particularly widespread for foster children. There are approximately 700,000 youth in foster care and nonfamily settings in the United States. The mean entry age is 3 years. The average stay is 2 years. Experts estimate that between 30% and 85% of youngsters in out-of-home care have significant emotional disturbances. Foster care children represent 5% of Medicaid enrollees but use approximately 40% of Medicaid funds. A substantial number of these children have psychological problems so serious that they require residential placement. Adolescents living with foster parents or in group homes have about four times the rate of serious psychiatric disorders than those living with their own families (2009a). Despite this level of need, less than one-third of children in the child protective system are receiving mental health services (2009a). Child psychiatric nurse advocates from the Association of Child and Adolescent Psychiatric Nurses Division of the International Society of Psychiatric-Mental Health Nurses compiled this position statement for adoption by the Board of Directors as the Association's formal statement on the plight of children and adolescents in foster care. Areas that need to be addressed include (a) lack of consistent and comprehensive service planning; (b) communications across agencies and with the youth, their foster parents, and key stakeholders; (c) use of evidence-based interventions to prevent and reduce the incidence of disability; (d) education of child welfare case workers about mental and emotional therapeutic management; and (e) education of foster parents and youth about mental health issues and appropriate treatments.

Competency of Psychiatric Residents in the Treatment of People with Severe Mental Illness before and after a Community Psychiatry Rotation

ERIC Educational Resources Information Center

Randall, Melinda; Romero-Gonzalez, Mauricio; Gonzalez, Gerardo; Klee, Anne; Kirwin, Paul

2011-01-01

Objective: Psychiatric rehabilitation is an evidence-based service with the goal of recovery for people with severe mental illness. Psychiatric residents should understand the services and learn the principles of psychiatric rehabilitation. This study assessed whether a 3-month rotation in a psychiatric rehabilitation center changes the competency…

Predeployment and in-theater diagnoses of American military personnel serving in Iraq.

PubMed

Larson, Gerald E; Hammer, Paul S; Conway, Terry L; Schmied, Emily A; Galarneau, Michael R; Konoske, Paula; Webb-Murphy, Jennifer A; Schmitz, Kimberly J; Edwards, Nathan; Johnson, Douglas C

2011-01-01

This purpose of this study was to determine the incidence and types of preexisting mental disorders among military personnel who received mental health services in an Iraqi war zone. The study examined psychiatric histories of 1,078 American military personnel (Marines, 65%; Army, 23%; Navy, 11%; and Air Force, <1%) deployed to Iraq and seen by in-theater mental health providers between January 2006 and February 2007. Among the 1,078 patients, the most frequent in-theater diagnoses were anxiety (24%), adjustment (23%), and mood (19%) disorders. Twenty-nine percent of the sample (N=308) had a psychiatric diagnosis in their medical records before their first encounter with mental health services in Iraq (Navy patients, 42%; Army patients, 39%; and Marine Corps patients, 23%). The mean time between last predeployment diagnosis and first in-theater mental health encounter was 21 months. For patients with a prior diagnosis, the highest rate of relapse (receipt of the same diagnosis in theater) was for attention-deficit hyperactivity disorder (57%), followed by anxiety disorders (44%)--especially posttraumatic stress disorder (PTSD) (55%)--mood disorders (38%), and adjustment disorders (32%). A significant proportion of military personnel who experienced mental health problems in a combat zone had preexisting psychiatric conditions. Because more than half of predeployment diagnoses were received in the nine months before the in-theater mental health encounter, further study may be advisable to determine whether a time-based algorithm for deployability is needed, particularly for PTSD, for which a high rate of repeat diagnosis in theater was found.

[Shift of usage of medical psychiatric and psychosocial services in Upper Austria (whole territory of Austria) in the period 1965-2005].

PubMed

Hofmann, Gustav; Schöny, Werner; Donabauer, Rita; Rachbnauer, Christian

2005-06-01

Psychiatric reforms in Upper Austria have considerably improved the quality of life of psychiatric patients. Modernizing the status of acute psychiatric departments based on a bio- psycho-, social concept implemented multidimensional approach in diagnostics and therapeutic methods applied by multiprofessional teams. Prophylactic procedures and rehabilitation programs have minimized chronification of psychiatric diseases. By "late rehabilitation programs" increased autonomy, more individualized planning of life processes could be achieved even with "chronic" patients. We do not see any need to confine "chronic" psychiatric patients in psychiatric hospitals. These patients are cared for, socially integrated by special rehabilitation measures and professional rehabilitation in community-based services and units of Pro Mente Upper Austria--a non-profit organization. Problems decreased the duration of stay in psychiatric hospitals, and increased admission rates when the number of beds in psychiatric departments was considerably decreased in the course of psychiatric reforms in Austria. In our province--Upper Austria--these problems are of lesser importance because private non-profit organizations like Pro Mente Upper Austria have provided a variety of community-based services (mental health centres, day clinics, housing facilities and special services for drug addicts and geriatric patients) in ever increasing numbers. Still there is the need for further development of community-based services provided by specially trained professionals. These services are financed mainly by the state, the provincial government, the labour market services and to a small degree by funds of the European Union. In these days of reduced social budgets of the state and social departments of provincial governments it is not easy to keep our standards and meet the increased needs of our clients.

[Service use patterns among adults with mental health problems in Chile].

PubMed

Vicente, Benjamín; Kohn, Robert; Saldivia, Sandra; Rioseco, Pedro; Torres, Silverio

2005-01-01

To describe the patterns in the use of general health services and specialized health services among adults with mental health problems in Chile, as well as those persons' level of satisfaction with the services. The overall objective was to optimize the use of the limited resources available for mental health care in the countries of the Americas, especially Chile. The diagnoses and the patterns of use of mental health services were obtained from the Chilean Study of Psychiatric Prevalence (Estudio Chileno de Prevalencia Psiquiátrica). That representative research on the adult population of Chile was based on a stratified random sample of 2,987 people 15 years old and older, done over the period of 1992 to 1999. The psychiatric diagnoses were obtained using the Composite International Diagnostic Interview (CIDI). The interviewees were also asked about their use of general health care services and of mental health services in the preceding six months, as well as any barriers to accessing the services. More than 44% of the interviewees had had contact with some type of health service during the six months prior to the study, but only 5.6% received specialized care. Those who presented with a diagnosis of obsessive-compulsive disorder or of panic disorder consulted more frequently, but not in specialized centers. Consumption of substances such as alcohol and drugs as well as antisocial personality disorder were associated with a low level of consultation. When asked about sources of assistance for mental health problems, the majority of the interviewees mentioned only the formal health care system. More than 75% of the interviewees said that they were satisfied or very satisfied with the care that they had received. Our results confirm the existence of a wide gap between the need for care and the treatment that is actually received. The informal and folkloric alternative resources (priests, family members, healers, herbalists, etc.) were used less frequently than is generally believed to be true. The indirect barriers of access to services--linked to a lack of knowledge and to stigma--were more frequent than were the direct barriers. A sizable number of people who did not have a positive diagnosis on the CIDI utilized mental health services.

Closing service system gaps for homeless clients with a dual diagnosis: integrated teams and interagency cooperation.

PubMed

Rosenheck, Robert A; Resnick, Sandra G; Morrissey, Joseph P

2003-06-01

There is great concern about fragmentation of mental health service delivery, especially for dually diagnosed homeless people, and apprehension that such fragmentation adversely affects service access and outcomes. This study first seeks to articulate two alternative approaches to the integration of psychiatric and substance abuse services, one involving an integrated team model and the other a collaborative relationship between agencies. It then applies this conceptualization to a sample of dually diagnosed homeless people who participated in the ACCESS demonstration. Longitudinal outcome data were obtained through interviews at baseline, 3 months, and 12 months with homeless clients with a dual diagnosis (N = 1074) who received ACT-like case management services through the ACCESS demonstration. A survey of ACCESS case managers was conducted to obtain information on: (i) the proportion of clients who received substance abuse services directly from ACCESS case management teams, and the proportion who received services from other agencies; and (ii) the perceived quality of the relationship (i.e. communication, cooperation and trust) between providers--both within the same teams and between agencies. Hierarchical linear modeling was then used to examine the relationship of these two factors to service use and outcome with mixed-model regression analysis. Significant (p<.05) and positive relationships were observed in 4 of the 20 analyses of the association of service use and measures of communication, cooperation, and trust (either intrateam or inter-agency) while none were significant and negative. At 12 months, receipt of a higher proportion of services from agencies other than the ACCESS team was associated with fewer days homeless, and greater reduction of psychiatric symptoms, contradicting the hypothesis that integrated team care is more effective than interagency collaborations. This study broadens the conceptual framework for addressing service system fragmentation by considering both single team integration and interagency coordination, and by considering both program structure and the quality of relationships between providers. Data from a multi-site outcome study demonstrated suggestive associations between perceptions of communication, cooperation and measures of clinical service use. However, the proportion of clients treated entirely within a single team was associated with poorer housing and psychiatric outcomes. These empirical results must be regarded as illustrative rather than conclusive because of the use of a non-experimental study design, imperfections in the available measures, and the incomplete sampling of case managers. This study suggests that fragmentation of services for dually diagnosed clients may be reduced by improving the interactions within and between agencies providing these services. While primary emphasis has been placed on developing integrated teams, interagency approaches should not be prematurely excluded. Research on approaches to reducing system fragmentation have focused on either global efforts to integrate numerous agencies in a community or highly focused efforts to develop specialized teams. Future research should also focus on the possibility of fostering constructive relationships between selected pairs or subsets of agencies. Research in this area will also benefit from the further development measures of team integration and of both intra-team and inter-agency communication, collaboration, and trust.

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

Code of Federal Regulations, 2010 CFR

2010-10-01

... other than psychiatric hospitals. 424.13 Section 424.13 Public Health CENTERS FOR MEDICARE & MEDICAID... other than psychiatric hospitals. (a) Content of certification and recertification. Medicare Part A pays for inpatient hospital services of hospitals other than psychiatric hospitals only if a physician...

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

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 5 2010-10-01 2010-10-01 false Condition of participation: psychiatric and... Condition of participation: psychiatric and rehabilitation distinct part units. (a) Conditions. (1) If a CAH provides inpatient psychiatric services in a distinct part unit, the services furnished by the distinct...

75 FR 71441 - Universal Health Services, Inc. and Psychiatric Solutions, Inc.; Analysis of Agreement Containing...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-11-23

... FEDERAL TRADE COMMISSION [File No. 101 0142] Universal Health Services, Inc. and Psychiatric Solutions, Inc.; Analysis of Agreement Containing Consent Orders To Aid Public Comment AGENCY: Federal Trade... Health Services, Inc. (collectively, ``UHS'') and Psychiatric Solutions, Inc. (``PSI''). The purpose of...

[Historic evolution of psychiatric care paradigms].

PubMed

Gabay, Pablo M; Fernández Bruno, Mónica

2017-09-01

The rehabilitation of severely mentally-ill patients and their return to the community are related to historical progress. Their potential of achieving these goals is higher or lower depending on the presence of more or less stigma attached to their condition. Watts and Bennett have divided psychiatric rehabilitation into three phases: Phase 1: Very little was done because there was not much to be done. Patients were rejected and received mistreatment. Phase 2: Their vulnerability was admitted and protection was given to the disabled; services were provided by charity and voluntary religious institutions; there was no clear distinction between illness and poverty. Phase 3: Modern psychiatric rehabilitation began after the two World Wars in the 20th century, with attempts to modify and to oppose disability with the development of other skills. Psychiatric rehabilitation programs help these patients to resume life in the community and prevent their social isolation. By ensuring continuity of their treatment, rehabilitation programs reduce relapses and hospitalizations, thereby contributing to preserve family life and social inclusion. This reduces treatment costs to both families and communities, while promoting patients' reinsertion and recovery in the community according to their individual needs.

Psychiatric Medication Intake in Suicide Victims: Gender Disparities and Implications for Suicide Prevention.

PubMed

Paraschakis, Antonios; Michopoulos, Ioannis; Christodoulou, Christos; Koutsaftis, Filippos; Douzenis, Athanassios

2016-11-01

Frequency and gender differences of psychiatric medication intake in a sample of suicide victims from the Athens Greater Area were investigated with a particular focus on the implications for suicide prevention. Data were collected from the toxicological analyses of the suicide cases of the period November 2007-October 2009. Information was available for 262 individuals, 196 men (74.8%) and 66 women (25.2%); 109 of these (41.6%) were receiving psychiatric medication(s). Women were statistically more frequently under treatment: antidepressants (32.8% vs. 11.3%, p < 0.001), antiepileptics (9.1% vs. 0.5%, p = 0.001), antipsychotics (24.2% vs. 9.2%, p = 0.003), and benzodiazepines (16.7% vs. 6.6%, p = 0.024). Campaigns aiming to bring men with psychological difficulties in contact with mental health services and to lessen the stigma of mental illness, together with better training of nonpsychiatrists into "suspecting" "male" depression, could be particularly helpful for decreasing male suicides. More thoughtful choice of psychiatric medication could possibly already prevent a number of female suicides. © 2016 American Academy of Forensic Sciences.

[TANDEM (TAsk force oN long Duration unemployment of Elderly People and Mental health) implementation of a cross-institutional pilot project for elderly long-term unemployed persons - presentation of the project procedure and the utilisation].

PubMed

Steil, C; Meiler, B; Wiesten, I; Wiltfang, J; Kis, B

2013-08-01

The aim of this study is to implement and examine the feasibility of a cross-institutional mental health intervention to comprehend and advance mental health of elderly long-term unemployed persons. Report on the procedure and on the observational study utilisation in a 14-month period. The structure and processes chosen could be implemented into practice successfully. Utilisation was high but 30% dropped out during the procedure. Of the unemployed persons surveyed, 96% received a psychiatric diagnosis. 85% were not having psychiatric treatment. The method chosen is feasible and was accepted by the target group. Project structure and processes proved to be applicable for the implementation of the project aims. The method chosen reaches an up to now "psychiatry-inexperienced" target group characterised by frequent incidence of mental disorders and low utilisation of psychiatric care. Thus, vocational reintegration programmes should be supported by psychiatric services. © Georg Thieme Verlag KG Stuttgart · New York.

Short Text Messages to Encourage Adherence to Medication and Follow-up for People With Psychosis (Mobile.Net): Randomized Controlled Trial in Finland.

PubMed

Välimäki, Maritta; Kannisto, Kati Anneli; Vahlberg, Tero; Hätönen, Heli; Adams, Clive E

2017-07-12

A text messaging service (short message service [SMS]) has the potential to target large groups of people with long-term illnesses such as serious mental disorders, who may have difficulty with treatment adherence. Robust research on the impact of mobile technology interventions for these patients remains scarce. The main objective of our study was to investigate the impact of individually tailored short text messages on the rate of psychiatric hospital readmissions, health care service use, and clinical outcomes. In addition, we analyzed treatment costs. Between September 2011 and November 2012, we randomly assigned 1139 people to a tailored text message intervention (n=569) or usual care (n=570). Participants received semiautomated text messages for up to 12 months or usual care. The primary outcome, based on routinely collected health register data, was patient readmission into a psychiatric hospital during a 12-month follow-up period. Secondary outcomes were related to other service use, coercion, medication, adverse events, satisfaction, social functioning, quality of life, and economic factors (cost analysis). There was 98.24% (1119/1139) follow-up at 12 months. Tailored mobile telephone text messages did not reduce the rate of hospital admissions (242/563, 43.0% of the SMS group vs 216/556, 38.8% of the control group; relative risk 1.11; 95% CI 0.92-1.33; P=.28), time between hospitalizations (mean difference 7.0 days 95% CI -8.0 to 24.0; P=.37), time spent in a psychiatric hospital during the year (mean difference 2.0 days 95% CI -2.0 to 7.0; P=.35), or other service outcomes. People who received text messages were less disabled, based on Global Assessment Scale scores at the time of their readmission, than those who did not receive text messages (odds ratio 0.68; 95% CI 0.47-0.97; P=.04). The costs of treatment were higher for people in the SMS group than in the control group (mean €10,103 vs €9210, respectively, P<.001). High-grade routinely collected data can provide clear outcomes for pragmatic randomized trials. SMS messaging tailored with the input of each individual patient did not decrease the rate of psychiatric hospital visits after the 12 months of follow-up. Although there may have been other, more subtle effects, the results of these were not evident in outcomes of agreed importance to clinicians, policymakers, and patients and their families. International Standard Randomized Controlled Trial Number (ISRCTN): 27704027; http://www.isrctn.com/ISRCTN27704027 (Archived by WebCite at http://www.webcitation.org/6rVzZrbuz). ©Maritta Välimäki, Kati Anneli Kannisto, Tero Vahlberg, Heli Hätönen, Clive E Adams. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 12.07.2017.

Effectiveness of collaborative stepped care for anxiety disorders in primary care: a pragmatic cluster randomised controlled trial.

PubMed

Muntingh, Anna; van der Feltz-Cornelis, Christina; van Marwijk, Harm; Spinhoven, Philip; Assendelft, Willem; de Waal, Margot; Adèr, Herman; van Balkom, Anton

2014-01-01

Collaborative stepped care (CSC) may be an appropriate model to provide evidence-based treatment for anxiety disorders in primary care. In a cluster randomised controlled trial, the effectiveness of CSC compared to care as usual (CAU) for adults with panic disorder (PD) or generalised anxiety disorder (GAD) in primary care was evaluated. Thirty-one psychiatric nurses who provided their services to 43 primary care practices in the Netherlands were randomised to deliver CSC (16 psychiatric nurses, 23 practices) or CAU (15 psychiatric nurses, 20 practices). CSC was provided by the psychiatric nurses (care managers) in collaboration with the general practitioner and a consultant psychiatrist. The intervention consisted of 3 steps, namely guided self-help, cognitive behavioural therapy and antidepressants. Anxiety symptoms were measured with the Beck Anxiety Inventory (BAI) at baseline and after 3, 6, 9 and 12 months. We recruited 180 patients with a DSM-IV diagnosis of PD or GAD, of whom 114 received CSC and 66 received usual primary care. On the BAI, CSC was superior to CAU [difference in gain scores from baseline to 3 months: -5.11, 95% confidence interval (CI) -8.28 to -1.94; 6 months: -4.65, 95% CI -7.93 to -1.38; 9 months: -5.67, 95% CI -8.97 to -2.36; 12 months: -6.84, 95% CI -10.13 to -3.55]. CSC, with guided self-help as a first step, was more effective than CAU for primary care patients with PD or GAD.

The mental health needs of military service members and veterans.

PubMed

Lazar, Susan G

2014-09-01

The prevalence in active duty military service members of 30-day DSM-IV psychiatric disorders, including posttraumatic stress disorders and major depressive disorder, is greater than among sociodemographically-matched civilians. Only 23-40% of returning military who met strict criteria for any mental health problem in 2004 had received professional help in the past year. One-fourth of Regular Army soldiers meet criteria for a 30-day DSM-IV mental disorder, two-thirds of whom report a pre-enlistment age of onset. Both pre- and post-enlistment age of onset are predictors of severe role impairment which was reported by 12.8% of respondents. In addition, three-fifths of those with severe role impairment had at least one psychiatric diagnosis. The number of deployments, especially three or more, is positively correlated with all disorders, especially major depressive disorder, bipolar disorder, generalized anxiety disorder, posttraumatic stress disorder, and intermittent explosive disorder. Patients with posttraumatic stress disorder and major depressive disorder frequently have comorbidity with other psychiatric diagnoses and an increased death rate from homicide, injury, and cardiovascular disease, and are at increased risk of medical illness, smoking and substance abuse, decreased employment and work productivity, marital and family dysfunction and homelessness. Active duty suicides have increased from a rate lower than among civilians to one exceeding that in civilians in 2008. Suicides among veterans climbed to 22 per day in 2010 with male veterans having twice the risk of dying from suicide as their civilian counterparts. Associated extremely high costs of psychiatric illness in decreased productivity and increased morbidity and mortality can be ameliorated with appropriate treatment which is not yet fully available to veterans in need. In addition, Veterans Administration/Department of Defense treatment guidelines to date do not recognize the need for intensive and extended psychotherapies for chronic complex psychiatric conditions including personality disorders and chronic anxiety and depressive disorders. It has been suggested that treatment should be available for all military service member mental illness regardless of whether or not it predates military service, a goal which remains distant.

Descriptive Analysis of a Novel Health Care Approach: Reverse Colocation—Primary Care in a Community Mental Health “Home”

PubMed Central

Sirna, Megan; Mangurian, Christina; Dilley, James W.; Shumway, Martha

2013-01-01

Objective: Persons with serious mental illness have increased rates of chronic medical conditions, have limited access to primary care, and incur significant health care expenditures. Few studies have explored providing medical care for these patients in the ambulatory mental health setting. This study describes a real-world population of mental health patients receiving primary care services in a community mental health clinic to better understand how limited primary care resources are being utilized. Method:Chart review was performed on patients receiving colocated primary care (colocation group, N = 143) and randomly chosen patients receiving mental health care only (mental-health group, N = 156) from January 2006 through June 2011. Demographic and mental and physical health variables were assessed. Results: Compared to the mental-health group, the colocation patients had more psychiatric hospitalizations (mean = 1.07 vs 0.23, P < .01), were more likely to be homeless (P < .01), and were more likely to require intensive case management (P < .01). Interestingly, the colocation group was not more medically ill than the mental-health group on key metabolic measures, including mean body mass index (colocation = 27.8 vs mental-health = 28.7, P = .392), low-density liprotein (colocation = 110.0 vs mental-health = 104.4, P = .480), and glucose (colocation = 94.1 vs mental-health = 109.2, P = .059). The most common medical disorders in the colocation group were related to metabolic syndrome. Conclusions: Colocated primary care services were allocated on the basis of severity of psychiatric impairment rather than severity of medical illness. This program serves as a model for other systems to employ for integrated primary and behavioral health services for patients with serious mental illness. PMID:24511447

What is the impact of socio-economic inequalities on the use of mental health services?

PubMed

Amaddeo, Francesco; Jones, Julia

2007-01-01

Amartya Sen, who received the Nobel Prize for Economics, has demonstrated that the incidence of deprivation, in terms of capability, can be surprisingly high even in the most developed countries of the world. The study of socio-economic inequalities, in relation to the utilisation of health services, is a priority for epidemiological research. Socio-economic status (SES) has no universal definition. Within the international research literature, SES has been related to social class, social position, occupational status, educational attainment, income, wealth and standard of living. Existing research studies have shown that people from a more deprived social background, with a lower SES, are more likely to have a higher psychiatric morbidity. Many studies show that SES influences psychiatric services utilization, however the real factors linking SES and mental health services utilisation remain unclear. In this editorial we discuss what is currently known about the relationship between SES and the use of mental health services. We also make an argument for why we believe there is still much to uncover in this field, to understand fully how individuals are influenced by their personal socio-economic status, or the neighbourhood in which they live, in terms of their use of mental health services. Further research in this area will help clarify what interventions are required to provide greater equality in access to mental health services.

Ethnic Disparities in School-Based Behavioral Health Service Use for Children with Psychiatric Disorders

ERIC Educational Resources Information Center

Locke, Jill; Kang-Yi, Christina D.; Pellecchia, Melanie; Marcus, Steven; Hadley, Trevor; Mandell, David S.

2017-01-01

Background: We examined racial/ethnic disparities in school-based behavioral health service use for children with psychiatric disorders. Methods: Medicaid claims data were used to compare the behavioral healthcare service use of 23,601 children aged 5-17 years by psychiatric disorder (autism, attention deficit hyperactivity disorder [ADHD],…

Emergency Presentations to an Inner-City Psychiatric Service for Children and Adolescents

ERIC Educational Resources Information Center

Dil, L. M.; Vuijk, P. J.

2012-01-01

Psychiatric emergency services for children and adolescents vary in process, structure and outcome. There are few systematic studies on the type and prevalence of psychiatric problems encountered, related circumstances or resulting interventions. Evidence in these areas is important in evaluation of the function of mental health services in the…

Cost-effectiveness of smoking cessation treatment initiated during psychiatric hospitalization: analysis from a randomized, controlled trial

PubMed Central

Barnett, Paul G.; Wong, Wynnie; Jeffers, Abra; Hall, Sharon M.; Prochaska, Judith J.

2016-01-01

Objective We examined the cost-effectiveness of smoking cessation treatment for psychiatric inpatients. Method Smokers, regardless of intention to quit, were recruited during psychiatric hospitalization and randomized to receive stage-based smoking cessation services or usual aftercare. Smoking cessation services, quality of life, and biochemically-verified abstinence from cigarettes were assessed during 18-months of follow-up. Trial findings were combined with literature on changes in smoking status and the age and gender adjusted effect of smoking on health care cost, mortality, and quality of life in a Markov model of cost-effectiveness during a lifetime horizon. Results Among 223 smokers randomized between 2006 and 2008, the mean cost of smoking cessation services was $189 in the experimental treatment group and $37 in the usual care condition (p < 0.001). At the end of follow-up, 18.75% of the experimental group was abstinent from cigarettes, compared to 6.80% abstinence in the usual care group (p <0.05). The model projected that the intervention added $43 in lifetime cost and generated 0.101 additional Quality Adjusted Life Years (QALYs), an incremental cost-effectiveness ratio of $428 per QALY. Probabilistic sensitivity analysis found the experimental intervention was cost-effective against the acceptance criteria of $50,000/QALY in 99.0% of the replicates. Conclusions A cessation intervention for smokers identified in psychiatric hospitalization did not result in higher mental health care costs in the short-run and was highly cost-effective over the long-term. The stage-based intervention was a feasible and cost-effective way of addressing the high smoking prevalence in persons with serious mental illness. PMID:26528651

Contrasting jail diversion and in-jail services for mental illness and substance abuse: do they serve the same clients?

PubMed

Draine, Jeffrey; Blank, Amy; Kottsieper, Petra; Solomon, Phyllis

2005-01-01

Baseline data from a study of jail diversion services and in-jail behavioral health services were used to examine the differences in clients served by these two models of responding to people with co-occurring mental health and substance abuse problems in the criminal justice system. Clients of the diversion service had more acute psychiatric symptoms and were more likely to have a diagnosis of psychosis NOS. Clients of the in-jail service were more likely to have been on probation or parole in the past and to have received substance abuse treatment. Different service models may attract and serve different populations of clients. Diversion services may cast a wider net that includes clients who may not have otherwise been involved in forensic services. Copyright (c) 2005 John Wiley & Sons, Ltd.

Barriers to Employment Among Social Security Disability Insurance Beneficiaries in the Mental Health Treatment Study.

PubMed

Milfort, Roline; Bond, Gary R; McGurk, Susan R; Drake, Robert E

2015-12-01

This study examined barriers to employment among Social Security Disability Insurance (SSDI) beneficiaries who received comprehensive vocational and mental health services but were not successful in returning to work. This study examined barriers to employment among 430 SSDI beneficiaries with mental disorders who received evidence-based vocational and mental health services for two years but worked less than one month or not at all. Comprehensive care teams, which included employment specialists, made consensus judgments for each participant, identifying the top three barriers to employment from a checklist of 14 common barriers. Teams most frequently identified three barriers to employment: poorly controlled symptoms of mental illness (55%), nonengagement in supported employment (44%), and poorly controlled general medical problems (33%). Other factors were identified much less frequently. Some SSDI beneficiaries, despite having access to comprehensive services, continued to experience psychiatric impairments, difficulty engaging in vocational services, and general medical problems that limited their success in employment.

Food insecurity and antiretroviral adherence among HIV positive adults who drink alcohol.

PubMed

Kalichman, Seth C; Grebler, Tamar; Amaral, Christina M; McKerney, Megan; White, Denise; Kalichman, Moira O; Cherry, Chauncey; Eaton, Lisa

2014-10-01

Food insecurity is associated with HIV treatment non-adherence and poor health outcomes for people living with HIV/AIDS. Given the poor nutritional status common to people who drink alcohol, food insecurity may be particularly problematic for HIV positive individuals who drink alcohol. To examine food insecurity among HIV positive men and women who drink alcohol and its association with antiretroviral therapy (ART) adherence, health outcomes and health service utilization. Adults living with HIV (N = 183) in Atlanta, Georgia who reported alcohol use in the previous week and were receiving ART participated in a 12-month cohort. Participants were recruited from infectious disease clinics and social services to complete computerized interviews, monthly-unannounced pill counts to monitor ART adherence, and daily cell-phone delivered interactive-text assessments for alcohol use. Forty-three percent of participants experienced food insecurity during at least one month of the study period. Food insecurity was independently associated with suboptimal ART adherence and less suppressed HIV viral load over. Individuals who experienced food insecurity also had histories of more medical and psychiatric hospitalizations, and greater mental health problems. Food insecurity is prevalent among alcohol using people receiving ART and food insecurity is associated with treatment non-adherence, poor health outcomes, and increased medical and psychiatric hospitalizations.

Friendship and money: A qualitative study of service users' experiences of participating in a supported socialisation programme.

PubMed

Sheridan, Ann; O'Keeffe, Donal; Coughlan, Barbara; Frazer, Kate; Drennan, Johnathan; Kemple, Mary

2018-06-01

Social opportunities can be limited in the lives of people with enduring mental illness (EMI) due to psychiatric stigma, restricted home environments and employment barriers. Supported socialisation programmes have the potential to redress the impact of social isolation. To explore the experiences of service users with EMI taking part in a supported socialisation programme, using written diary entries. This article reports on the qualitative component of a randomised controlled trial of supported socialisation for people with EMI (published previously in this journal). Trial participation involved (1) being matched with a volunteer partner and engaging in social/leisure activities while receiving a stipend of €20 or (2) receiving this stipend only and engaging in self-driven socialisation. Participants completed written diaries documenting their perspectives on their experiences of supported socialisation. Data were analysed using Thematic Analysis. Experiences of participation were characterised by involvement 'normalising' life, fostering a sense of connectedness, improving physical health, and facilitating engagement with culture. Taking part helped participants integrate socialising into their identity, enhanced their perceived capacity to be social, and cemented/expanded social networks. Participants also experienced significant obstacles to socialisation. Supported socialisation can increase confidence, social competence and self-agency; buffer against psychiatric stigma; build social capital; and afford opportunities to enhance social integration, inclusion and belonging.

Psychiatric units in Brazilian general hospitals: a growing philanthropic field.

PubMed

Botega, Neury José

2002-06-01

Some countries, mainly in North America and Europe, have adopted psychiatric wards in the general hospital as an alternative to the classic psychiatric hospital. In Brazil there are 6,169 general hospitals, 1.3% of which with a psychiatric unit. This service strategy is scarcely developed in the country and comprises only 4% of all psychiatric admissions. There was no information on the facilities and functioning of the psychiatric units in general hospitals. To determine the main characteristics of psychiatric units in Brazilian general hospitals and to assess the current trends in the services provided. A mailing survey assessed all 94 Brazilian general hospitals which made psychiatric admissions. A two-page questionnaire was designed to determine the main characteristics of each institution and of the psychiatric unit. Seventy-nine (84%) questionnaires were returned. In contrast to the 1970s and 1980s, in the last decade the installation of psychiatric units has spread to smaller philanthropic institutions that are not linked to medical schools. A fifth of hospitals admit psychiatric patients to medical wards because there is no specialist psychiatric ward. They try to meet all the local emergency demands, usually alcohol-dependent patients who need short term admission. This could signal the beginning of a program through which mental health professionals may become an integral part of general health services. The inauguration of psychiatric wards in philanthropic hospitals, as well as the admission of psychiatric patients in their medical wards, is a phenomenon peculiar to this decade. The installation of psychiatric services in these and other general hospitals would overcome two of major difficulties encountered: prejudice and a lack of financial resources.

Development and usability testing of a web-based decision support for users and health professionals in psychiatric services.

PubMed

Grim, Katarina; Rosenberg, David; Svedberg, Petra; Schön, Ulla-Karin

2017-09-01

Shared decision making (SMD) related to treatment and rehabilitation is considered a central component in recovery-oriented practice. Although decision aids are regarded as an essential component for successfully implementing SDM, these aids are often lacking within psychiatric services. The aim of this study was to use a participatory design to facilitate the development of a user-generated, web-based decision aid for individuals receiving psychiatric services. The results of this effort as well as the lessons learned during the development and usability processes are reported. The participatory design included 4 iterative cycles of development. Various qualitative methods for data collection were used with potential end users participating as informants in focus group and individual interviews and as usability and pilot testers. Interviewing and testing identified usability problems that then led to refinements and making the subsequent prototypes increasingly user-friendly and relevant. In each phase of the process, feedback from potential end-users provided guidance in developing the formation of the web-based decision aid that strengthens the position of users by integrating access to information regarding alternative supports, interactivity between staff and users, and user preferences as a continual focus in the tool. This web-based decision aid has the potential to strengthen service users' experience of self-efficacy and control as well as provide staff access to user knowledge and preferences. Studies employing participatory models focusing on usability have potential to significantly contribute to the development and implementation of tools that reflect user perspectives. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

Costs and outcome of assertive community treatment (ACT) in a rural area in Denmark: 4-year register-based follow-up.

PubMed

Hastrup, Lene Halling; Aagaard, Jørgen

2015-02-01

Health economic evidence of assertive community treatment (ACT) in Denmark is limited. The aim of the study was to assess the costs and outcome of ACT among 174 patients with severe and persistent mental illness in a rural area of Denmark. The study was based on a quasi-experimental design with a control group from the neighbouring region. Costs and retention in mental health services were analysed by using register data 1 year before and 4 years after inclusion in the study. Data on the use of supportive housing were available for the year before baseline and the subsequent 2 years only. Seventy eight percent of the patients receiving ACT were in contact with psychiatric services at the 4-year follow-up, while 69% of the patients in the control group had contact with psychiatric services (P < 0.17). Days in supportive housing were lower for the ACT group before baseline and remained so (dropping to zero) for the subsequent 2 years. Over 4 years, the mean total costs per patient in the group receiving ACT were DDK 493,442 (SE = 34,292). Excluding costs of supportive housing, the mean total costs per patient of the control group were DDK 537,218 (SE = 59,371), P < 0.53. If these costs are included, however, the mean total costs for the ACT group are unchanged, whereas costs for the control group rise to DDK 671,500 (SE = 73,671), P < 0.03. While ACT appears to have resulted in a significant reduction in costs for psychiatric hospitalizations, baseline differences in use of supportive housing make the effects of ACT on overall costs more ambiguous. At worst, however, overall costs did not increase. Given the generally acknowledged clinical benefits of ACT over standard outpatient care, the results support further dissemination of ACT in Denmark.

Psychiatric investigation of 18 bereaved pet owners.

PubMed

Kimura, Yuya; Kawabata, Hidenobu; Maezawa, Masaji

2011-08-01

This survey explores the grief associated with the loss of a pet, and was carried out using a self-administered questionnaire. The questionnaires were handed out to 50 bereaved pet owners attending a public animal cremation service, and we received 18 responses. Participants responded within 0 to 44 (median 4) days of the death of their pet. Although most mental health problems immediately following mourning are presumed to be normal grief reactions, on the basis of several psychiatric scales, 8 of the 16 valid responses indicated depression and/or neurosis. Statistical analyses showed that the following factors were significantly associated with grief reactions: age of owner, other stressful life events, family size, age of deceased animal, rearing place, and preliminary veterinary consultation.

Unequal access and unmet need: neurotic disorders and the use of primary care services.

PubMed

Bebbington, P; Meltzer, H; Brugha, T; Farrell, M; Jenkins, R; Ceresa, C; Lewis, G

2003-01-01

In this paper we use data from the National Survey of Psychiatric Morbidity to examine how many people with neurotic disorders receive professional evaluation, and how this is affected by clinical and sociodemographic differences. We hypothesized that psychiatric symptoms and attendant dysfunctions would both have an effect on contacting, and that key demographic variables would not. The household component of the British National Surveys of Psychiatric Morbidity was based on a random sample of >10,000 subjects. Lay interviewers using the CIS-R established psychiatric symptoms and ICD-10 diagnosis. Social dysfunction was tapped by asking about difficulties in performing seven types of everyday activity. We examined symptom score, ADL deficit score, and demographic variables in relation to contact with primary care physicians for psychiatric symptoms. The major determinant of contacting a primary care physician was severity, mainly due to the level of psychiatric symptoms, but with an independent contribution from social dysfunction. There were also significant contributions from sex, marital status, age, employment status, and whether the subject had a physical condition as well. The major influence on whether people seek the help of their family doctors for mental health problems is the severity of disorder. Although there are some social inequalities in access to family doctors, these are less important. The most salient finding from our study is that even people suffering from high levels of psychiatric symptoms very often do not have contact with professionals who might help them.

"GP Psych Opinion": evaluation of a psychiatric consultation service.

PubMed

Simpson, Alex E; Emmerson, W Brett; Frost, Aaron D J; Powell, Jacinta L

2005-07-18

To evaluate a hospital-based psychiatric consultation service for patients referred by general practitioners (GPs), and the effect on its use of a focused marketing strategy aimed at GPs. Postal survey of GPs in the catchment area (inner north Brisbane, Queensland), September to November 2003; and assessment of referrals, March to August 2003. Patient referrals, satisfaction among GPs who had referred, and awareness and opinions of the service among GPs who had not referred, compared with results of a similar survey conducted before marketing. In the 6 months after marketing, 43 patients were referred by 23 GPs, an average of 7.2 patients per month, compared with 2.5 per month in the first 12 months of the service. Survey responses were received from 13 of 36 GPs who had referred patients and 97 of 282 GPs who had not (response rate, 35%). Satisfaction among GPs who had referred remained high, and 12/13 felt the service should continue. Among GPs who had not referred, 76% were aware of the service, up from 26% in the previous survey, and 99% liked the concept of the service. Given the ongoing low utilisation of this service, we question whether this model is accepted by most GPs in our district. Possibly, they prefer more traditional models, where treatment is taken over by psychiatrists in the public or private system. We believe there is a need to increase the capacity and scope of publicly funded services to treat mental health problems.

Psychiatric disposition of patients brought in by crisis intervention team police officers.

PubMed

Strauss, Gordon; Glenn, Mark; Reddi, Padma; Afaq, Irfan; Podolskaya, Anna; Rybakova, Tatyana; Saeed, Osman; Shah, Vital; Singh, Baljit; Skinner, Andrew; El-Mallakh, Rif S

2005-04-01

As part of an effort to improve police interactions with mentally ill citizens, and improve mental health care delivery to subjects in acute distress, the University of Louisville, in conjunction with the Louisville Metro Police, established the crisis intervention team (CIT). CIT is composed of uniformed officers who receive extensive training in crisis intervention and psychiatric issues and who are preferentially called to investigate police calls that may involve a mentally ill individual. In an effort to determine the characteristics of the individuals brought to the emergency psychiatric service (EPS) by CIT officers, a comparative (CIT vs. mental inquest warrant [MIW, a citizen-initiated court order to bring someone for psychiatric evaluation because of concerns regarding dangerousness] vs non-CIT/non-MIW), descriptive evaluation was performed. With the exception of a higher rate of schizophrenic subjects brought in by CIT (43.0% vs. 22.1%, non-CIT, P = .002), the demographics, diagnosis, and disposition of CIT-referred subjects were not different in any way from non-CIT patients. Subjects referred on MIWs were more likely to be admitted to a psychiatric hospital than non-MIW patients (71.6% vs. 34.8%, P < .0001), but CIT-referred hospitalization rates were not different from hospitalization rates of self-referred subjects (20.7% vs. 33.3%, ns). CIT officers appear to do a good job at identifying patients in need of psychiatric care.

[Die entwicklung der psychiatrie in oberosterreich 1960 - 2000.].

PubMed

Hofmann, Gustav; Schöny, Werner

2004-09-01

Psychiatric reforms in Upper Austria have considerably improved the quality of life of psychiatric patients. Modernizing the status of acute psychiatric departments based on a bio- psycho-, social concept implemented multidimensional approach in diagnostics and therapeutic methods applied by multiprofessional teams. Prophylactic procedures and rehabilitation programs have minimized chronification of psychiatric diseases. By "late rehabilitation programs" increased autonomy, more individualized planning of life processes could be achieved even with "chronic" patients. We do not see any need to confine "chronic" psychiatric patients in psychiatric hospitals. These patients are cared for, socially integrated by special rehabilitation measures and professional rehabilitation in community - based services and units of Pro Mente Upper Austria - a non-profit organization. Problems are decreased duration of stay in psychiatric hospitals, increased admission rates when the number of beds in psychiatric departments was considerably decreased in the course of psychiatric reforms in Austria. In our province - Upper Austria - these problems are of lesser importance because private non-profit organizations like Pro Mente Upper Austria have provided a variety of community-based services (mental health centres, day clinics, housing facilities and special services for drug addicts and geriatric patients ) in ever increasing numbers. Still there is need of further development of community-based services provided by specially trained professionals. These services are financed mainly by the state, the provincial government, the labour market services and to a small degree by funds of the European Union. In these days of reduced social budgets of the state and social departments of provincial governments it is not easy to keep our standards and meet the increased needs of our clients.

House calls revisited: Leveraging technology to overcome obstacles to psychiatric care and improve treatment outcomes

PubMed Central

Olden, Megan; Cukor, Judith; Rizzo, Albert “Skip”; Rothbaum, Barbara; Difede, JoAnn

2014-01-01

Despite an increasing number of military service members in need of mental health treatment following deployment to Iraq and Afghanistan, numerous psychological and practical barriers limit access to care. Perceived stigma about admitting psychological difficulties as well as frequent long distances to treatment facilities reduce many veterans' willingness and ability to receive care. Telemedicine and virtual human technologies offer a unique potential to expand services to those in greatest need. Telemedicine-based treatment has been used to address multiple psychiatric disorders, including posttraumatic stress disorder, depression, and substance use, as well as to provide suicide risk assessment and intervention. Clinician education and training has also been enhanced and expanded through the use of distance technologies, with trainees practicing clinical skills with virtual patients and supervisors connecting with clinicians via videoconferencing. The use of these innovative and creative vehicles offer a significant and as yet unfulfilled promise to expand delivery of high quality psychological therapies, regardless of clinician and patient location. PMID:20955335

Screening parents during child evaluations: exploring parent and child psychopathology in the same clinic.

PubMed

Vidair, Hilary B; Reyes, Jazmin A; Shen, Sa; Parrilla-Escobar, Maria A; Heleniak, Charlotte M; Hollin, Ilene L; Woodruff, Scott; Turner, J Blake; Rynn, Moira A

2011-05-01

Children of depressed and/or anxious parents are at increased risk for developing psychiatric disorders. Little research has focused on screening parents bringing their children for psychiatric evaluation, and few studies have included fathers or Hispanic children. This study had the following aims: 1) to identify current symptom rates in parents bringing their children for evaluation; and 2) to determine whether parental symptoms were associated with children's symptoms, diagnoses, and functioning. The sample included 801 mothers, 182 fathers, and 848 children (aged 6 through 17 years). The majority (55.66%) were Hispanic, who attended a child and adolescent psychiatric evaluation service. Parent and child symptoms were assessed via parental reports. Children's diagnoses and functioning were determined by clinicians. Multiple regression analyses were used to determine whether severity of parental symptoms was associated with clinical child variables adjusting for child and parent demographic variables. In all, 18.80% of mothers and 18.42% of fathers reported elevated internalizing symptoms. Maternal symptoms were significantly associated with problems in children's functioning and children's anxiety, depression, and oppositional/conduct diagnoses; but not attention-deficit/hyperactivity disorder. Adjusting for parental and child demographics had a reduction on the effect of maternal symptoms on child depression. Paternal symptoms and functioning were positively associated with children's diagnoses, but the associations were smaller and not significant. Both parents' symptoms were significantly associated with children's internalizing and externalizing symptoms. However, these significant effects were not moderated by marital status or child ethnicity. This study highlights the importance of screening parents when their children receive a psychiatric evaluation. The findings support the development of mental health services that address psychiatric needs of the entire family within one clinical setting. Copyright © 2011 American Academy of Child and Adolescent Psychiatry. Published by Elsevier Inc. All rights reserved.

Racial and ethnic differences in utilization of mental health services among high-risk youths.

PubMed

Garland, Ann F; Lau, Anna S; Yeh, May; McCabe, Kristen M; Hough, Richard L; Landsverk, John A

2005-07-01

Racial and ethnic disparities in mental health service use have been identified as a major public health problem. However, the extent to which these disparities may be accounted for by other confounding sociodemographic or clinical predictors of service use (e.g., family income, functional impairment, caregiver strain) is relatively unexplored, especially for youth services. The goal of this study was to test for racial/ethnic disparities in use of a variety of outpatient, inpatient, and informal mental health services among high-risk youths, with the effects of other predictive factors controlled. Participants were 1,256 youths ages 6-18 years who received services in a large, publicly funded system of care (including the child welfare, juvenile justice, special education, alcohol and drug abuse, and mental health service sectors). Youths and caregivers were interviewed with established measures of mental health service use, psychiatric diagnoses, functional impairment, caregiver strain, and parental depression. Significant racial/ethnic group differences in likelihood of receiving any mental health service and, specifically, formal outpatient services were found after the effects of potentially confounding variables were controlled. Race/ethnicity did not exert a significant effect on the use of informal or 24-hour-care services. Racial/ethnic disparities in service use remain a public health problem.

Does staff-patient agreement on needs for care predict a better mental health outcome? A 4-year follow-up in a community service.

PubMed

Lasalvia, A; Bonetto, C; Tansella, M; Stefani, B; Ruggeri, M

2008-01-01

Patients treated in primary care settings report better mental outcomes when they agree with practitioners about the nature of their core presenting problems. However, no study has examined the impact of staff-patient agreement on treatment outcomes in specialist mental health services. We investigated whether a better staff-patient agreement on needs for care predicts more favourable outcome in patients receiving community-based psychiatric care. A 3-month prevalence cohort of 188 patients with the full spectrum of psychiatric conditions was assessed at baseline and at 4 years using the Camberwell Assessment of Need (CAN), both staff (CAN-S) and patient versions (CAN-P), and a set of standardized outcome measures. Baseline staff-patient agreement on needs was included among predictors of outcome. Both clinician-rated (psychopathology, social disability, global functioning) and patient-rated (subjective quality of life and satisfaction with services) outcomes were considered. Controlling for the effect of sociodemographics, service utilization and changes in clinical status, better staff-patient agreement makes a significant additional contribution in predicting treatment outcomes not only on patient-rated but also on clinician-rated measures. Mental health care should be provided on the basis of a negotiation process involving both professionals and service users to ensure effective interventions; every effort should be made by services to implement strategies aiming to increase consensus between staff and patients.

Reasons for Referral, Intervention Approaches and Demographic Characteristics of Clients with Intellectual Disability Attending Adult Psychiatric Outpatient Services in the Kingdom of Bahrain

ERIC Educational Resources Information Center

Grey, I.; Al-Saihati, B. A.; Al-Haddad, M.; McClean, B.

2015-01-01

Background: Relatively little information is available regarding the use of psychiatric services by individuals with intellectual disability (ID) in Arab countries. The current study aimed to identify (1) the reasons for referral; (2) demographic characteristics of individuals referred; (3) previous contact with child psychiatric services; (4)…

Psychiatric stigma and discrimination in South Africa: perspectives from key stakeholders.

PubMed

Egbe, Catherine O; Brooke-Sumner, Carrie; Kathree, Tasneem; Selohilwe, One; Thornicroft, Graham; Petersen, Inge

2014-07-04

Stigma and discrimination against people with mental illness remain barriers to help seeking and full recovery for people in need of mental health services. Yet there is scarce research investigating the experiences of psychiatric stigma on mental health service users in low- and middle-income countries (LMICs). The aim of this study was therefore to explore the experiences of psychiatric stigma by service users in order to inform interventions to reduce such stigma and discrimination in one LMIC, namely South Africa. Participants comprised a total of 77 adults aged above 18 years, made up of service providers including professional nurses (10), lay counsellors (20), auxiliary social workers (2); and service users (45). Psychiatric stigma was found to be perpetuated by family members, friends, employers, community members and health care providers. Causes of psychiatric stigma identified included misconceptions about mental illness often leading to delays in help-seeking. Experiencing psychiatric stigma was reported to worsen the health of service users and impede their capacity to lead and recover a normal life. Media campaigns and interventions to reduce stigma should be designed to address specific stigmatizing behaviours among specific segments of the population. Counselling of families, caregivers and service users should include how to deal with experienced and internalized stigma.

Psychiatric stigma and discrimination in South Africa: perspectives from key stakeholders

PubMed Central

2014-01-01

Background Stigma and discrimination against people with mental illness remain barriers to help seeking and full recovery for people in need of mental health services. Yet there is scarce research investigating the experiences of psychiatric stigma on mental health service users in low- and middle-income countries (LMICs). The aim of this study was therefore to explore the experiences of psychiatric stigma by service users in order to inform interventions to reduce such stigma and discrimination in one LMIC, namely South Africa. Methods Participants comprised a total of 77 adults aged above 18 years, made up of service providers including professional nurses (10), lay counsellors (20), auxiliary social workers (2); and service users (45). Results Psychiatric stigma was found to be perpetuated by family members, friends, employers, community members and health care providers. Causes of psychiatric stigma identified included misconceptions about mental illness often leading to delays in help-seeking. Experiencing psychiatric stigma was reported to worsen the health of service users and impede their capacity to lead and recover a normal life. Conclusion Media campaigns and interventions to reduce stigma should be designed to address specific stigmatizing behaviours among specific segments of the population. Counselling of families, caregivers and service users should include how to deal with experienced and internalized stigma. PMID:24996420

42 CFR 483.354 - General requirements for psychiatric residential treatment facilities.

Code of Federal Regulations, 2010 CFR

2010-10-01

... treatment facilities. 483.354 Section 483.354 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES... LONG TERM CARE FACILITIES Condition of Participation for the Use of Restraint or Seclusion in Psychiatric Residential Treatment Facilities Providing Inpatient Psychiatric Services for Individuals Under...

42 CFR 482.1 - Basis and scope.

Code of Federal Regulations, 2010 CFR

2010-10-01

... in Medicare as a psychiatric hospital must meet certain specified requirements imposed on hospitals... physician, psychiatric services for the diagnosis and treatment of mentally ill persons, must maintain... furnished services in the hospital. A distinct part of an institution can participate as a psychiatric...

Timeline historical review of income and financial transactions: a reliable assessment of personal finances.

PubMed

Black, Anne C; Serowik, Kristin L; Ablondi, Karen M; Rosen, Marc I

2013-01-01

The need for accurate and reliable information about income and resources available to individuals with psychiatric disabilities is critical for the assessment of need and evaluation of programs designed to alleviate financial hardship or affect finance allocation. Measurement of finances is ubiquitous in studies of economics, poverty, and social services. However, evidence has demonstrated that these measures often contain error. We compare the 1-week test-retest reliability of income and finance data from 24 adult psychiatric outpatients using assessment-as-usual (AAU) and a new instrument, the Timeline Historical Review of Income and Financial Transactions (THRIFT). Reliability estimates obtained with the THRIFT for Income (0.77), Expenses (0.91), and Debt (0.99) domains were significantly better than those obtained with AAU. Reliability estimates for Balance did not differ. THRIFT reduced measurement error and provided more reliable information than AAU for assessment of personal finances in psychiatric patients receiving Social Security benefits. The instrument also may be useful with other low-income groups.

Racial and Ethnic Disparities in Mental Health Care for Children and Young Adults: A National Study.

PubMed

Marrast, Lyndonna; Himmelstein, David U; Woolhandler, Steffie

2016-10-01

Psychiatric and behavior problems are common among children and young adults, and many go without care or only receive treatment in carceral settings. We examined racial and ethnic disparities in children's and young adults' receipt of mental health and substance abuse care using nationally representative data from the 2006-2012 Medical Expenditure Panel Surveys. Blacks' and Hispanics' visit rates (and per capita expenditures) were about half those of non-Hispanic whites for all types and definitions of outpatient mental health services. Disparities were generally larger for young adults than for children. Black and white children had similar psychiatric inpatient and emergency department utilization rates, while Hispanic children had lower hospitalization rates. Multivariate control for mental health impairment, demographics, and insurance status did not attenuate racial/ethnic disparities in outpatient care. We conclude that psychiatric and behavioral problems among minority youth often result in school punishment or incarceration, but rarely mental health care. © The Author(s) 2016.

Adolescents and Dual Diagnosis in a Psychiatric Emergency Service.

PubMed

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

2016-03-02

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

[The long road for psychiatric care in prisons].

PubMed

Laurencin, Gérard

2016-01-01

From the 19th century to the present day, the history of psychiatry in prisons has evolved considerably. In parallel with successive laws, codes and articles, psychiatry has gained in structure. From the "medical prison", mental health consultations in every detention centre, the regional medico-psychological services, to today's specially equipped hospital units (UHSA), prisoners receive both preventive care as well as curative treatment. Copyright © 2016. Published by Elsevier Masson SAS.

42 CFR 456.481 - Admission certification and plan of care.

Code of Federal Regulations, 2010 CFR

2010-10-01

... SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Inpatient Psychiatric Services for... of care. If a facility provides inpatient psychiatric services to a recipient under age 21— (a) The...

Race and psychiatric services in post-apartheid South Africa: a preliminary study of psychiatrists' perceptions.

PubMed

Kohn, Robert; Szabo, Christopher P; Gordon, Alan; Allwood, Clifford W

2004-03-01

The primary objective of this study was to examine the perception of the quality of psychiatric services five years after apartheid, and specifically whether care for black patients had improved. A survey was distributed to South African psychiatrists during a national congress and by mail. The questionnaire focused on the quality of psychiatric care in general, for black and white patients, the racial composition of each respondent's psychiatric practice currently, and the racial composition of the psychiatric practice during apartheid. Psychiatric services in South Africa were viewed as deteriorating. The end of apartheid has done little to improve the quality of psychiatric care for both black and white patients. Although less pronounced, racial inequality in psychiatric care continues to exist. Psychiatric practices continue to be overrepresented with white patients. There remains a differential in quality of psychiatric care and further monitoring should continue. Continued efforts to improve racial equality and the need for greater awareness of cultural issues need to be addressed. Limitations of this study included possible social desirability bias, use of subjective rather than objective measures, and a survey that was limited in scope.

42 CFR 412.400 - Basis and scope of subpart.

Code of Federal Regulations, 2010 CFR

2010-10-01

... Inpatient Hospital Services of Inpatient Psychiatric Facilities § 412.400 Basis and scope of subpart. (a... psychiatric facilities. (b) Scope. This subpart sets forth the framework for the prospective payment system for the inpatient hospital services of inpatient psychiatric facilities, including the methodology...

Bibliotherapy for mental health service users Part 2: a survey of psychiatric libraries in the UK.

PubMed

Fanner, Deborah; Urqhuart, Christine

2009-06-01

UK health policy advocates a patient-centred approach to patient care. Library services could serve the rehabilitation needs of mental health service users through bibliotherapy (the use of written, audio or e-learning materials to provide therapeutic support). Part 2 of this two-part paper assesses the views of psychiatric libraries in the UK on providing access to service users and possible services provided. An e-mail questionnaire survey of psychiatric library members of the psychiatric lending co-operative scheme (n = 100) obtained a response rate of 55%, mostly from libraries based in hospitals. At present, libraries funded by the health service provide minimal facilities for service users. Librarians are uncertain about the benefits and practicalities of providing access to service users. In order to implement change, information providers across the National Health Service (NHS) will need to work collaboratively to overcome attitudinal and institutional barriers, including the key issue of funding.

Mental illness and homicide--prevention of recidivism.

PubMed

Talevska, Valentina; Stefanovski, Branko

2011-12-01

We hypothesized that the integration of forensic psychiatrists and the forensic system into the general stream of mental health should lead to better reintegration of forensic patients into the society. The aims of the study were to explore the link between violence, murder, psychiatric disorders and other variables, and to suggest a mode of prevention of criminal recidivism. This investigation provided a more reflective profile of mentally ill persons convicted of murder, hospitalized in Psychiatric Hospital in Demir Hisar in Macedonia between 2007 and 2009. Study results indicated the offender with severe mental illness incarcerated for murder in Demir Hisar Psychiatric Hospital to be predominantly suffering from a mood disorder, to be a male with secondary school education, and to have significant intimate and family relationships characterized by rage as a frequently mentioned motive for murder. On committing homicide, they frequently used firearm or sharp objects. The offenders lived in dysfunctional families, had extensive histories of substance abuse and criminal activity before their murder conviction, and received inadequate treatment for their mental disorder and substance abuse. We suggest that the offenders (murderers) continue their treatment in mental health forensic services upon completing their obligatory treatment at a psychiatric hospital.

42 CFR 441.154 - Active treatment.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 42 Public Health 4 2013-10-01 2013-10-01 false Active treatment. 441.154 Section 441.154 Public... Psychiatric Services for Individuals Under Age 21 in Psychiatric Facilities or Programs § 441.154 Active treatment. Inpatient psychiatric services must involve “active treatment”, which means implementation of a...

42 CFR 441.154 - Active treatment.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 42 Public Health 4 2014-10-01 2014-10-01 false Active treatment. 441.154 Section 441.154 Public... Psychiatric Services for Individuals Under Age 21 in Psychiatric Facilities or Programs § 441.154 Active treatment. Inpatient psychiatric services must involve “active treatment”, which means implementation of a...

42 CFR 441.154 - Active treatment.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 42 Public Health 4 2012-10-01 2012-10-01 false Active treatment. 441.154 Section 441.154 Public... Psychiatric Services for Individuals Under Age 21 in Psychiatric Facilities or Programs § 441.154 Active treatment. Inpatient psychiatric services must involve “active treatment”, which means implementation of a...

42 CFR 441.154 - Active treatment.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 4 2011-10-01 2011-10-01 false Active treatment. 441.154 Section 441.154 Public... Psychiatric Services for Individuals Under Age 21 in Psychiatric Facilities or Programs § 441.154 Active treatment. Inpatient psychiatric services must involve “active treatment”, which means implementation of a...

The attendees' view of quality in community-based day centre services for people with psychiatric disabilities.

PubMed

Lundqvist, Lars-Olov; Ivarsson, Ann-Britt; Rask, Mikael; Brunt, David; Schröder, Agneta

2018-05-01

Community-based day centres in Sweden are well-established arenas for psychiatric rehabilitation, but little is known of the attendees' perception of the quality of the service provided. The aim of the study was thus to describe and investigate the quality of the services in community-based day centre for people with psychiatric disabilities. A sample of 218 attendees in 14 community-based day centre services in Sweden completed the Quality in Psychiatric Care - Daily Activities (QPC-DA). The results showed that people with psychiatric disabilities perceived the quality of community-based day centre services as high. Most notably, quality of service was rated higher by those with lower educational level, had waited shorter time to attend the centre, and had better mental and physical health. However, particularly aspects of a secluded environment and participation (information) may be areas with potential for improvement. From an occupational science perspective, the results adhere to the importance of occupational balance, with periods of rest/privacy during the time at the centre.

Students with Psychiatric Disabilities on Campus: Examining Predictors of Enrollment with Disability Support Services

ERIC Educational Resources Information Center

Collins, Mary Elizabeth; Mowbray, Carol T.

2008-01-01

Because of advances in psychotropic medications, psychiatric rehabilitation methods, the implementation of civil rights legislation, and empowerment movement of consumers with psychiatric disabilities, students with mental illnesses are increasingly able to access and complete higher education. Disability services offices on college campuses can…

Strategies for Effective Psychiatric Hospitalization of College and University Students

ERIC Educational Resources Information Center

Rockland-Miller, Harry; Eells, Gregory

2008-01-01

University and college counseling services face growing demands for services and self-reported increases in the level of presenting psychopathology, including need for psychiatric hospitalization. However, challenges in communication often occur between the systems of an inpatient psychiatric unit and an outpatient college and/or university…

42 CFR 483.358 - Orders for the use of restraint or seclusion.

Code of Federal Regulations, 2010 CFR

2010-10-01

... FACILITIES Condition of Participation for the Use of Restraint or Seclusion in Psychiatric Residential Treatment Facilities Providing Inpatient Psychiatric Services for Individuals Under Age 21 § 483.358 Orders... require that inpatient psychiatric services for recipients under age 21 be provided under the direction of...

Service Use and Unmet Needs in Youth Suicide: A Study of Trajectories

PubMed Central

Renaud, Johanne; Séguin, Monique; Lesage, Alain D; Marquette, Claude; Choo, Bettina; Turecki, Gustavo

2014-01-01

Objective: While 90% of suicide victims have suffered from mental health disorders, less than one-half are in contact with a mental health professional in the year preceding their death. Service use in the last year of life of young suicide victims and control subjects was studied in Quebec. We wanted to determine what kinds of health care services were needed and if they were actually received by suicide victims. Method: We recruited 67 consecutive suicide victims and 56 matched living control subjects (aged 25 years and younger). We evaluated subjects’ psychopathological profile and determined which services would have been indicated by conducting a needs assessment. We then compared this with what services were actually received. Results: Suicide victims were more likely than living control subjects to have a psychiatric diagnosis. They were most in need of services to address substance use disorder, depression, interpersonal distress, and suicide-related problems. There were significant deficits in the domains of coordination and continuity of care, mental health promotion and training, and governance. Conclusions: Our results show that we need to urgently take action to address these identified deficits to prevent further loss of life in our young people. PMID:25565685

Service use and unmet needs in youth suicide: a study of trajectories.

PubMed

Renaud, Johanne; Séguin, Monique; Lesage, Alain D; Marquette, Claude; Choo, Bettina; Turecki, Gustavo

2014-10-01

While 90% of suicide victims have suffered from mental health disorders, less than one-half are in contact with a mental health professional in the year preceding their death. Service use in the last year of life of young suicide victims and control subjects was studied in Quebec. We wanted to determine what kinds of health care services were needed and if they were actually received by suicide victims. We recruited 67 consecutive suicide victims and 56 matched living control subjects (aged 25 years and younger). We evaluated subjects' psychopathological profile and determined which services would have been indicated by conducting a needs assessment. We then compared this with what services were actually received. Suicide victims were more likely than living control subjects to have a psychiatric diagnosis. They were most in need of services to address substance use disorder, depression, interpersonal distress, and suicide-related problems. There were significant deficits in the domains of coordination and continuity of care, mental health promotion and training, and governance. Our results show that we need to urgently take action to address these identified deficits to prevent further loss of life in our young people.

Mental illness and principal physical diagnoses among Asian American and Pacific Islander users of emergency services.

PubMed

Chen, Huey Jen

2005-12-01

The stigma of mental illness is one of the factors that prevents Asian Americans/Pacific Islanders (APIs) from seeking formal mental health services. A somatic complaint is more acceptable in expressing psychiatric/emotional distress. Admission diagnoses in API emergency service users with secondary psychiatric diagnoses were identified from the 2001 National Inpatient Sample (NIS) of the Healthcare Cost and Utilization Project (HCUP). The sample consisted of 10,623 adult APIs. The study examined the differences in the six leading principal physical admission diagnoses between API emergency service users with psychiatric diagnoses and those without psychiatric diagnoses. Several of the study findings create concern (e.g., the higher percentage of APIs with psychiatric diagnosis who were discharged against medical advice, the high percentage admitted with medication intoxication). Further study is needed to provide guidance for clinical practice.

Behavioral health needs and problem recognition by older adults receiving home-based aging services.

PubMed

Gum, Amber M; Petkus, Andrew; McDougal, Sarah J; Present, Melanie; King-Kallimanis, Bellinda; Schonfeld, Lawrence

2009-04-01

Older adults' recognition of a behavioral health need is one of the strongest predictors of their use of behavioral health services. Thus, study aims were to examine behavioral health problems in a sample of older adults receiving home-based aging services, their recognition of behavioral health problems, and covariates of problem recognition. The study design was cross-sectional. Older adults (n = 141) receiving home-based aging services completed interviews that included: Structured Clinical Interview for DSM-IV; Brief Symptom Inventory-18; attitudinal scales of stigma, expectations regarding aging, and thought suppression; behavioral health treatment experience; and questions about recognition of behavioral health problems. Thirty (21.9%) participants received an Axis I diagnosis (depressive, anxiety, or substance); another 17 (12.1%) were diagnosed with an adjustment disorder. Participants were more likely to recognize having a problem if they had an Axis I diagnosis, more distress on the BSI-18, family member or friend with a behavioral health problem, and greater thought suppression. In logistic regression, participants who identified a family member or friend with a behavioral health problem were more likely to identify having a behavioral health problem themselves. Findings suggest that older adults receiving home-based aging services who recognize behavioral health problems are more likely to have a psychiatric diagnosis or be experiencing significant distress, and they are more familiar with behavioral health problems in others. This familiarity may facilitate treatment planning; thus, older adults with behavioral health problems who do not report familiarity of problems in others likely require additional education. (c) 2008 John Wiley & Sons, Ltd.

Health care service utilization and associated factors among heroin users in northern Taiwan.

PubMed

Chen, Yi-Chih; Chen, Chih-Ken; Lin, Shih-Ku; Chiang, Shu-Chuan; Su, Lien-Wen; Wang, Liang-Jen

2013-11-01

Due to the needs of medical care, the probability of using health care service from heroin users is high. This cross-sectional study investigated the frequency and correlates of health service utilization among heroin users. From June to September 2006, 124 heroin users (110 males and 14 females, mean age: 34.2 ± 8.3 years) who entered two psychiatric hospitals (N = 83) and a detention center (N = 41) in northern Taiwan received a face-to-face interview. Therefore, socio-demographic characteristics, patterns of drug use, psychiatric comorbidities, blood-borne infectious diseases and health service utilization were recorded. The behaviors of health service utilization were classified into the frequency of out-patient department visit and hospitalization, as well as the purchase of over-the-counter drugs. During 12 months prior to interview, 79.8% of the participants attended health care service at least once. The rate of having any event in out-patients service visit, hospitalization, and over-the-counter drugs were 66.1%, 29.8% and 25.8% respectively. The frequency of health service utilization was associated with numerous factors. Among these factors, patients who were recruited from hospital and having a mood disorder were conjoint predictors of out-patient department visit, hospitalization and purchase of over-the-counter drugs. According to the results of this study, social education and routine screening for mood disorders can help heroin users to obtain adequate health care service. The findings of this study are useful references for targeting the heroin users for whom a successful intervention represents the greatest cost benefit. © 2013 Elsevier Ltd. All rights reserved.

Predictors of outpatient mental health clinic follow-up after hospitalization among Medicaid-enrolled young adults.

PubMed

Marino, Leslie; Wissow, Lawrence S; Davis, Maryann; Abrams, Michael T; Dixon, Lisa B; Slade, Eric P

2016-12-01

To assess demographic and clinical predictors of outpatient mental health clinic follow-up after inpatient psychiatric hospitalization among Medicaid-enrolled young adults. Using logistic regression and administrative claims data from the Maryland public mental health system and Maryland Medicaid for young adults ages 18-26 who were enrolled in Medicaid (N = 1127), the likelihood of outpatient mental health follow-up within 30 days after inpatient psychiatric hospitalization was estimated . Only 51% of the young adults had any outpatient mental health follow-up visits within 30 days of discharge. Being black and having a co-occurring substance use disorder diagnosis were associated with a lower probability of having a follow-up visit (OR = 0.60, P < 0.01 and OR = 0.36, P < 0.01, respectively). In addition, those who utilized any outpatient public mental health services during the 180 days prior to their index hospitalization (N = 625, 55.4%) were more likely to have a follow-up visit than those without prior outpatient use (OR = 2.45, P < 0.01). Prior Medicaid-reimbursed primary care visits were not significantly associated with follow-up. In this predominantly urban, low-income statewide sample of young adults hospitalized for serious psychiatric conditions, half did not connect with an outpatient mental healthcare provider following their discharge. Outpatient transition supports may be especially needed for young adults who were not receiving outpatient services prior to being admitted for psychiatric inpatient care, as well as for young adults with substance use disorders and African Americans. © 2015 Wiley Publishing Asia Pty Ltd.

Interventions designed to improve therapeutic communications between black and minority ethnic people and professionals working in psychiatric services: a systematic review of the evidence for their effectiveness.

PubMed

Bhui, Kamaldeep; Aslam, Rabbea'h W; Palinski, Andrea; McCabe, Rose; Johnson, Mark R D; Weich, Scott; Singh, Swaran Preet; Knapp, Martin; Ardino, Vittoria; Szczepura, Ala

2015-04-01

Black and minority ethnic (BME) people using psychiatric services are at greater risk of non-engagement, dropout from care and not receiving evidence-based interventions than white British people. To identify effective interventions designed to improve therapeutic communications (TCs) for BME patients using psychiatric services in the UK, to identify gaps in the research literature and to recommend future research. Black African, black Caribbean, black British, white British, Pakistani and Bangladeshi patients in psychiatric services in the UK, or recruited from the community to enter psychiatric care. Some studies from the USA included Hispanic, Latino, Chinese, Vietnamese, Cambodian and African American people. Any that improve TCs between BME patients and staff in psychiatric services. The published literature, 'grey' literature, an expert survey, and patients' and carers' perspectives on the evidence base. Databases were searched from their inception to 4 February 2013. Databases included MEDLINE, Applied Social Sciences Index and Abstracts, The Cochrane Library, Social Science Citation Index, Allied and Complementary Medicine Database, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, EMBASE, The Campbell Collaboration and ProQuest for dissertations. Studies were included if they reported evaluation data about interventions designed to improve therapeutic outcomes by improving communication between BME patients and psychiatric professionals. Qualitative studies and reports in the grey literature were included only if they gave a critical evaluative statement. Two members of the team selected studies against pre-established criteria and any differences were resolved by consensus or by a third reviewer, if necessary. Data were extracted independently by two people and summarised in tables by specific study designs. Studies were subjected to a narrative synthesis that included a thematic analysis contrasting populations, countries and the strength of evidence for any intervention. The components of the interventions were compared. Patient perspectives on acceptability were considered alongside quality scores and methodological strengths and weaknesses. Twenty-one studies (19 from the published literature and two from the grey literature) met the inclusion criteria. There were 12 trials, two observational quantitative studies, three case series, a qualitative study and three descriptive case studies. Only two studies, one a pilot trial and one a case series, included economic data; in both, a favourable but weak economic case could be made for the intervention. The trials tested interventions to prepare patients for therapeutic interventions, variable levels of ethnic matching (of professional to patient), cultural adaptation of therapies, and interventions that included social community systems in order to facilitate access to services. Empowering interventions favoured by patients and carers included adapted cognitive-behavioural therapy, assessments of explanatory models, cultural consultation, ethnographic and motivational interviews, and a telepsychiatry intervention. Studies tended to have small sample sizes or to be pilot studies, and to use proxy rather than direct measures for TCs. Empowering interventions should be further researched and brought to the attention of commissioners. Several promising interventions need further evaluative research and economic evaluations are needed. The study is registered as PROSPERO CRD42011001661. The National Institute for Health Research Health Technology Assessment programme.

Psychological distress in torture survivors: pre- and post-migration risk factors in a US sample.

PubMed

Song, Suzan J; Kaplan, Charles; Tol, Wietse A; Subica, Andrew; de Jong, Joop

2015-04-01

To investigate the relationships between sociodemographic, pre- and post-migration variables with prevalence of psychological distress and global functioning in a heterogeneous sample of torture survivors. Clients referred from resettlement agencies via the Office of Refugee Resettlement (ORR) to a community clinic in the United States (N = 278) were interviewed with structured, translated questionnaires. Univariate and multivariate logistic regression analyses determined the associations of sociodemographic, pre-, and post-migration risk factors with posttraumatic stress disorder (PTSD), depression, anxiety, and global functioning. Regression data indicate that length of time between arrival in US and clinical services was significantly associated with PTSD and depression; participants receiving services after 1 year of resettlement were more likely to experience PTSD (adjusted OR = 3.29) and depression (adjusted OR = 4.50) than participants receiving services within 1 year. Anxiety was predicted by female gender (adjusted OR = 3.43), age over 40 years (adjusted OR = 3.12), Muslim religion (adjusted OR = 2.64), and receiving medical services (AOR 3.1). Severely impaired global functioning was associated with female gender (adjusted OR = 2.75) and unstable housing status (adjusted OR = 2.21). Findings highlight the importance of examining post-migration variables such as length of time in country prior to receiving services in addition to pre-migration torture history upon relocated torture survivors. Clinicians and policy-makers should be aware of the importance of early mental health screening and intervention on reducing the psychiatric burden associated with torture and forced relocation.

42 CFR 456.480 - Scope.

Code of Federal Regulations, 2010 CFR

2010-10-01

... ASSISTANCE PROGRAMS UTILIZATION CONTROL Inpatient Psychiatric Services for Individuals Under Age 21... requirements that apply to inpatient psychiatric services for individuals under age 21 in hospitals, mental...

Outpatient care programs of mental health organizations, United States, 1988.

PubMed

Redick, R W; Witkin, M J; Atay, J E; Manderscheid, R W

1991-09-01

In 1988, 2,989 (60 percent) of the 4,961 mental health organizations in the United States (including the territories) offered outpatient care programs. A total of 5.8 million patient care episodes were generated by these organized outpatient programs. These episodes included 3.1 million outpatient additions, produced 54 million outpatient visits, and represented 67 percent of all patient care episodes in mental health organizations in 1988. Although the number of mental health organizations with outpatient care programs increased by less than one percent between 1986 and 1988, the number of outpatient additions showed an 11 percent gain during this period. Multiservice mental health organizations were the primary locus of outpatient care in 1988, accounting for 41 percent of the 2,989 mental health organizations providing this care. Ranking next in this respect, were free-standing psychiatric outpatient clinics, and the separate psychiatric outpatient services in non-Federal general hospitals, with 25 and 16 percent, respectively, of the total outpatient care programs. In general, these three organization types had similar rankings with respect to the volume of the outpatient caseload. By definition, all of the freestanding psychiatric outpatient clinics provided outpatient care, and almost all of the VA mental health programs and multiservice mental health organizations also offered this care (99 and 92 percent, respectively). In contrast, psychiatric outpatient care was available in only 37 percent of non-Federal general hospitals with separate psychiatric services, 36 percent of private psychiatric hospitals, 29 percent of State mental hospitals, and 22 percent of RTCs for emotionally disturbed children. Outpatient care was available in mental health organizations in all States in 1988, with every State having at least two or more organization types providing this service. In general, the most populous States had the largest number and the greatest variety of mental health organizations with outpatient care programs. Of the 2.87 million clients receiving outpatient care in mental health organizations at the end of 1988, 23 percent were under 18 years of age, 68 percent were 18 to 64, and 9 percent were 65 and older. Male outpatient clients slightly outnumbered female clients. The majority (77 percent) of the outpatient clients were white, with blacks representing 21 percent; native Americans and Asians/Pacific Islanders, the remaining two percent. Eleven percent of the total client population were reported to be of Hispanic origin.(ABSTRACT TRUNCATED AT 400 WORDS)

Which skills boost service provider confidence when managing people presenting with psychiatric emergencies?

PubMed

Poremski, Daniel; Lim, Xin Ya; Kunjithapatham, Ganesh; Koh, Doris; Alexander, Mark; Cheng, Lee

2016-12-01

The way service seekers interact with the staff at emergency services has been shown to influence the standard of care, especially in the case of certain psychiatric manifestations. Staff reactions to psychiatric complaints have been linked to their comfort dealing with these types of service users as well as their competencies understanding the illness. It is therefore vital to understand which skills increase confidence in treating psychiatric emergencies. Twenty-six open-ended convergent interviews were conducted with staff working in a psychiatric emergency department. Thematic analysis was used to analyze the data. Participants reported several non-technical skills which developed from exclusively serving people with psychiatric emergencies: 1) Vigilance allowed staff to be sensitive to minor changes in behavior which precede psychiatric emergencies. 2) The ability to negotiate and find tangible solutions was particularly important when dealing with psychiatric complaints which may not have tangible resolutions. 3) The ability to appraise social support networks allowed staff to plan follow-up actions and ensure continuity of care when support was available. 4) The ability to self-reflect allowed participants to learn from their experience and avoid burnout, frustration, and fatigue. Participants also reported several other clinical skills which they gained during training, including teamwork, de-escalating techniques and risk assessment. Tentatively speaking, these skills improve staff's confidence when treating psychiatric emergencies. Certain skills may be generalized to staff working in medical emergency departments who frequently encounter psychiatric complaints. © 2016 The Authors. International Journal of Mental Health Nursing published by John Wiley & Sons Australia, Ltd on behalf of Australian College of Mental Health Nurses Inc.

Psychiatric comorbidity and intimate partner violence among women who inject drugs in Europe: a cross-sectional study.

PubMed

Tirado-Muñoz, Judit; Gilchrist, Gail; Fischer, Gabriele; Taylor, Avril; Moskalewicz, Jacek; Giammarchi, Cinzia; Köchl, Birgit; Munro, Alison; Dąbrowska, Katarzyna; Shaw, April; Di Furia, Lucia; Leeb, Isabella; Hopf, Caroline; Torrens, Marta

2018-06-01

Women who inject drugs (WWID) are an especially vulnerable group of drug users. This study determined the prevalence of psychiatric comorbidity and intimate partrner violence (IPV), and factors associated with psychiatric comorbidity among WWID recruited from drug treatment services (67%) and harm reduction services in five European regions in Austria, Catalonia, Italy, Poland, and Scotland. Psychiatric comorbidity was assessed among 226 WWID using the Dual Diagnosis Screening Instrument. IPV was assessed using the Composite Abuse Scale and injecting and sexual risk behaviors were assessed using a battery of questionnaires adapted and developed for the study. Eighty-seven percent met criteria for at least one lifetime psychiatric disorder. The most common disorders were depression (76%), panic (54%), and post-traumatic stress (52%). WWID recruited in drug treatment services were almost three times as likely (OR 2.90 95% CI 1.30-6.43; p = 0.007) to meet criteria for a lifetime psychiatric disorder than those recruited from harm reduction services, specifically dysthymia (OR 5.32 95% CI 2.27-12.48; p = 0.000) and post-traumatic stress disorder (OR 1.83 95% CI 1.02-3.27; p = 0.040). WWID who reported sharing needles and syringes were almost three times as likely to meet criteria for lifetime psychiatric comorbidity than those who did not (OR 2.65 95% CI 1.07-6.56). Compared to WWID who had not experienced IPV, victims (70%) were almost two times more likely to meet criteria for post-traumatic stress disorder (OR 1.95 95% CI 1.10-3.48). Psychiatric comorbidity and IPV among WWID are common. Drug treatment and harm reduction services should address psychiatric comorbidity and IPV to improve treatment outcomes.

Costs of treating patients with schizophrenia who have illness-related crisis events.

PubMed

Zhu, Baojin; Ascher-Svanum, Haya; Faries, Douglas E; Peng, Xiaomei; Salkever, David; Slade, Eric P

2008-08-26

Relatively little is known about the relationship between psychosocial crises and treatment costs for persons with schizophrenia. This naturalistic prospective study assessed the association of recent crises with mental health treatment costs among persons receiving treatment for schizophrenia. Data were drawn from a large multi-site, non-interventional study of schizophrenia patients in the United States, conducted between 1997 and 2003. Participants were treated at mental health treatment systems, including the Department of Veterans Affairs (VA) hospitals, community mental health centers, community and state hospitals, and university health care service systems. Total costs over a 1-year period for mental health services and component costs (psychiatric hospitalizations, antipsychotic medications, other psychotropic medications, day treatment, emergency psychiatric services, psychosocial/rehabilitation group therapy, individual therapy, medication management, and case management) were calculated for 1557 patients with complete medical information. Direct mental health treatment costs for patients who had experienced 1 or more of 5 recent crisis events were compared to propensity-matched samples of persons who had not experienced a crisis event. The 5 non-mutually exclusive crisis event subgroups were: suicide attempt in the past 4 weeks (n = 18), psychiatric hospitalization in the past 6 months (n = 240), arrest in the past 6 months (n = 56), violent behaviors in the past 4 weeks (n = 62), and diagnosis of a co-occurring substance use disorder (n = 413). Across all 5 categories of crisis events, patients who had a recent crisis had higher average annual mental health treatment costs than patients in propensity-score matched comparison samples. Average annual mental health treatment costs were significantly higher for persons who attempted suicide ($46,024), followed by persons with psychiatric hospitalization in the past 6 months ($37,329), persons with prior arrests ($31,081), and persons with violent behaviors ($18,778). Total cost was not significantly higher for those with co-occurring substance use disorder ($19,034). Recent crises, particularly suicide attempts, psychiatric hospitalizations, and criminal arrests, are predictive of higher mental health treatment costs in schizophrenia patients.

Costs of treating patients with schizophrenia who have illness-related crisis events

PubMed Central

Zhu, Baojin; Ascher-Svanum, Haya; Faries, Douglas E; Peng, Xiaomei; Salkever, David; Slade, Eric P

2008-01-01

Background Relatively little is known about the relationship between psychosocial crises and treatment costs for persons with schizophrenia. This naturalistic prospective study assessed the association of recent crises with mental health treatment costs among persons receiving treatment for schizophrenia. Methods Data were drawn from a large multi-site, non-interventional study of schizophrenia patients in the United States, conducted between 1997 and 2003. Participants were treated at mental health treatment systems, including the Department of Veterans Affairs (VA) hospitals, community mental health centers, community and state hospitals, and university health care service systems. Total costs over a 1-year period for mental health services and component costs (psychiatric hospitalizations, antipsychotic medications, other psychotropic medications, day treatment, emergency psychiatric services, psychosocial/rehabilitation group therapy, individual therapy, medication management, and case management) were calculated for 1557 patients with complete medical information. Direct mental health treatment costs for patients who had experienced 1 or more of 5 recent crisis events were compared to propensity-matched samples of persons who had not experienced a crisis event. The 5 non-mutually exclusive crisis event subgroups were: suicide attempt in the past 4 weeks (n = 18), psychiatric hospitalization in the past 6 months (n = 240), arrest in the past 6 months (n = 56), violent behaviors in the past 4 weeks (n = 62), and diagnosis of a co-occurring substance use disorder (n = 413). Results Across all 5 categories of crisis events, patients who had a recent crisis had higher average annual mental health treatment costs than patients in propensity-score matched comparison samples. Average annual mental health treatment costs were significantly higher for persons who attempted suicide ($46,024), followed by persons with psychiatric hospitalization in the past 6 months ($37,329), persons with prior arrests ($31,081), and persons with violent behaviors ($18,778). Total cost was not significantly higher for those with co-occurring substance use disorder ($19,034). Conclusion Recent crises, particularly suicide attempts, psychiatric hospitalizations, and criminal arrests, are predictive of higher mental health treatment costs in schizophrenia patients. PMID:18727831

Stigma, American military personnel and mental health care: challenges from Iraq and Afghanistan.

PubMed

Schreiber, Michael; McEnany, Geoffry Phillips

2015-02-01

Since 2001, more than 2.5 million United States military personnel have been deployed for combat. Over one million have served multiple deployments. Combat generally involved repeated exposure to highly traumatic events. Personnel were also victims of military sexual trauma (MST), a major risk factor for psychiatric illness. Most survivors do not seek or receive mental health care. Stigma is one of the main barriers to that care. To explore the impact of stigma on personnel with psychiatric illness, and suggest some innovative ways to potentially reduce stigma and improve care. Cinahl and PubMed databases were searched from 2001 to 2014. Anonymity, the use of non-stigmatizing language, peer-to-peer, and stigma-reduction programs help military personnel receive mental health care. Technology offers the opportunity for effective and appropriate education and treatment. Although stigma is formidable, several innovative services are available or being developed for military victims of trauma. Commitment of resources for program development and further research to explore which interventions offer the best clinical outcomes are needed to increase efforts to combat stigma and ensure quality care.

42 CFR 483.350 - Basis and scope.

Code of Federal Regulations, 2010 CFR

2010-10-01

... Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED.... Sections 1905(a)(16) and (h) of the Act provide that inpatient psychiatric services for individuals under... psychiatric services for children under the age of 21 as defined by sections 1905(a)(16) and (h) of the Act...

Uptake of the MedsCheck annual medication review service in Ontario community pharmacies between 2007 and 2013

PubMed Central

Dolovich, Lisa; Consiglio, Giulia; MacKeigan, Linda; Abrahamyan, Lusine; Pechlivanoglou, Petros; Rac, Valeria E.; Pojskic, Nedzad; Bojarski, Elizabeth A.; Su, Jiandong; Krahn, Murray; Cadarette, Suzanne M.

2016-01-01

Background: MedsCheck Annual (MCA) is an Ontario government-funded medication review service for individuals taking 3 or more prescription medications for chronic conditions. Methods: This cohort study analyzed linked administrative claims data from April 1, 2007, to March 31, 2013. Trends in MCA claims and recipient characteristics were examined. Results: A total of 1,498,440 Ontarians (55% seniors, 55% female) received an MCA. One-third (36%) had 2 or more MCAs within 6 years. Service provision increased over time, with a sharper increase from 2010 onward. Almost half of Ontario pharmacies made at least 1 MCA claim in the first month of the program. Hypertension, respiratory disease, diabetes, psychiatric conditions and arthritis were common comorbidities. Recipients older than 65 years were most commonly dispensed an antihypertensive and/or antihyperlipidemic drug in the prior year and received an average of 11 unique prescription medications. Thirty-eight percent of recipients visited an emergency department or were hospitalized in the year prior to their first MCA. Discussion: Over the first 6 years of the program, approximately 1 in 9 Ontarians received an MCA. There was rapid and widespread uptake of the service. Common chronic conditions were well represented among MCA recipients. Older MCA recipients had less emergency department use compared with population-based estimates. Conclusions: Medication reviews increased over time; however, the number of persons receiving the service more than once was low. Service delivery was generally consistent with program eligibility; however, there are some findings possibly consistent with delivery to less complex patients. PMID:27708675

[Shortage of doctors in psychiatric hospitals--providing for the future by reorganizing medical services].

PubMed

Jordan, Wolfgang; Adler, Lothar; Bleich, Stefan; von Einsiedel, Regina; Falkai, Peter; Grosskopf, Volker; Hauth, Iris; Steiner, Johann; Cohrs, Stefan

2011-11-01

Increasing psychiatric disorder treatment need, increased work load, changes in the working hour regulations, the nation-wide shortage of physicians, efficiency principle and economisation can necessitate a reorganisation of medical services. The essential steps and instruments of process optimisation in medical services for a psychiatric clinic are elucidated and discussed in the context of demographic changes, generation change, and a new concept of values. © Georg Thieme Verlag KG Stuttgart · New York.

On the potential for iatrogenic effects of psychiatric crisis services: The example of dialectical behavior therapy for adult women with borderline personality disorder.

PubMed

Coyle, Trevor N; Shaver, Jennifer A; Linehan, Marsha M

2018-02-01

Although previous research has suggested that people with a history of using psychiatric crisis services are at higher risk for suicide, it is unclear whether this link is attributable to individual risk factors or iatrogenic effects of service utilization. We examined this question by analyzing data from a randomized controlled trial of dialectical behavior therapy (DBT), a treatment for highly suicidal individuals in which patients took advantage of crisis services less than those in the comparison condition. We hypothesized that crisis-service utilization during a treatment year, rather than pretreatment indicators of suicide risk, would be associated with higher suicide risk after treatment, and that DBT's treatment effects would be partially attributable to this association. Participants were 101 women (Mage = 29.3, 87% Caucasian) with recent suicidal and self-injurious behaviors meeting Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV; American Psychiatric Association [APA], 1994) criteria for borderline personality disorder. We examined relationships between suicidal ideation (using the Suicide Behaviors Questionnaire; Linehan, 1981), number of suicide attempts (using the Suicide Attempt Self-Injury Interview; Linehan, Comtois, Brown, Heard, & Wagner, 2006), and number of psychiatric inpatient admissions and psychiatric emergency-room (ER) visits (using the Treatment History Interview; Linehan & Heard, 1987) from the years prior to, during, and following treatment. Treatment-year psychiatric ER visits were the sole predictor of the number of follow-up year suicide attempts. Treatment condition and pretreatment inpatient admissions predicted treatment-year psychiatric ER visits. Finally, there was evidence that DBT resulted in fewer suicide attempts at follow-up, in part because getting DBT led to fewer psychiatric ER visits. In this population and context, data suggest that crisis-service utilization conveys risk for suicide. DBT may reduce suicide risk in part by reducing use of these services. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Characterizing psychiatric comorbidity in children with autism spectrum disorder receiving publicly funded mental health services.

PubMed

Brookman-Frazee, Lauren; Stadnick, Nicole; Chlebowski, Colby; Baker-Ericzén, Mary; Ganger, William

2017-09-01

Publicly funded mental health programs play a significant role in serving children with autism spectrum disorder. Understanding patterns of psychiatric comorbidity for this population within mental health settings is important to implement appropriately tailored interventions. This study (1) describes patterns of psychiatric comorbidity in children with autism spectrum disorder who present to mental health services with challenging behaviors and (2) identifies child characteristics associated with comorbid conditions. Data are drawn from baseline assessments from 201 children with autism spectrum disorder who participated in a community effectiveness trial across 29 publicly funded mental health programs. Non-autism spectrum disorder diagnoses were assessed using an adapted Mini-International Neuropsychiatric Interview, parent version. Approximately 92% of children met criteria for at least one non-autism spectrum disorder diagnosis (78% attention deficit hyperactivity disorder, 58% oppositional defiant disorder, 56% anxiety, 30% mood). Logistic regression indicated that child gender and clinical characteristics were differentially associated with meeting criteria for attention deficit hyperactivity disorder, oppositional defiant disorder, an anxiety, or a mood disorder. Exploratory analyses supported a link between challenging behaviors and mood disorder symptoms and revealed high prevalence of these symptoms in this autism spectrum disorder population. Findings provide direction for tailoring intervention to address a broad range of clinical issues for youth with autism spectrum disorder served in mental health settings.

[European standardization and German language adaptation of scales for collection of outcomes and costs of treatment for patients with severe mental disorders].

PubMed

Kilian, R; Roick, C; Bernert, S; Mory, C; Matschinger, H; Becker, T; Angermeyer, M C

2001-03-01

For the evaluation of the effectiveness of psychiatric service systems internationally standardised instruments for the assessment of the outcome and the costs of psychiatric and psychosocial treatment and care are increasingly needed. Beside the measurement of objective facts there is a growing importance of the consideration of the subjective perspective of patients and relatives. In the research project "Cost-effectiveness analysis of psychiatric service systems in the European comparison" of the Research association for Public Health in Saxony, developments were worked out, in close cooperation with the BIOMED-2 project "European Psychiatric Services: Inputs Linked to Outcome Domains and Needs", German versions of five European standardized instruments for the assessment of needs for care, treatment satisfaction, burden of care on relatives, quality of life and service costs. The psychometric properties of the instruments were tested within the framework of a longitudinal study with 307 patients with the diagnosis of schizophrenia. As a result of this study, German versions of all relevant European instruments for psychiatric service evaluation are now available.

Help-seeking patterns and attitudes to treatment amongst men who attempted suicide.

PubMed

Cleary, Anne

2017-06-01

A high percentage of those who complete suicide are not in contact with the psychiatric services and this is particularly evident among men who are the most at-risk group. To examine take-up of psychiatric services and attitudes to treatment among a sample of men who made a suicide attempt. Fifty-two males, aged between 18 and 30 years, who made a medically serious suicide attempt, were followed up 7 years later using chart information and national mortality records. On discharge from hospital all participants were referred to psychiatric aftercare services but one-third (32.7%) never presented and 20% attended only for a short period. Yet almost half (48%) of the sample made a subsequent attempt and 12% completed suicide. Factors contributing to low take-up of services include lack of awareness of psychiatric symptoms, reluctance to disclose distress and negative attitudes to seeking professional help. Young males are reluctant to seek professional help for psychiatric problems even following a serious suicide attempt. Factors influencing this include health behaviours linked to traditional expectations for men as well as the type of services provided.

Mastery matters: consumer choice, psychiatric symptoms and problematic substance use among adults with histories of homelessness.

PubMed

Greenwood, Ronni Michelle; Manning, Rachel M

2017-05-01

Previous research demonstrated the importance of consumer choice and mastery to residential stability and psychiatric functioning for adults with histories of homelessness. In the present study, we investigated whether these relationships hold, even in the context of problem-related substance misuse. Questionnaire data were collected in Ireland from 101 residents of long-term homeless accommodation in 2010. Hayes' PROCESS macro for mediation and moderation analysis in SPSS was employed to test our hypotheses. Findings demonstrated that the indirect effect of choice through mastery on psychiatric functioning was stronger for individuals with more recent problem-related substance use than for those with no or distant histories of problem-related substance use. Our findings confirm that consumer choice in housing and services is important to homeless services users' recovery experiences. Because of its relationship with mastery, consumer choice in housing and services protects homeless services users' psychiatric functioning, especially when substance use-related choices have had negative consequences. Our findings suggest that if homeless services take away consumer choice when substance use causes problems, they may actually undermine, rather than foster, service users' psychiatric functioning. © 2016 John Wiley & Sons Ltd.

Rural psychiatric services. A collaborative model.

PubMed Central

Kaufmann, I. M.

1993-01-01

Psychiatric services are difficult to obtain in rural communities because few psychiatrists practise outside urban centres. Family physicians who are willing to develop their skills with the support of their psychiatrist colleagues could alleviate this problem. This article describes a community mental health clinic where a family physician acts as psychiatric consultant. Images p1958-a p1961-a PMID:8219844

Organizational models of emergency psychiatric intervention: state of the art.

PubMed

Barra, A; Daini, S; Tonioni, F; Bria, P

2007-01-01

Authors outline the differences between medical and psychiatric definition of emergency and analyze different organizational models of psychiatric intervention in Emergency Room. The historical evolution changed these models, and the relation with services for acute and subacute patients in hospital and community services. The Italian reform model is compared with the slow deinstitutionalization of psychiatry in other countries. Critical points in Italian emergency organization after the Psychiatric Reform are pointed out: low number of beds for acute patients, difficulties and delays in transfer from Emergency Room to GHPW (General Hospital Psychiatric Ward), waiting lists for voluntary treatments. To overcome some of these problems, the Authors propose that even in hospitals without psychiatric ward, a small unit of short psychiatric observation be implemented, for voluntary treatments, before transfer to other institutions.

Mental illness and psychiatric treatment amongst firesetters, other offenders and the general community.

PubMed

Ducat, Lauren; Ogloff, James R P; McEwan, Troy

2013-10-01

Firesetting is often reported to be associated with psychopathology, but frequently these conclusions are based on studies reliant on selective forensic psychiatric samples without the use of comparison groups. The aim of the study was to examine the rates of mental illness, substance use disorders, personality pathology and psychiatric service usage in a population of convicted firesetters compared with other offenders and community controls. Using a data-linkage design, the study examined the psychiatric histories and usage of public mental health services by 1328 arsonists convicted between 2000 and 2009 in Victoria, Australia. These were compared with 1328 matched community controls and 421 non-firesetting offenders. Firesetters were significantly more likely to have been registered with psychiatric services (37%) compared with other offenders (29.3%) and community controls (8.7%). The firesetters were also more likely to have utilised a diverse range of public mental health services. Firesetters attracted psychiatric diagnoses more often than community controls and other offenders, particularly affective, substance use, and personality disorders. This study confirms that there is a link between firesetting and psychopathology, suggesting that there is a role for the psychiatric screening of known firesetters, and a need to consider psychopathology in formulating the risk for further firesetting.

Important first encounter: Service user experience of pathways to care and early detection in first-episode psychosis.

PubMed

Jansen, Jens Einar; Pedersen, Marlene Buch; Hastrup, Lene Halling; Haahr, Ulrik Helt; Simonsen, Erik

2018-04-01

Long duration of untreated psychosis is associated with poor clinical and functional outcomes. However, few systematic attempts have been made to reduce this delay and little is known of service users' experience of early detection efforts. We explored service users' experience of an early detection service and transition to specialized treatment service, including pathway to care, understanding of illness and barriers to adequate assessment and treatment. In-depth interviews were conducted with 10 service users (median age 21, range 18-27, five males and five females) who were diagnosed with a first-episode non-affective psychosis and who were seen by an early detection team (TOP) and currently enrolled in a specialized early intervention service for this disorder (OPUS). Stigma and fear of the 'psychiatric system' were reported as significant barriers to help seeking, while family members were seen as a crucial support. Moreover, the impact of traumatic events on the experience and development of psychosis was highlighted. Finally, participants were relieved by the prospect of receiving help and the early detection team seemed to create a trusting relationship by offering a friendly, 'anti-stigmatized' space, where long-term symptomatology could be disclosed through accurate and validating questioning. Early detection services have two important functions. One is to make accurate assessments and referrals. The other is to instil hope and trust, and to facilitate further treatment by forming an early therapeutic alliance. The findings in this study provide important insights into the way in which early detection efforts and pathways to care are experienced by service users, with direct implications for improving psychiatric services. © 2015 Wiley Publishing Asia Pty Ltd.

Reactions to Psychiatry Referral in Patients Presenting with Physical Complaints to Medical and Surgical Outpatient Services.

PubMed

Singh, Shubh Mohan; Subodh, B N; Mehra, Aseem; Mehdi, Abbas

2017-01-01

While it is well known that patients with psychiatric illness feel stigmatized, little is known about the reactions to a psychiatric referral among those who visit general hospital medical and surgical services for their complaints. This study assessed the sociodemographic details, psychiatric diagnosis, somatic symptom severity, and interview-based reactions to referral among patients referred to psychiatry services from other departments in a general tertiary hospital in North India. Fifty-nine males and 101 females were assessed over 6 months for this purpose. A majority of patients were diagnosed with a psychiatric disorder and had significant somatic symptom severity. The themes explored were the decision to accept the referral, possibility of the presence of mental illness as signified by a psychiatric diagnosis and factors that enabled or impeded psychiatric treatment seeking. Results indicate that patients did not empower in decision-making, a reluctance to accept the possibility of a psychiatric diagnosis and accept medication and had poor knowledge about psychiatry. Referring clinicians and psychiatrists should be sensitive to patient perceptions so that better care is possible.

Degree of Anger During Anger-Generating Situations Among Psychiatric Staff Nurses: Association Between Nurses' Attitudes Toward Service Users' Aggression and Confidence in Intervening in Aggressive Situations.

PubMed

Shimosato, Seiji; Kinoshita, Aimi

2018-04-17

Some situations require psychiatric staff nurses to respond to service users' negativity or aggression. As a result, psychiatric staff nurses may experience anger. The current study examined how anger levels of psychiatric staff nurses triggered by anger-generating situations by service users affected nurses' confidence and attitudes. A questionnaire survey was administered among 386 psychiatric staff nurses. The questionnaire surveyed anger levels in anger-generating situations, aggressiveness, nurses' attitudes toward aggression, and self-efficacy of intervening in aggressive situations. Path analysis revealed differences between male and female nurses. Male nurses' anger in response to physical aggression was mild when they were confident in handling aggression. Furthermore, female nurses who had high confidence in intervening in an aggressive situation had low anger levels. Confidence in intervening in aggressive situations appeared to dissipate anger and ease nurses during aggressive interactions. [Journal of Psychosocial Nursing and Mental Health Services, xx(x), xx-xx.]. Copyright 2018, SLACK Incorporated.

The Low Proportion and Associated Factors of Involuntary Admission in the Psychiatric Emergency Service in Taiwan

PubMed Central

Wang, Jen-Pang; Chiu, Chih-Chiang; Yang, Tsu-Hui; Liu, Tzong-Hsien; Wu, Chia-Yi; Chou, Pesus

2015-01-01

Background The involuntary admission regulated under the Mental Health Act has become an increasingly important issue in the developed countries in recent years. Most studies about the distribution and associated factors of involuntary admission were carried out in the western countries; however, the results may vary in different areas with different legal and socio-cultural backgrounds. Aims The aim of this study was to investigate the proportion and associated factors of involuntary admission in a psychiatric emergency service in Taiwan. Methods The study cohort included patients admitted from a psychiatric emergency service over a two-year period. Demographic, psychiatric emergency service utilization, and clinical variables were compared between those who were voluntarily and involuntarily admitted to explore the associated factors of involuntary admission. Results Among 2,777 admitted patients, 110 (4.0%) were involuntarily admitted. Police referrals and presenting problems as violence assessed by psychiatric nurses were found to be associated with involuntary admission. These patients were more likely to be involuntarily admitted during the night shift and stayed longer in the psychiatric emergency service. Conclusions The proportion of involuntary admissions in Taiwan was in the lower range when compared to Western countries. Dangerous conditions evaluated by the psychiatric nurses and police rather than diagnosis made by the psychiatrists were related factors of involuntary admission. As it spent more time to admit involuntary patients, it was suggested that multidisciplinary professionals should be included in and educated for during the process of involuntary admission. PMID:26046529

Ringleader bullying: association with psychopathic narcissism and theory of mind among child psychiatric inpatients.

PubMed

Stellwagen, Kurt K; Kerig, Patricia K

2013-10-01

This study examined the association of ringleader bullying with psychopathic traits and theory of mind among 100 youth aged 10-15 (62 boys and 38 girls) receiving inpatient psychiatric services at a state facility. Results of hierarchical multiple regression analyses indicated a positive association between ringleader bullying and psychopathic narcissism, and a significant interaction effect between narcissism and theory of mind. More specifically, narcissism moderated the relationship between theory of mind and ringleader bullying such that theory of mind was positively associated with ringleader bullying when levels of narcissism were high, and theory of mind was negatively associated ringleader bullying when levels of narcissism were low. The discussion of these results focuses on the importance of developing effective treatment techniques for youth whose bullying behavior is associated with narcissistic features and social acuity.

Community Psychiatric Rehabilitation in Israel.

ERIC Educational Resources Information Center

Levy, Amihay; Neumann, Micha

1988-01-01

This paper describes the development of community-based rehabilitation services for persons with mental illness in Israel. It focuses on occupational, social, and residential community psychiatric rehabilitation services. The paper argues that service development has been slow and out of step with the philosophy and objectives of community…

"What We Have Here is a Failure to Communicate": Association of Preferred Language With the Rate of Psychiatric Consultation.

PubMed

Cheung, Stephanie G; Mishkin, Adrienne D; Shapiro, Peter A

In the United States, people with limited English proficiency (LEP) receive poorer medical care than those proficient in English. Few studies demonstrate how linguistic barriers complicate psychiatric care; in consultation-liaison (C-L) psychiatry, there are no published data about care disparities for patients with LEP or for whom English is not the preferred language (PL). We sought to determine if PL affects the psychiatric consultation rate. Among adult patients admitted during 1 year to a large urban academic medical center, we compared psychiatric consultation rates in English PL patients with non-English PL patients. PL was ascertained from demographics during the medical record. The occurrence of psychiatric consultation was ascertained from C-L service logs. There were 54,534 admissions: the no-consultation group (N = 53,196) and the consultation group (N = 1,398). English as PL was more common in the consult group (72.0% of consult group, 62.0% of no-consult group, χ 2 = 92.98, p < 0.0001). Spanish speakers were underrepresented in the consult group (14.2% of consult, 25.8% of no-consult, χ 2 = 98.78, p < 0.0001). Primary teams requested more consultations for patients whose PL was English than for patients with other PLs, suggesting that psychiatric needs of patients with non-English PL may be unaddressed. This is the first study to demonstrate a disproportionately low rate of general hospital psychiatric consultations in this population. Further study is necessary to confirm and understand this disparity. We recommend routine use of professional interpreters and low threshold for consultation in patients with non-English PL. Copyright © 2017 The Academy of Psychosomatic Medicine. Published by Elsevier Inc. All rights reserved.

42 CFR 456.482 - Medical, psychiatric, and social evaluations.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 4 2011-10-01 2011-10-01 false Medical, psychiatric, and social evaluations. 456..., psychiatric, and social evaluations. If a facility provides inpatient psychiatric services to a recipient under age 21, the medical, psychiatric, and social evaluations required by §§ 456.170, and 456.370 must...

42 CFR 456.482 - Medical, psychiatric, and social evaluations.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 42 Public Health 4 2014-10-01 2014-10-01 false Medical, psychiatric, and social evaluations. 456..., psychiatric, and social evaluations. If a facility provides inpatient psychiatric services to a beneficiary under age 21, the medical, psychiatric, and social evaluations required by §§ 456.170, and 456.370 must...

42 CFR 456.482 - Medical, psychiatric, and social evaluations.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 42 Public Health 4 2013-10-01 2013-10-01 false Medical, psychiatric, and social evaluations. 456..., psychiatric, and social evaluations. If a facility provides inpatient psychiatric services to a beneficiary under age 21, the medical, psychiatric, and social evaluations required by §§ 456.170, and 456.370 must...

42 CFR 456.482 - Medical, psychiatric, and social evaluations.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 42 Public Health 4 2012-10-01 2012-10-01 false Medical, psychiatric, and social evaluations. 456..., psychiatric, and social evaluations. If a facility provides inpatient psychiatric services to a beneficiary under age 21, the medical, psychiatric, and social evaluations required by §§ 456.170, and 456.370 must...

42 CFR 456.482 - Medical, psychiatric, and social evaluations.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 4 2010-10-01 2010-10-01 false Medical, psychiatric, and social evaluations. 456..., psychiatric, and social evaluations. If a facility provides inpatient psychiatric services to a recipient under age 21, the medical, psychiatric, and social evaluations required by §§ 456.170, and 456.370 must...

Emotional and cardiovascular reactivity to a child-focused interpersonal stressor among depressed mothers of psychiatrically ill children.

PubMed

Cyranowski, Jill M; Swartz, Holly A; Hofkens, Tara L; Frank, Ellen

2009-01-01

Impairment in maternal interpersonal function represents a risk factor for poor psychiatric outcomes among children of depressed mothers. However, the mechanisms by which this effect occurs have yet to be fully elucidated. Elevated levels of emotional or physiological reactivity to interpersonal stress may impact depressed mothers' ability to effectively negotiate child-focused conflicts. This effect may become particularly pronounced when depressed mothers are parenting a psychiatrically ill child. The current feasibility study evaluated mothers' emotional and cardiovascular reactivity in response to an acute, child-focused stress task. Twenty-two depressed mothers of psychiatrically ill children were recruited from a larger clinical trial; half were randomly assigned to receive an adapted form of interpersonal psychotherapy (IPT-MOMS), while the other half received treatment as usual (TAU). For comparison purposes, a matched sample of 22 nondepressed mothers of psychiatrically healthy children was also evaluated. Depressed mothers receiving minimal-treatment TAU displayed the greatest increases in depressed mood, heart rate, and diastolic blood pressure in response to the child-focused stress task, and significantly differed from the relatively low levels of reactivity observed among nondepressed mothers of healthy children. In contrast, depressed mothers receiving IPT-MOMS displayed patterns of reactivity that fell between these extreme groups. Maternal stress reactivity was associated not only with maternal psychiatric symptoms, but also with levels of chronic parental stress and maternal history of childhood emotional abuse. Future, more definitive research is needed to evaluate depressed mothers' interpersonal stress reactivity, its amenability to treatment, and its long-term impact on child psychiatric outcomes. (c) 2008 Wiley-Liss, Inc.

Prior hospitalization and age as predictors of mental health resource utilization in Israel.

PubMed

Ginsberg, G; Lerner, Y; Mark, M; Popper, M

1997-03-01

A two-part demand model based on data from a psychiatric case registry was estimated in order to search for predictors of hospital-based psychiatric care utilization. Using only age as an independent variable, explanation of future resource utilization is considerably weaker than when number of cumulative days of psychiatric hospital-based service use during the previous five years is also included. Only a small marginal gain is achieved by also adding diagnoses. Prospective remuneration by capitating sick funds according to age and past hospital-based service utilization records is recommended to avoid the twin pitfalls of cream-skimming and a distorted allocation of resources for psychiatric services.

An Analysis of Canadian Psychiatric Mental Health Nursing through the Junctures of History, Gender, Nursing Education, and Quality of Work Life in Ontario, Manitoba, Alberta, and Saskatchewan

PubMed Central

2013-01-01

A society that values mental health and helps people live enjoyable and meaningful lives is a clear aspiration echoed throughout our Canadian health care system. The Mental Health Commission of Canada has put forth a framework for a mental health strategy with goals that reflect the virtue of optimal mental health for all Canadians (Mental Health Commission Canada, 2009). Canadian nurses, the largest group of health care workers, have a vital role in achieving these goals. In Canada, two-thirds of those who experience mental health problems do not receive mental health services (Statistics Canada, 2003). Through a gendered, critical, and sociological perspective the goal of this paper is to further understand how the past has shaped the present state of psychiatric mental health nursing (PMHN). This integrative literature review offers a depiction of Canadian PMHN in light of the intersections of history, gender, education, and quality of nursing work life. Fourteen articles were selected, which provide a partial reflection of contemporary Canadian PMHN. Findings include the association between gender and professional status, inconsistencies in psychiatric nursing education, and the limitations for Canadian nurse practitioners to advance the role of the psychiatric mental health nurse practitioner. PMID:23710367

Police referrals at the psychiatric emergency service in Taiwan.

PubMed

Wang, Jen-Pang; Wu, Chia-Yi; Chiu, Chih-Chiang; Yang, Tsu-Hui; Liu, Tzong-Hsien; Chou, Pesus

2015-12-01

The police are the frontline workers in crisis situations involving patients with severe mental illness and act as a primary referral source for psychiatric emergency services (PES) in the community. The aims of this study were to investigate the distribution and characteristics of police referral among psychiatric patients in Taiwan. The study cohort consisted of patients who visited the PES of Taipei City Psychiatric Center from January 2009 to December 2010. The associations between the factors of demographics, clinical characteristics, and psychiatric service utilization and police referral were evaluated. Among the 7656 psychiatric emergency visits, 3029 (39.6%) were referred by the police. These patients referred by police were more likely to be male and aged between 30 to 49 years. Clinical factors related to police referrals including a higher triage assessment level, chief problems included violence, disturbance, substance use, less anxiety, and a diagnosis of unspecified psychosis. The triage assessment level and chief problems assessed by nurses were major predictors. These patients tended to be referred from the catchment area and during the nighttime shift, were discharged during the daytime shift, and stayed longer in the PES. Disposition arrangements such as discharge against medical advice and involuntary admission were also associated with police referrals. Patients referred by the police to the PES were those with more severe psychiatric problems and illnesses assessed by psychiatric nurses and psychiatrists. They tended to have more complex service utilization at the PES. © 2015 Wiley Publishing Asia Pty Ltd.

Epidemiology of psychiatric disability without posttraumatic stress disorder among U.S. Army and Marine Corps personnel evaluated for disability discharge.

PubMed

Piccirillo, Amanda L; Packnett, Elizabeth R; Boivin, Michael R; Cowan, David N

2015-12-01

Psychiatric disorders are a common reason for disability discharge from the U.S. military. Research on psychiatric disorders in military personnel evaluated for disability discharge has historically focused on posttraumatic stress disorder (PTSD), yet 40% of service members evaluated for a psychiatric-related disability do not have PTSD. This study's objective was to describe characteristics and correlates of disability in Army and Marine Corps personnel diagnosed with psychiatric disorders other than PTSD. In this cross-sectional study, the chi-square and Wilcoxon-Mann-Whitney tests compared the distribution of demographic, disability and deployment characteristics between those evaluated for non-PTSD psychiatric disability (N = 9125) versus those evaluated for any other non-psychiatric condition (N = 78,072). Multivariate logistic regression examined associations between disability retirement and demographic and disability characteristics. Results show a significantly higher prevalence of disability retirement, deployment, and comorbidity among Army and Marine Corps personnel evaluated for disability discharge related to a non-PTSD psychiatric disorder. Mood disorders, anxiety disorders and dementia were the most commonly evaluated psychiatric disorders. Characteristics associated with increased odds of non-PTSD psychiatric-related disability retirement includes being in the Marine Corps (OR = 1.24), being black (OR = 1.29) or other race (OR = 1.33), having a combat-related condition (OR = 2.50), and older age. Service members evaluated for a non-PTSD psychiatric disability have similar rates of disability retirement as those evaluated for PTSD, suggesting non-PTSD psychiatric disorders cause a severe and highly compensated disability. Additional research is needed describing the epidemiology of specific non-PTSD psychiatric disorders, such as depression, in service members evaluated for disability discharge. Copyright © 2015 Elsevier Ltd. All rights reserved.

Randomized controlled trial of contingency management for stimulant use in community mental health patients with serious mental illness.

PubMed

McDonell, Michael G; Srebnik, Debra; Angelo, Frank; McPherson, Sterling; Lowe, Jessica M; Sugar, Andrea; Short, Robert A; Roll, John M; Ries, Richard K

2013-01-01

The primary objective of this study was to determine whether contingency management was associated with increased abstinence from stimulant drug use in stimulant-dependent patients with serious mental illness treated in a community mental health center. Secondary objectives were to determine whether contingency management was associated with reductions in use of other substances, psychiatric symptoms, HIV risk behavior, and inpatient service utilization. A randomized controlled design was used to compare outcomes of 176 outpatients with serious mental illness and stimulant dependence. Participants were randomly assigned to receive 3 months of contingency management for stimulant abstinence plus treatment as usual or treatment as usual with reinforcement for study participation only. Urine drug tests and self report, clinician-report, and service utilization outcomes were assessed during the 3-month treatment period and the 3-month follow-up period. Although participants in the contingency management condition were significantly less likely to complete the treatment period than those assigned to the control condition (42% compared with 65%), they were 2.4 times (95% CI=1.9–3.0)more likely to submit a stimulant-negative urine test during treatment. Compared with participants in the control condition,they had significantly lower levels of alcohol use, injection drug use, and psychiatric symptoms and were one-fifth as likely as those assigned to the control condition to be admitted for psychiatric hospitalization during treatment. They also reported significantly fewer days of stimulant drug use during the 3-month follow-up. When added to treatment as usual, contingency management is associated with large reductions in stimulant,injection drug, and alcohol use.Reductions in psychiatric symptoms and hospitalizations are important secondary benefits.

Danish translation and validation of Kessler's 10-item psychological distress scale - K10.

PubMed

Thelin, Camilla; Mikkelsen, Benjamin; Laier, Gunnar; Turgut, Louise; Henriksen, Bente; Olsen, Lis Raabaek; Larsen, Jens Knud; Arnfred, Sidse

2017-08-01

Psychological distress is a trans-diagnostic feature of mental suffering closely associated with mental disorders. Kessler's 10-item Psychological Distress Scale (K10), a scale with sound psychometric properties, is widely used in epidemiological studies. To translate and investigate whether K10 is a reliable and valid rating scale for the measurement of psychological distress in a Danish population. The translation was carried out according to official WHO translation guidelines. A sample of 100 subjects was included, 54 patients from the regional Mental Health Service (MHS) and 46 subjects with no psychiatric history. All participants were assessed with a psychiatric diagnostic interview (MINI) and handed out K10. Concurrent validity was assessed by WHO Well-being Index (WHO-5). Correlation matrix analysis was conducted for the full sample and receiver operating characteristic (ROC) curves for discriminating mental health service affiliation. Mean K10 scores differed, with decreasing levels, between inpatients and outpatient in MHS and the subjects with no psychiatric history. Factor analysis confirmed a unidimensional structure, and Cronbach's alpha and Omega showed excellent internal reliability. AUC for the K10 ROC curves showed excellent sensitivity (0.947 [0.900-0.995]), accurately differentiating mental health from non-mental health patients. The Danish K10 has the same strong internal reliability as the original English version, and scores differ between psychiatric patients in outpatient and emergency ward settings. The Danish K10 translation is authorized and freely available for download at https://www.hcp.med.harvard.edu/ncs/k6_scales.php . The utility as an instrument for clinical screening in a mental healthcare setting is supported.

Managing complex patients on a medical psychiatric unit: an observational study of university hospital costs associated with medical service use, length of stay, and psychiatric intervention.

PubMed

Leue, Carsten; Driessen, Ger; Strik, Jacqueline J; Drukker, Marjan; Stockbrügger, Reinhold W; Kuijpers, Petra M; Masclee, Ad A; van Os, Jim

2010-03-01

Although there is a suggestion that the medical psychiatric unit (MPU) may reduce length of hospital stay (LOS), little is known about costs in terms of medical service use and psychiatric interventions in MPU care. A record linkage study was conducted, linking cost data of hospital medical service use, LOS, and hospital psychiatric interventions to patients admitted to the MPU of the Maastricht University Medical Centre (MUMC) between 1998 and 2004. The data set was analyzed to enable comparison between cost changes of the same complex patient population following either MPU index admission or index admissions to reference MUMC medical wards. Comparisons revealed lower costs of medical service use in favor of the MPU (-euro104; 95% CI -euro174 to -euro35; P<.01). However, cost of psychiatric intervention and cost of LOS were higher after MPU admission (respectively, +euro165; 95% CI +euro25 to +euro305; P<.05; and +euro202; 95% CI +euro170 to +euro235; P<.001). Total costs were higher after MPU admission compared to medical ward admission (+euro263; 95% CI +euro68 to +euro458; P<.05). These differences were not moderated by somatic diagnosis or previous pattern of admissions. The findings suggest that patients at the interface of psychiatric and somatic morbidity are diagnosed and treated adequately at the MPU, leading to a decrease in medical service use and an appropriate increase in exposure to psychiatric interventions. These results are specifically generalizable to MPUs with a focus on psychosomatic conditions, for instance, somatoform disorders or affective disorders with comorbid somatic diseases. However, failure to show cost savings in terms of LOS compared to medical wards outweighs cost-benefit derived from lower medical service use, suggesting that MPU activities may gain in cost-effectiveness if shifted more to outpatient psychosomatic care solutions. Copyright 2010 Elsevier Inc. All rights reserved.

Factor structure of the autonomy preference index in people with severe mental illness.

PubMed

Bonfils, Kelsey A; Adams, Erin L; Mueser, Kim T; Wright-Berryman, Jennifer L; Salyers, Michelle P

2015-08-30

People vary in the amount of control they want to exercise over decisions about their healthcare. Given the importance of patient-centered care, accurate measurement of these autonomy preferences is critical. This study aimed to assess the factor structure of the Autonomy Preference Index (API), used widely in general healthcare, in individuals with severe mental illness. Data came from two studies of people with severe mental illness (N=293) who were receiving mental health and/or primary care/integrated care services. Autonomy preferences were assessed with the API regarding both psychiatric and primary care services. Confirmatory factor analysis was used to evaluate fit of the hypothesized two-factor structure of the API (decision-making autonomy and information-seeking autonomy). Results indicated the hypothesized structure for the API did not adequately fit the data for either psychiatric or primary care services. Three problematic items were dropped, resulting in adequate fit for both types of treatment. These results suggest that with relatively minor modifications the API has an acceptable factor structure when asking people with severe mental illness about their preferences to be involved in decision-making. The modified API has clinical and research utility for this population in the burgeoning field of autonomy in patient-centered healthcare. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

42 CFR 412.405 - Preadmission services as inpatient operating costs under the inpatient psychiatric facility...

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 2 2011-10-01 2011-10-01 false Preadmission services as inpatient operating costs under the inpatient psychiatric facility prospective payment system. 412.405 Section 412.405 Public... PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES Prospective Payment System for Inpatient Hospital...

42 CFR 412.405 - Preadmission services as inpatient operating costs under the inpatient psychiatric facility...

Code of Federal Regulations, 2013 CFR

2013-10-01

... 42 Public Health 2 2013-10-01 2013-10-01 false Preadmission services as inpatient operating costs under the inpatient psychiatric facility prospective payment system. 412.405 Section 412.405 Public... PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES Prospective Payment System for Inpatient Hospital...

42 CFR 412.405 - Preadmission services as inpatient operating costs under the inpatient psychiatric facility...

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 2 2010-10-01 2010-10-01 false Preadmission services as inpatient operating costs under the inpatient psychiatric facility prospective payment system. 412.405 Section 412.405 Public... PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES Prospective Payment System for Inpatient Hospital...

42 CFR 412.405 - Preadmission services as inpatient operating costs under the inpatient psychiatric facility...

Code of Federal Regulations, 2014 CFR

2014-10-01

... 42 Public Health 2 2014-10-01 2014-10-01 false Preadmission services as inpatient operating costs under the inpatient psychiatric facility prospective payment system. 412.405 Section 412.405 Public... PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES Prospective Payment System for Inpatient Hospital...

42 CFR 412.405 - Preadmission services as inpatient operating costs under the inpatient psychiatric facility...

Code of Federal Regulations, 2012 CFR

2012-10-01

... 42 Public Health 2 2012-10-01 2012-10-01 false Preadmission services as inpatient operating costs under the inpatient psychiatric facility prospective payment system. 412.405 Section 412.405 Public... PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES Prospective Payment System for Inpatient Hospital...

Rural jail telepsychiatry: a pilot feasibility study.

PubMed

Manfredi, Luisa; Shupe, Joann; Batki, Steven L

2005-10-01

New York State has a large rural population, and many of the jails in rural areas have minimal or no psychiatric services available on site. Cost of transport to off-site psychiatric services and the safety issues related to moving inmates from a secure building may limit inmate access to appropriate psychiatric services. This feasibility study describes a project that provided telepsychiatric consultation to increase access to psychiatric treatment in an underserved rural jail in upstate New York. Subjects were consenting jail inmates who requested or were found to be in need of psychiatric care. The project provided interactive two-way audio-video communication between the psychiatrist located in an urban university medical center and subjects who were incarcerated 182 miles away. During the project period, 15 inmates were assessed and treated in 37 consultations. Subjects were predominantly young white males with anxiety, mood, and substance use disorders. Services were readily accepted by inmates and staff. Telepsychiatric examination and treatment appears to be a feasible method to increase access to mental health care in rural jails. Future advocacy for increased mental health services in rural areas in criminal justice setting is likely to depend on further evidence of favorable cost benefit.

Utilization of psychiatric care and antidepressants among people with different severity of depression: a population-based cohort study in Stockholm, Sweden.

PubMed

Sun, Yuying; Möller, Jette; Lundin, Andreas; Wong, Samuel Y S; Yip, Benjamin H K; Forsell, Yvonne

2018-06-01

To identify how severity of depression predicts future utilization of psychiatric care and antidepressants. Data derived from a longitudinal population-based study in Stockholm, Sweden, include 10443 participants aged 20-64 years. Depression was assessed by Major Depression Inventory and divided into subsyndromal, mild, moderate and severe depression. Outcomes were the first time of hospitalization, specialized outpatient care and prescribed drugs obtained from national register records. The association between severity of depression and outcomes was tested by Cox regression analysis, after adjusting for gender, psychiatric treatment history and socio-environmental factors. The cumulative incidences of hospitalizations, outpatient care and antidepressants were 4.0, 11.2, and 21.9% respectively. Compared to the non-depressed group, people with different severity of depression (subsyndromal, mild, moderate and severe depression) all had significantly higher risk of all three psychiatric services (all log-rank test P < 0.001). Use of psychiatric care and antidepressants increased by rising severity of depression. Although the associations between severity of depression and psychiatric services were significant, the dose relationship was not present in people with previous psychiatric history or after adjusting for gender and other factors. People with subsyndromal to severe depression all have increased future psychiatric service utilization compared to non-depressed people.

Caregiver perceptions of mental health problems and treatment utilisation in siblings of children with mental health problems.

PubMed

Ma, Nylanda; Furber, Gareth; Roberts, Rachel; Winefield, Helen

2016-01-01

Siblings of children with mental health problems (MHPs) have been found to have higher rates of psychopathology and impaired psychosocial functioning compared to control children. It is not yet known how these siblings are managed within the clinical service context (e.g., are they assessed for mental health problems? Do they receive appropriate psychological treatment?). The following brief report describes a pilot study which aimed to explore (a) the rate of caregiver-identified MHPs in siblings and (b) the proportion of siblings receiving psychiatric or psychosocial treatment or support (i.e., treatment utilisation). Eighty-five caregivers of children receiving treatment at CAMHS were interviewed about the mental health and treatment utilisation of their siblings. The findings revealed a high rate of caregiver-identified MHPs in siblings (34.1%) and a high rate of treatment utilisation (85.7%). The findings suggest that, for the vast majority, when siblings of children with MHPs are identified by their caregivers as having MHPs, they are receiving some kind of support and treatment. Implications for mental health service costs are discussed and recommendations for future research are outlined.

Characteristics and Risk Factors for Suicide and Deaths Among College Students: A 23-Year Serial Prevalence Study of Data From 8.2 Million Japanese College Students.

PubMed

Uchida, Chiyoko; Uchida, Mai

2017-04-01

Suicide is a leading cause of death for college students. The aim of this study was to identify risk factors of suicide among college students that could improve university services to help prevent college suicide. We conducted a 23-year serial prevalence study of the prevalence and characteristics of death and suicide among 8,262,314 Japanese college students. We analyzed rates of suicide from the 1989 to 1990 academic year through the 2011-2012 academic year and characterized suicide among this population, focusing on students' sex and psychiatric and academic backgrounds to identify risk factors for suicide. Suicide rates increased throughout the 23 years, and suicide was the leading cause of death every year from 1996 onward. Suicide accounted for 42.4% of all deaths that happened in the 23 years. Male students, medicine majors, students in the final year of their program, and students who completed extra years of schooling or took academic leaves of absence were at higher risk for suicide. Only 16.4% had received an official psychiatric diagnosis and 16.0% had received services through the university health center prior to the suicides. Results suggest the need for a stronger support system for college students. Areas for improvement could include better advertising of mental health services, student and staff education about suicide risk factors, and mentorship and outreach programs for students in their final year of classes, those majoring in medicine, and those who have taken leaves of absence or failed classes. Accommodations at the administrative level would also be helpful for students who need to retake classes or transfer credit. © Copyright 2017 Physicians Postgraduate Press, Inc.

Immigrants and borderline personality disorder at a psychiatric emergency service.

PubMed

Pascual, J C; Malagón, A; Córcoles, D; Ginés, J M; Soler, J; García-Ribera, C; Pérez, V; Bulbena, A

2008-12-01

Several studies have suggested that immigrants have higher rates of psychiatric emergency service use and a higher risk of mental disorders such as schizophrenia than indigenous populations. To compare the likelihood that immigrants (immigrant group) v. indigenous population (indigenous group) will be diagnosed with borderline personality disorder in a psychiatric emergency service and to determine differences according to area of origin. A total of 11 578 consecutive admissions over a 4-year period at a tertiary psychiatric emergency service were reviewed. The collected data included socio-demographic and clinical variables and the Severity of Psychiatric Illness rating score. Psychiatric diagnosis was limited to information available in the emergency room given that a structured interview is not usually feasible in this setting. The diagnosis of borderline personality disorder was based on DSM-IV criteria. Immigrants were divided into five groups according to region of origin: North Africa, sub-Saharan Africa, South America, Asia and Western countries. Multivariate statistical logistic regression analysis showed that all subgroups of immigrants had a lower likelihood of being diagnosed with borderline personality disorder than the indigenous population independently of age and gender. Furthermore, the rates of borderline personality disorder diagnosis were considerably lower in Asian and sub-Saharan subgroups than in South American, North African, Western or native subgroups. Our results showed that in the psychiatric emergency service borderline personality disorder was diagnosed less frequently in the immigrant group v. the indigenous group. Our results do not support the concept of migration as a risk factor for borderline personality disorder.

Prediction of community mental health service utilization by individual and ecological level socio-economic factors.

PubMed

Donisi, Valeria; Tedeschi, Federico; Percudani, Mauro; Fiorillo, Andrea; Confalonieri, Linda; De Rosa, Corrado; Salazzari, Damiano; Tansella, Michele; Thornicroft, Graham; Amaddeo, Francesco

2013-10-30

Individuals with a more deprived socioeconomic status (SES) are more likely to have higher rates of psychiatric morbidity and use of psychiatric services. Such service use is also influenced by socioeconomic factors at the ecological level. The aim of this article is to investigate the influence of these variables on service utilization. All patients in contact with three Italian community psychiatric services (CPS) were included. Community and hospital contacts over 6 months were investigated. Socio-economic characteristics were described using a SES Index and two new Resources Accessibility Indexes. Low SES was found to be associated with more community service contacts. When other individual and ecological variables were controlled for, SES was negatively associated only with the number of home visits, which was about half the rate in deprived areas. An association between service utilization and the resources of the catchment area was also detected. The economic crisis in Europe is increasing inequality of access, so paying attention to SES characteristics at both the individual and the ecological levels is likely to become increasingly important in understanding patterns of psychiatric service utilization and planning care accordingly. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

[Educational guidance for families with mentally ill parents: a bridge between youth welfare services and psychiatric care system].

PubMed

Schrappe, Andreas

2013-01-01

In the last fifteen years a lot of services were established to assist children and their mentally ill parents. To improve the preventive and therapeutic interventions in favour of these families, the cooperation between all the institutions involved has to be enhanced. Family counselling centers can play an important role as a link between the psychiatric care system and the youth welfare services. By transferring the psychiatric terminology to the families' everyday language, the counsellors help the parents and the children to share their experiences with the parental illness. To implement a consultation-hour in a psychiatric clinic is an example of how educational guidance can close the gap between the two systems and strengthen the cooperation.

Price elasticity of demand for psychiatric consultation in a Nigerian psychiatric service.

PubMed

Esan, Oluyomi

2016-12-01

This paper addresses price elasticity of demand (PED) in a region where most patients make payments for consultations out of pocket. PED is a measure of the responsiveness of the quantity demanded of goods or services to changes in price. The study was done in the context of an outpatient psychiatric clinic in a sub -Saharan African country. The study was performed at the University College Hospital (UCH), Ibadan, Nigeria. Aggregate data were collected on weekly clinic attendance over a 24-month period October 2008 - September 2010 representing 12 months before, to 12months after a 67% increase in price of outpatient psychiatric consultation. The average weekly clinic attendance prior to the increase was compared to the average clinic attendance after the price increase. Arc-PED for consultation was also estimated. Clinic attendance dropped immediately and significantly in the weeks following the price increase. There was a 34.4% reduction in average weekly clinic attendance. Arc-PED for psychiatric consultation was -0.85. In comparison to reported PED on health care goods and services, this study finds a relatively high PED in psychiatric consultation following an increase in price of user fees of psychiatric consultation.

Seeking and securing work: Individual-level predictors of employment of psychiatric survivors.

PubMed

Hall, Peter V; Montgomery, Phyllis; Davie, Samantha; Dickins, Kevin; Forchuk, Cheryl; Jeng, Momodou S; Kersey, Melissa; Meier, Amanda; Lahey, Pam; Rudnick, Abraham; Solomon, Michelle; Warner, Laura

2015-01-01

For people with mental illness (psychiatric survivors), seeking and securing employment involves personal, social, and environmental factors. In Canada, psychiatric survivors are under-represented in the workforce, and services can help by tailoring their supports to help make the most gains in employment. Determine whether individual socio-demographic and health factors predict seeking and securing employment among psychiatric survivors. A community sample of psychiatric survivors from a Southwestern Ontario region participated in this study. Stepwise logistic regression was used to analyze data from 363 participants who had completed a variety of questionnaires to ascertain individual characteristics and employment outcomes. Health service utilization, living circumstances, homelessness, substance use issues, general health, social integration, ethnicity, having children under 18, and being a student emerged as significant predictors of seeking and securing work. Other commonly accepted human capital indicators, such as education and age, were not predictive of employment search behavior and outcomes. Individual characteristics that predict employment search and success outcomes for psychiatric survivors include aspects related to treatment and living circumstances, which stands in contrast to predictors of employment for the general population, suggesting that employment support services may need to be tailored to psychiatric survivors specifically.

A cross-sectional study about associations between personality characteristics and mental health service utilization in a Korean national community sample of adults with psychiatric disorders.

PubMed

Park, Subin; Lee, Yeeun; Seong, Su Jeong; Chang, Sung Man; Lee, Jun Young; Hahm, Bong Jin; Hong, Jin Pyo

2017-05-05

Personality traits are not only associated with psychiatric symptoms, but also with treatment seeking behavior. Our purpose was to examine the relationship between mental health service utilization and personality characteristics in a nationwide community sample of Korean adults. Of the 6022 subjects aged 18-74 years who participated in the Korean Epidemiologic Catchment Area study, 1544 (25.6%) with a lifetime diagnosis of any DSM-IV psychiatric disorder were analyzed. Diagnostic assessments were based on the Composite International Diagnostic Interview and personality constructs were measured by Big Five Personality Inventory-10. Of the 1544 participants, 275 (17.8%) had used mental health services. Multivariate analyses revealed positive associations between mental health service utilization and both neuroticism and openness, and an inverse association between mental health service utilization and agreeableness. These findings suggest that specific personality traits may have a role in treatment-seeking behaviors for mental health problems independent of the psychiatric disorder.

Workers safety in public psychiatric services: problems, laws and protections.

PubMed

Carabellese, F; Urbano, M; Coluccia, A; Gualtieri, G

2017-01-01

The dramatic case of murder of a psychiatrist during her service in her public office (Centro di Salute Mentale of Bari-Libertà) has led the authors to reflect on the safety of workplaces, in detail of public psychiatric services. It is in the light of current legislation, represented by the Legislative Decree of April 9th, 2008 no. 81, which states the implementing rules of Law 123/2007. In particular, the Authors analyzed the criticalities of the application of this Law, with the aim of safeguarding the health and safety of the workers in all psychiatric services (nursing departments, outpatient clinics, community centers, day care centers, etc.). The Authors suggest the need to set up an articulated specific organizational system of risk assessment of psychiatric services, that can prevent and protect the workers from identified risks, and finally to ensure their active participation in prevention and protection activities, in absence of which specific profiles of responsibility would be opened up to the employers.

Identifying Recipients of Electroconvulsive Therapy: Data From Privately Insured Americans.

PubMed

Wilkinson, Samuel T; Agbese, Edeanya; Leslie, Douglas L; Rosenheck, Robert A

2018-05-01

Despite the effectiveness of electroconvulsive therapy (ECT), limited epidemiologic research has been conducted to identify rates of ECT use and characteristics of patients who receive ECT. Sociodemographic and clinical characteristics associated with ECT use were examined among patients with mood disorders in the MarketScan commercial insurance claims database. Among individuals with major depressive disorder or bipolar disorder, sociodemographic and clinical characteristics of those who received ECT and those who did not were compared by using bivariate effect size comparisons and multivariate logistic regression. Among unique individuals in the 2014 MarketScan database (N=47,258,528), the ECT utilization rate was 5.56 ECT patients per 100,000 in the population. Of the 969,277 patients with a mood disorder, 2,471 (.25%) received ECT. Those who received ECT had substantially higher rates of additional comorbid psychiatric disorders (risk ratio [RR]=5.70 for any additional psychiatric disorder), numbers of prescription fills for any psychotropic medication (Cohen's d=.77), rates of any substance use disorder (RR=1.97), and total outpatient psychotherapy visits (Cohen's d=.49). The proportion of patients with a mood disorder who received ECT in the West (.19%) was substantially lower than in other U.S. regions (.28%). This difference was almost entirely accounted for by one western state comprising 59.1% of patients in that region. Use of ECT is exceptionally uncommon and limited to patients with extensive multimorbidity and high levels of service use. ECT utilization is most limited in areas of the country where regulatory restrictions are greatest.

Effect of full-service partnerships on homelessness, use and costs of mental health services, and quality of life among adults with serious mental illness.

PubMed

Gilmer, Todd P; Stefancic, Ana; Ettner, Susan L; Manning, Willard G; Tsemberis, Sam

2010-06-01

Chronically homeless adults with severe mental illness are heavy users of costly inpatient and emergency psychiatric services. Full-service partnerships (FSPs) provide housing and engage clients in treatment. To examine changes in recovery outcomes, mental health service use and costs, and quality of life associated with participation in FSPs. A quasi-experimental, difference-in-difference design with a propensity score-matched control group was used to compare mental health service use and costs of FSP with public mental health services. Recovery outcomes were compared before and after services use, and quality of life was compared cross-sectionally. San Diego County, California, from October 2005 through June 2008. Two hundred nine FSP clients and 154 clients receiving public mental health services. Recovery outcomes (housing, financial support, and employment), mental health service use (use of outpatient, inpatient, emergency, and justice system services), and mental health services and housing costs from the perspective of the public mental health system. Among FSP participants, the mean number of days spent homeless per year declined 129 days from 191 to 62 days; the probability of receiving inpatient, emergency, and justice system services declined by 14, 32, and 17 percentage points, respectively; and outpatient mental health visits increased by 78 visits (P < .001 each). Outpatient costs increased by $9180; inpatient costs declined by $6882; emergency service costs declined by $1721; jail mental health services costs declined by $1641; and housing costs increased by $3180 (P < .003 each). Quality of life was greater among FSP clients than among homeless clients receiving services in outpatient programs. Participation in an FSP was associated with substantial increases in outpatient services and days spent in housing. Reductions in costs of inpatient/emergency and justice system services offset 82% of the cost of the FSP.

Open Notes in Swedish Psychiatric Care (Part 1): Survey Among Psychiatric Care Professionals.

PubMed

Petersson, Lena; Erlingsdóttir, Gudbjörg

2018-02-02

When the Swedish version of Open Notes, an electronic health record (EHR) service that allows patients online access, was introduced in hospitals, primary care, and specialized care in 2012, psychiatric care was exempt. This was because psychiatric notes were considered too sensitive for patient access. However, as the first region in Sweden, Region Skåne added adult psychiatry to its Open Notes service in 2015. This made it possible to carry out a unique baseline study to investigate how different health care professionals (HCPs) in adult psychiatric care in the region expect Open Notes to impact their patients and their practice. This is the first of two papers about the implementation of Open Notes in adult psychiatric care in Region Skåne. The objective of this study was to describe, compare, and discuss how different HCPs in adult psychiatric care in Region Skåne expect Open Notes to impact their patients and their own practice. A full population Web-based questionnaire was distributed to psychiatric care professionals in Region Skåne in late 2015. The response rate was 28.86% (871/3017). Analyses show that the respondents were representative of the staff as a whole. A statistical analysis examined the relationships between different professionals and attitudes to the Open Notes service. The results show that the psychiatric HCPs are generally of the opinion that the service would affect their own practice and their patients negatively. The most striking result was that more than 60% of both doctors (80/132, 60.6%) and psychologists (55/90, 61%) were concerned that they would be less candid in their documentation in the future. Open Notes can increase the transparency between patients and psychiatric HCPs because patients are able to access their EHRs online without delay and thus, can read notes that have not yet been approved by the responsible HCP. This may be one explanation as to why HCPs are concerned that the service will affect both their own work and their patients. ©Lena Petersson, Gudbjörg Erlingsdóttir. Originally published in JMIR Mental Health (http://mental.jmir.org), 02.02.2018.

[Transcultural psychiatry or ethnopsychiatry].

PubMed

Serce, A; Davatz, U

1993-08-17

Dr. med. Ursula Davatz is heading the socio-psychiatric service at the psychiatric clinic of Königsfelden. She has trained as a family therapist according to M. Bowen. Dr. med. Adnan Serce is as turkish speaking physician responsive for the "transcultural" psychiatric domain in this service. The authors describe their experiences and difficulties in treating turkish and kurdish psychiatric patients. The language barrier, a divergent cultural background and the tendency of patients and somatic physicians to ascribe psychic problems to somatic causes or symptoms impede, according to the authors, a timely and adequate psychiatric treatment. A dialogue-oriented introspective therapeutic approach is often met by unsurmountable difficulties. Therapeutic success is, however, not excluded as the following examples demonstrate.

Psychiatric disorders and treatment in low-income pregnant women.

PubMed

Cook, Cynthia A Loveland; Flick, Louise H; Homan, Sharon M; Campbell, Claudia; McSweeney, Maryellen; Gallagher, Mary Elizabeth

2010-07-01

This study estimated the prevalence of twenty-two 12-month and lifetime psychiatric disorders in a sample of 744 low-income pregnant women and the frequency that women with psychiatric disorders received treatment. To identify psychiatric disorders, the Diagnostic Interview Schedule (DIS) was administered to Medicaid or Medicaid-eligible pregnant women enrolled in the Special Supplemental Nutrition Program for Women, Infants and Children (WIC). The sample was stratified by the rural or urban location of the WIC sites in southeastern Missouri and the city of St. Louis. Eligible women were enrolled at each site until their numbers were proportional to the racial distribution of African American and Caucasian pregnant women served there. The 12-month prevalence of one or more psychiatric disorders was 30.9%. Most common were affective disorders (13.6%), particularly major depressive disorder (8.2%) and bipolar I disorder (5.2%). Only 24.3% of those with a psychiatric disorder reported that they received treatment in the past year. Lifetime prevalence of at least one disorder was 45.6%, with affective disorders being the most frequent (23.5%). Caucasian women were more likely than African Americans to have at least one 12-month disorder, with the difference largely accounted for by nicotine dependence. Higher prevalence of lifetime disorders was also found in Caucasian women, particularly affective disorders and substance use disorders. There were no differences in the prevalence of 12-month or lifetime psychiatric disorders by the urban or rural residence of subjects. With nearly one third of pregnant women meeting criteria for a 12-month psychiatric disorder and only one fourth receiving any type of mental health treatment, comprehensive psychiatric screening during pregnancy is needed along with appropriate treatment.

Incremental predictive validity of the Addiction Severity Index psychiatric composite score in a consecutive cohort of patients in residential treatment for drug use disorders.

PubMed

Thylstrup, Birgitte; Bloomfield, Kim; Hesse, Morten

2018-01-01

The Addiction Severity Index (ASI) is a widely used assessment instrument for substance abuse treatment that includes scales reflecting current status in seven potential problem areas, including psychiatric severity. The aim of this study was to assess the ability of the psychiatric composite score to predict suicide and psychiatric care after residential treatment for drug use disorders after adjusting for history of psychiatric care. All patients treated for drug use disorders in residential treatment centers in Denmark during the years 2000-2010 with complete ASI data were followed through national registers of psychiatric care and causes of death (N=5825). Competing risks regression analyses were used to assess the incremental predictive validity of the psychiatric composite score, controlling for previous psychiatric care, length of intake, and other ASI composite scores, up to 12years after discharge. A total of 1769 patients received psychiatric care after being discharged from residential treatment (30.3%), and 27 (0.5%) committed suicide. After adjusting for all covariates, psychiatric composite score was associated with a higher risk of receiving psychiatric care after residential treatment (subhazard ratio [SHR]=3.44, p<0.001), and of committing suicide (SHR=11.45, p<0.001). The ASI psychiatric composite score has significant predictive validity and promises to be useful in identifying patients with drug use disorders who could benefit from additional mental health treatment. Copyright © 2017 Elsevier Ltd. All rights reserved.

Study protocol for a cluster randomised controlled trial to assess the effectiveness of user-driven intervention to prevent aggressive events in psychiatric services.

PubMed

Välimäki, Maritta; Yang, Min; Normand, Sharon-Lise; Lorig, Kate R; Anttila, Minna; Lantta, Tella; Pekurinen, Virve; Adams, Clive E

2017-04-04

People admitted to psychiatric hospitals with a diagnosis of schizophrenia may display behavioural problems. These may require management approaches such as use of coercive practices, which impact the well-being of staff members, visiting families and friends, peers, as well as patients themselves. Studies have proposed that not only patients' conditions, but also treatment environment and ward culture may affect patients' behaviour. Seclusion and restraint could possibly be prevented with staff education about user-centred, more humane approaches. Staff education could also increase collaboration between patients, family members and staff, which may further positively affect treatment culture and lower the need for using coercive treatment methods. This is a single-blind, two-arm cluster randomised controlled trial involving 28 psychiatric hospital wards across Finland. Units will be randomised to receive either a staff educational programme delivered by the team of researchers, or standard care. The primary outcome is the incidence of use of patient seclusion rooms, assessed from the local/national health registers. Secondary outcomes include use of other coercive methods (limb restraint, forced injection, and physical restraint), service use, treatment satisfaction, general functioning among patients, and team climate and employee turn-over (nursing staff). The study, designed in close collaboration with staff members, patients and their relatives, will provide evidence for a co-operative and user-centred educational intervention aiming to decrease the prevalence of coercive methods and service use in the units, increase the functional status of patients and improve team climate in the units. We have identified no similar trials. ClinicalTrials.gov NCT02724748 . Registered on 25 th of April 2016.

Recovery-Oriented Vocational Rehabilitation Services for Individuals with Co-Occurring Psychiatric Disabilities and Substance Use Disorders

ERIC Educational Resources Information Center

Lusk, Stephanie L.; Koch, Lynn C.; Paul, Teresia M.

2016-01-01

Purpose: In this article, we examined how individuals with co-occurring psychiatric disabilities and substance use disorders encounter numerous challenges when it comes to the vocational rehabilitation (VR) process. Method: A comprehensive review of the literature demonstrated barriers to service delivery (e.g., access to services, exclusionary…

Psychiatric Services in Dubai (A Short Descriptive Report)

ERIC Educational Resources Information Center

Al Mualla, Saoud

2011-01-01

The paper gives an account of psychiatric services in Dubai (U.A.E). It describes the unique demographic constitution of Dubai and its complex health system. It also discusses the reasons behind the primitiveness of psychiatry in comparison to other medical specialties and services, especially considering the wealth of Dubai. The paper then goes…

Emergency Psychiatric Services for Individuals with Intellectual Disabilities: Perspectives of Hospital Staff

ERIC Educational Resources Information Center

Lunsky, Yona; Gracey, Carolyn; Gelfand, Sara

2008-01-01

Strains on the mainstream mental health system can result in inaccessible services that force individuals with intellectual disabilities into the emergency room (ER) when in psychiatric crisis. The purpose of this study was to identify clinical and systemic issues surrounding emergency psychiatry services for people with intellectual disabilities,…

The importance of the patients deemed not guilty by reason of insanity for the psychiatric reform.

PubMed

Douzenis, Athanasios

2016-01-01

According to the Greek Penal Law if someone "because of a morbid disturbance of his mental functioning" (article 34) is acquitted of a crime or misdemeanour that the law punishes with more than 6 months imprisonment, then the court orders that this individual should be kept in a public psychiatric institution if the court reaches the conclusion that this person poses a threat to public safety.1 Individuals who have broken the law and deemed "not guilty by reason of insanity" are treated in psychiatric units of Psychiatric Hospitals according to the article 69 of the Penal Code. In Athens, in the Psychiatric Hospital of Athens and the Dromokaiteion Psychiatric Hospital, and in Thessaloniki in the Unit for "Not guilty by reason of insanity (NGRI)". The person who is deemed not guilty by reason of insanity following a crime is facing double stigmatisation and marginalisation from both the legal and the health system. He/she is usually treated initially with fear and later since there is no therapeutic aim but only the court instruction for "guardianship", with indifference. The patient who is committed by the courts in a psychiatric unit for being "NGRI" is facing a unique legal and psychiatric status.2 In this respect he/she is disadvantaged when compared to either convicted criminals or psychiatric inpatients. If the patient was not found "NGRI" (ie innocent as far as sentencing is concerned) he would have been punished with loss of liberty for a certain (specific) amount of time, and like all individuals convicted in court he/she would have the right to appeal and reduce his/her sentence in a higher court and maybe released from prison earlier for good behaviour etc. In this respect the individual found to be "NGRI" is disadvantaged when compared to a convicted felon since he/she is kept for an undefined period of time. Additionally, he/she will be allowed to leave the psychiatric unit following a subjective assessment of a judge with no psychiatric knowledge who will decide that this certain individual has "ceased to be dangerous". These problems are accentuated by the difficulties that the Greek justice system is facing. On the other side, from the psychiatric point of view, the "NGRI" patient who is an inpatient is not receiving the holistic, (bio psycho social) treatment and assessment of needs he/she requires. The psychiatric team looking after him, once the acute symptomatology is controlled is just getting used to a patient who will not be discharged in the immediate future. These patients form the "new chronic asylum psychiatric inpatients" for whom the treating psychiatrists are not allowed to discharge back into the community whilst it is unclear whether they can be transferred to supported rehabilitation units. It is a medical but also legal paradox to assign to contemporary psychiatric units aiming mainly to treat patients in the community to "keep and guard" inpatients whilst these psychiatric units should focus on care and rehabilitation of the patients (including the "NGRIs").3 Keeping patients like these in psychiatric units creates problems in the functioning of the units. These patients are "kept" in acute beds for long periods of time (5 to 6 years minimum) with patients treated voluntarily or against their will and cannot be discharged without a court's decision. The problems are obvious if one realises that the average time of hospitalisation is not exceeding 2 months for the vast majority of psychiatric patients. With the prolonged stay patients of the "article 69" (NGRIs) they not only burden the already limited resources (there is an established lack of psychiatric beds nationwide) but also this prolonged hospitalisation increases their stigmatisation and marginalisation. Thus the prolonged hospitalisation for "safety" reasons according to the court decision leads to the absence of a therapeutic aim other than maintaining the patient on the ward. Greece has agreed that there is an urgent need in developing community psychiatry services and closure/transformation of the big psychiatric hospitals (asylums). It is impossible to close hospitals where "NGRIs" are kept. The decision to move them into the community is not a medical-psychiatric but a legal one. In this respect it is imperative to establish a Forensic Psychiatric Unit for these patients. In our country as the "Psychargos" external evaluation highlighted, there are great gaps in the provision of Forensic psychiatric services.3 It must be emphasised that these gaps affect negatively psychiatric reform and social reintegration not only for the forensic psychiatric patients but for the whole of mentally ill individuals. Given that forensic Psychiatric services are developed in Athens and Thessaloniki and that training in Forensic Psychiatry has moved forward, it is imperative that the state should build upon the existing knowledge and experience and create specialist forensic units aiming to treat and rehabilitate this special and important group of patients.4 Only when the patients found "not guilty by reasons of insanity" have their own (safe for the society and them) therapeutic and rehabilitative services the aim of de-institutionalisation will be visible and realistic to implement.

Food insecurity among psychiatric patients and welfare clients in Israel.

PubMed

Kaufman, Roni; Mirsky, Julia; Witztum, Eliezer; Grisaru, Nimrod

2013-01-01

Twenty-two percent of households in Israel experience food insecurity, and it is especially widespread in socio-economically distressed strata. Although their low socio-economic status renders psychiatric patients at risk for food insecurity, this issue has thus far been ignored in both practice and research. To explore food insecurity among psychiatric patients in comparison with welfare-services clients in order to raise awareness of food insecurity in this population. 114 respondents were recruited from among patients admitted to the emergency room and hospitalized in a mental health center in Beer Sheva; 555 respondents were recruited from among low-income clients of welfare service agencies in the Beer Sheva area. All respondents were surveyed with a self-report questionnaire and with the Food Security Core Survey Module (FSCSM). Forty percent of psychiatric patients and 59% of welfare-services clients reported food insecurity. The use of formal and informal support systems was lower among food-insecure psychiatric patients than among food-insecure welfare clients. Psychiatric patients appear to be a risk population for food insecurity; therefore planned interventions and specific food programs are called for.

Psyche at the end of life: Psychiatric symptoms are prevalent in patients admitted to a palliative care unit.

PubMed

Masel, Eva K; Berghoff, Anna S; Mladen, Aleksandra; Schur, Sophie; Maehr, Bruno; Kirchhoff, Magdalena; Simanek, Ralph; Bauer, Martin; Watzke, Herbert H; Amering, Michaela

2016-06-01

Our aim was to evaluate the frequency and treatment of psychiatric symptoms in patients at palliative care units (PCUs). Patients admitted to one of five participating PCUs in Austria were included. The short version of the Patient Health Questionnaire (PHQ-D) was used to evaluate their mental health status. Pain intensity was rated on a numeric rating scale (NRS) from 0 to 10 by patients and physicians. Patients with a previously diagnosed psychiatric disorder were compared to those without or with newly diagnosed psychiatric symptoms, based on PHQ-D results. Pain and psychopharmacological medication were assessed. Opioid doses were converted into oral morphine equivalents (OMEs). Some 68 patients were included. Previously undetected psychiatric symptoms were identified in 38% (26 of 68), preexisting psychiatric comorbidities were evident in 25% (17), and no psychiatric symptoms were observed in 37% (25). Patients with a preexisting psychiatric comorbidity received antidepressants and benzodiazepines significantly more often than patients without or with previously undetected psychiatric symptoms (p < 0.001). Patient and physician median NRS ratings of pain intensity correlated significantly (p = 0.001). Median NRS rating showed no significant difference between patients with preexisting, previously undetected, or without psychiatric symptoms. OMEs did not differ significantly between preexisting, without, or previously undetected psychiatric symptoms. Patients with undetected and preexisting psychiatric comorbidities had a greater impairment in their activities of daily living than patients without psychiatric symptoms (p = 0.003). Undetected psychiatric comorbidities are common in patients receiving palliative care. Screening for psychiatric symptoms should be integrated into standard palliative care to optimize treatment and reduce the psychosocial burden of the disease.

Profile of children placed in residential psychiatric program: Association with delinquency, involuntary mental health commitment, and reentry into care.

PubMed

Yampolskaya, Svetlana; Mowery, Debra; Dollard, Norín

2014-05-01

This study examined characteristics and profiles of youth receiving services in 1 of Florida's Medicaid-funded residential mental health treatment programs--State Inpatient Psychiatric Program (SIPP)--between July 1, 2004, and June 30, 2008 (N=1,432). Latent class analysis (LCA) was used to classify youth, and 3 classes were identified: Children With Multiple Needs, Children With No Caregivers, and Abused Children With Substantial Maltreatment History. The results of LCA showed that Children With Multiple Needs experienced the greatest risk for adverse outcomes. Compared with youth in the other 2 classes, these children were more likely to get readmitted to SIPP, more likely to become involved with the juvenile justice system, and more likely to experience involuntary mental health assessments. Implications of the findings are discussed. PsycINFO Database Record (c) 2014 APA, all rights reserved

Anti-NMDA receptor encephalitis presenting as atypical anorexia nervosa: an adolescent case report.

PubMed

Mechelhoff, David; van Noort, Betteke Maria; Weschke, Bernhard; Bachmann, Christian J; Wagner, Christiane; Pfeiffer, Ernst; Winter, Sibylle

2015-11-01

Since 2007, more than 600 patients have been diagnosed with anti-N-methyl-D-aspartate (NMDA) receptor encephalitis, with almost 40 % of those affected being children or adolescents. In early phases of the illness, this life-threatening disease is characterized by psychiatric symptoms, such as depression, anxiety, obsessions, hallucinations or delusions. Consequently, a high percentage of patients receive psychiatric diagnoses at first, hindering the crucial early diagnosis and treatment of the anti-NMDA receptor encephalitis. We report on a 15-year-old girl initially presenting with pathological eating behaviour and significant weight loss resulting in an (atypical) anorexia nervosa (AN) diagnosis. Her early course of illness, diagnostic process, treatment and short-term outcome are described. This case report aims to raise awareness about the association between anorectic behaviour and anti-NMDA receptor encephalitis and highlight the importance of multidisciplinary teams in child and adolescent services.

77 FR 2067 - Agency Information Collection Activities: Proposed Collection; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2012-01-13

... and Seclusion in Psychiatric Residential Treatment Facilities Providing Psychiatric Services to Individuals Under Age 21 and Supporting Regulations at 42 CFR 483.350-483.376; Use: Psychiatric Residential...

Gender differences in homicide offenders' criminal career, substance abuse and mental health care. A nationwide register-based study of Finnish homicide offenders 1995-2004.

PubMed

Putkonen, Hanna; Weizmann-Henelius, Ghitta; Lindberg, Nina; Rovamo, Tuija; Häkkänen-nyholm, Helinä

2011-02-01

It is generally considered that women who kill are more likely to have a psychiatric disorder than their male counterparts, but as a relatively small group, women are much less often studied than men in this context. To explore gender differences in the psychosocial history of homicide offenders. In this nationwide register-based study, data were extracted from the forensic psychiatric examination and crime reports of all 91 women prosecuted for homicide in Finland between 1995 and 2004 and from those of the next adjacent man convicted of a separate homicide (n = 91). Both female and male homicide offenders had a troubled childhood, but more women had witnessed or experienced family violence; more women had failed to complete their primary education. Men, however, were more likely to have had an offending history. Although there were no differences between the men and women in the frequencies of psychiatric diagnoses or of substance abuse, the women had more often received prior mental health treatment. The women were also more likely to have had a history of suicidal behaviour. Both female and male homicide offenders are a troubled group of people, with slightly different criminal careers. Many use mental health services and therefore prevention could be improved. The suggestion of a special sub-group of women characterised by early educational and behavioural difficulties needs replication, as it may have implications for service development. Copyright © 2010 John Wiley & Sons, Ltd.

[Psychiatric specialty training in Greece: Comparative analysis of educational programs (2000 vs 2014)].

PubMed

Margariti, M; Papageorgiou, Ch

2017-01-01

Modern educational programs for specialization in psychiatry should follow the developments in psychiatric science, both in the part of acquired knowledge about mental disorders and their treatment, as well as in the part of clinical practice in the diverse spectrum of modern psychiatric services. In Greece, the institutional framework for psychiatric training during specialization has yet to modernize and conform to European standards. For the moment, it is covered by a 1994 Presidential Decree, which briefly describes the time of specialization in psychiatry and the duration of clinical practice in the relevant educational subjects. This study presents a comparative analysis of training in the specialty of Psychiatry in two distinct periods (2000 vs 2014). Already by the year 2000, psychiatric training showed many structural weaknesses. The areas of clinical experience, theoretical and psychotherapeutic training have shown wide divergences among training centers, and limited potential for convergence with European standards under the existing framework. Important exceptions were certain university clinics, with the bulk of future psychiatrists in the country falling short of educational benefits. Fifteen years later and under the burden of the consequences of the economic crisis, the institutional framework has not yet changed, and the overall situation seems to have deteriorated dramatically. The number of training centers offering full specialization and the number of psychiatrists who receive training increased in reverse proportion to the number of specialized psychiatrists employed in hospitals, which has been drastically reduced due to restrictive measures on staff recruitment. Almost all training indicators show deterioration, but mainly the area of theoretical training shows the most dramatic degradation. Nevertheless, it is noteworthy that nowadays several psychiatric clinics endeavor to develop training programs in conjunction with psychiatric services not under their own administration, a practice not provided for in the current legislative framework. At the same time, there is an increase in the number of training centers that adopt some statutory procedures to monitor and evaluate trainees during the training process. The long-term restrictions recorded however, reveal the difficulty hospitals and psychiatric clinics have in developing training programs responding to the full range of modern clinical and theoretical training in psychiatry independently and autonomously. The recent economic crisis in the country and the attempts for much needed administrational reforms, create now more than ever the appropriate conditions for a reform of the educational framework for specialization in psychiatry, taking into account national resources and future expectations for the mental health system of our country.

[Decentralization of psychiatric health service].

PubMed

Dabrowski, S

1996-01-01

The article discusses two stages of de-centralization of psychiatric hospitals: the first consists in further division into sub-districts, the second one includes successive establishment of psychiatric wards in general hospitals. With the growth of their number these wards are to take over more and more general psychiatric tasks from the specialized psychiatric hospitals. These wards will not substitute psychiatric hospitals completely. The hospitals, though decreasing in size and number, will be a necessary element of the de-centralized and versatile psychiatric care for a long time to come.

Burnout and work environments of public health nurses involved in mental health care.

PubMed

Imai, H; Nakao, H; Tsuchiya, M; Kuroda, Y; Katoh, T

2004-09-01

(1) To examine whether prevalence of burnout is higher among community psychiatric nurses working under recently introduced job specific work systems than among public health nurses (PHNs) engaged in other public health services. (2) To identify work environment factors potentially contributing to burnout. Two groups were examined. The psychiatric group comprised 525 PHNs primarily engaged in public mental health services at public health centres (PHCs) that had adopted the job specific work system. The control group comprised 525 PHNs primarily engaged in other health services. Pines' Burnout Scale was used to measure burnout. Respondents were classified by burnout score into three groups: A (mentally stable, no burnout); B (positive signs, risk of burnout); and C (burnout present, action required). Groups B and C were considered representative of "burnout". A questionnaire was also prepared to investigate systems for supporting PHNs working at PHCs and to define emergency mental health service factors contributing to burnout. Final respondents comprised 785 PHNs. Prevalence of burnout was significantly higher in the psychiatric group (59.2%) than in the control group (51.5%). Responses indicating lack of job control and increased annual frequency of emergency overtime services were significantly correlated with prevalence of burnout in the psychiatric group, but not in the control group. Prevalence of burnout is significantly higher for community psychiatric nurses than for PHNs engaged in other services. Overwork in emergency services and lack of job control appear to represent work environment factors contributing to burnout.

Impact of inpatient mental health rehabilitation on psychiatric readmissions: a propensity score matched case control study.

PubMed

Tsoutsoulis, Katrina; Maxwell, Anna; Menon Tarur Padinjareveettil, Aparna; Zivkovic, Frank; Rogers, Jeffrey M

2018-04-27

Examination of readmission data is a standard method for evaluating health service outcomes. Limited work has evaluated the efficacy of mental health rehabilitation, despite the need for evidence-based approaches. To evaluate the impact of inpatient mental health rehabilitation using metrics of psychiatric readmissions routinely collected at occasions of service. Consumers (n = 252) of a nonacute inpatient mental health rehabilitation unit were case matched with normative clients from community mental health services. The impact of inpatient care was measured on: (1) the occurrence of a psychiatric readmission within 12 months of discharge; (2) the total number of psychiatric readmissions within 12 months of discharge; and (3) the number of days to a psychiatric readmission after discharge. The proportion of consumers experiencing a readmission significantly decreased following inpatient care, comparable to the normative group. The number of readmissions also significantly decreased, approaching normative group levels, except in consumers with comorbid bipolar, substance use, or personality disorder. Time to a readmission significantly increased following inpatient care, approximating normative group values, and was related to the number of previous admissions. Routinely collected service data demonstrated nonacute inpatient mental health rehabilitation reduces re-hospitalization, which will have benefits for both consumers and health services.

Setting up psychiatric services: cross-cultural issues in planning and delivery.

PubMed

Bhugra, D

1997-01-01

There is convincing evidence that in the UK, various ethnic minorities are over-represented in psychiatric hospitals, prisons and special hospitals. Various explanations have been put forward for this picture. The expanding emphasis on community care means that models for looking after ethnic communities should be innovative and work from a bottom-up approach. Psychiatric emphasis on clinical diagnoses means that services are developed according to the diagnoses rather than needs.

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…

Predictors of mental health-related acute service utilisation and treatment costs in the 12 months following an acute psychiatric admission.

PubMed

Siskind, Dan; Harris, Meredith; Diminic, Sandra; Carstensen, Georgia; Robinson, Gail; Whiteford, Harvey

2014-11-01

A key step in informing mental health resource allocation is to identify the predictors of service utilisation and costs. This project aims to identify the predictors of mental health-related acute service utilisation and treatment costs in the year following an acute public psychiatric hospital admission. A dataset containing administrative and routinely measured outcome data for 1 year before and after an acute psychiatric admission for 1757 public mental health patients was analysed. Multivariate regression models were developed to identify patient- and treatment-related predictors of four measures of service utilisation or cost: (a) duration of index admission; and, in the year after discharge from the index admission (b) acute psychiatric inpatient bed-days; (c) emergency department (ED) presentations; and (d) total acute mental health service costs. Split-sample cross-validation was used. A diagnosis of psychosis, problems with living conditions and prior acute psychiatric inpatient bed-days predicted a longer duration of index admission, while prior ED presentations and self-harm predicted a shorter duration. A greater number of acute psychiatric inpatient bed-days in the year post-discharge were predicted by psychosis diagnosis, problems with living conditions and prior acute psychiatric inpatient admissions. The number of future ED presentations was predicted by past ED presentations. For total acute care costs, diagnosis of psychosis was the strongest predictor. Illness acuity and prior acute psychiatric inpatient admission also predicted higher costs, while self-harm predicted lower costs. The development of effective models for predicting acute mental health treatment costs using existing administrative data is an essential step towards a workable activity-based funding model for mental health. Future studies would benefit from the inclusion of a wider range of variables, including ethnicity, clinical complexity, cognition, mental health legal status, electroconvulsive therapy, problems with activities of daily living and community contacts. © The Royal Australian and New Zealand College of Psychiatrists 2014.

Neurotic disorders and the receipt of psychiatric treatment.

PubMed

Bebbington, P E; Brugha, T S; Meltzer, H; Jenkins, R; Ceresa, C; Farrell, M; Lewis, G

2000-11-01

Access to psychiatric treatment by people with neurotic disorders in the general population is likely to be affected both by the severity of disorder and by sociodemographic differences. In the household component of the National Surveys of Psychiatric Morbidity > 10,000 subjects in Great Britain with psychiatric symptoms were interviewed using the CIS-R. They were also asked about difficulties experienced in performing seven types of everyday activity. All subjects classed as having an ICD-10 disorder were questioned about their experience of treatment with antidepressants, hypnotics, and counselling or psychotherapy. Less than 14% of people with current neurotic disorders were receiving treatment for them. Within the previous year, only a third had made contact with their primary care physician for their mental problem: of these < 30% were receiving treatment. Overall, 9% of people with disorders were given medication and 8% counselling or psychotherapy. A diagnosis of depressive episode was that most associated with antidepressant medication. Treatment access was affected by employment status, marital status, and age, but the major determinant was symptom severity. Neither sex nor social class influenced which people received treatment. People with psychiatric disorders seldom receive treatment, even when they have consulted their primary care physician about them. In many cases, this must represent unmet needs with a strong claim on health resources. There are also inequalities in the receipt of treatment, although the major influence is the severity of disorder.

Neurotic disorders and the receipt of psychiatric treatment.

PubMed

Bebbington, P; Brugha, T; Meltzer, H; Jenkins, R; Ceresa, C; Farrell, M; Lewis, G

2003-01-01

Access to psychiatric treatment by people with neurotic disorders in the general population is likely to be affected both by the severity of disorder and by sociodemographic differences. In the household component of the National Surveys of Psychiatric Morbidity >10,000 subjects in Great Britain with psychiatric symptoms were interviewed using the CIS-R. They were also asked about difficulties experienced in performing seven types of everyday activity. All subjects classed as having an ICD-10 disorder were questioned about their experience of treatment with antidepressants, hypnotics, and counselling or psychotherapy. Less than 14% of people with current neurotic disorders were receiving treatment for them. Within the previous year, only a third had made contact with their primary care physician for their mental problem: of these <30% were receiving treatment. Overall, 9% of people with disorders were given medication and 8% counselling or psychotherapy. A diagnosis of depressive episode was that most associated with antidepressant medication. Treatment access was affected by employment status, marital status, and age, but the major determinant was symptom severity. Neither sex nor social class influenced which people received treatment. People with psychiatric disorders seldom receive treatment, even when they have consulted their primary care physician about them. In many cases, this must represent unmet needs with a strong claim on health resources. There are also inequalities in the receipt of treatment, although the major influence is the severity of disorder.

Gender differences in the use of psychiatric outpatient specialist services in Tromsø, Norway are dependent on age: a population-based cross-sectional survey.

PubMed

Hansen, Anne Helen; Høye, Anne

2015-10-22

Overall, men are less likely than women to seek health care services for mental health problems, but differences between genders in higher age groups are equivocal. The aim of the current study was to investigate the association between gender and the use of psychiatric outpatient specialist services in Norway, both in a general population and in a subpopulation with self-reported anxiety and/or depression. Using questionnaires from 12,982 participants (30-87 years) in the cross-sectional sixth Tromsø Study (2007-8) we estimated proportions reporting anxiety/depression, and proportions using psychiatric outpatient specialist services in a year. By logistic regressions we studied the association between gender and the use of psychiatric outpatient specialist services. Analyses were adjusted for age, marital status, income, education, self-reported degree of anxiety/depression, and GP visits last year. Analyses were also performed for genders separately. Anxiety/depression was reported by 21.5 % of women and 12.3 % of men in the general population. Visits to psychiatric outpatient services during one year were reported by 4.6 % of women and 3.3 % of men. The general population's probability of a visit was significantly lower among men compared to women in ages 30-49 years (odds ratio [OR] 0.58, confidence interval [CI] 0.39-0.84, p-value [p] = 0.004), whereas men used services slightly more than women in ages 50 years and over (OR 1.36, CI 1.00-1.83, p = 0.047). Among those with anxiety/depression 13.5 % of women and 10.5 % of men visited psychiatric outpatient services in a year. We found no statistically significant gender differences in the use of services in this subgroup. Other factors associated with services use in women with anxiety/depression were higher education, more severe anxiety/depression, and GP visits the last year, whereas in men only a more severe anxiety/depression was associated with psychiatric outpatient visits. Overall, the use of services decreased with higher age. Most people with self-reported anxiety/depression did not visit specialist outpatient clinics. This applies in particular to men aged 30-49 years, older individuals, and individuals with lower education. Gender differences in the use of services in the general population were dependent on age, whereas in the subgroup with anxiety/depression gender differences were not confirmed.

Linking the Medical and Educational Home to Support Children With Autism Spectrum Disorder: Practice Recommendations.

PubMed

Shahidullah, Jeffrey D; Azad, Gazi; Mezher, Katherine R; McClain, Maryellen Brunson; McIntyre, Laura Lee

2018-05-01

Children with autism spectrum disorder (ASD) present with complex medical problems that are often exacerbated by a range of other intellectual and psychiatric comorbidities. These children receive care for their physical and mental health from a range of providers within numerous child-serving systems, including their primary care clinic, school, and the home and community. Given the longitudinal nature in which care is provided for this chronic disorder, it is particularly necessary for services and providers to coordinate their care to ensure optimal efficiency and effectiveness. There are 2 primary venues that serve as a "home" for coordination of service provision for children with ASD and their families-the "medical home" and the "educational home." Unfortunately, these venues often function independently from the other. Furthermore, there are limited guidelines demonstrating methods through which pediatricians and other primary care providers (PCPs) can coordinate care with schools and school-based providers. The purpose of this article is 2-fold: (1) we highlight the provision of evidence-based care within the medical home and educational home and (2) we offer practice recommendations for PCPs in integrating these systems to optimally address the complex medical, intellectual, and psychiatric symptomology affected by autism.

A Longitudinal Study of Child Maltreatment and Mental Health Predictors of Admission to Psychiatric Residential Treatment Facilities

PubMed Central

Rose, Roderick A.; Lanier, Paul

2017-01-01

The child welfare system is an access point for children’s mental health services. Psychiatric residential treatment facilities (PRTFs) are the most restrictive, and most expensive setting for children to receive long-term care. Given the high rates of behavioral health concerns among maltreated children in out-of-home care, research is needed to examine the factors that predict entry in PRTFs among children investigated for maltreatment. This exploratory study used cross-sector administrative records linked across multiple systems, including child welfare records and Medicaid claims, from a single state over a five-year period (n = 105,982). Cox proportional hazards modeling was used to predict entry into a PRTF. After controlling for many factors, PRTF entry was predicted by diagnosis code indicating a trauma-related condition, antipsychotic medication prescriptions, and entry into lower levels of out-of-home care, supporting the view that youth are admitted to PRTFs largely due to clinical need. However, PRTF admission is also associated with characteristics of their experiences with the social service system, primarily foster care placement stability and permanency. Implications for practice and research are discussed. PMID:28956825

Continuing care and long-term substance use outcomes in managed care: early evidence for a primary care-based model.

PubMed

Chi, Felicia W; Parthasarathy, Sujaya; Mertens, Jennifer R; Weisner, Constance M

2011-10-01

How best to provide ongoing services to patients with substance use disorders to sustain long-term recovery is a significant clinical and policy question that has not been adequately addressed. Analyzing nine years of prospective data for 991 adults who entered substance abuse treatment in a private, nonprofit managed care health plan, this study aimed to examine the components of a continuing care model (primary care, specialty substance abuse treatment, and psychiatric services) and their combined effect on outcomes over nine years after treatment entry. In a longitudinal observational study, follow-up measures included self-reported alcohol and drug use, Addiction Severity Index scores, and service utilization data extracted from the health plan databases. Remission, defined as abstinence or nonproblematic use, was the outcome measure. A mixed-effects logistic random intercept model controlling for time and other covariates found that yearly primary care, and specialty care based on need as measured at the prior time point, were positively associated with remission over time. Persons receiving continuing care (defined as having yearly primary care and specialty substance abuse treatment and psychiatric services when needed) had twice the odds of achieving remission at follow-ups (p<.001) as those without. Continuing care that included both primary care and specialty care management to support ongoing monitoring, self-care, and treatment as needed was important for long-term recovery of patients with substance use disorders.

[Psychiatric disorders and neurological comorbidity in children with intellectual disability].

PubMed

Wriedt, Elke; Wiberg, Anja; Sakar, Vehbi; Noterdaeme, Michele

2010-05-01

This article gives an overview of the consultant child and adolescent psychiatric services in the region of Upper Bavaria (Germany). The data of 257 children and adolescents with intellectual disability and psychiatric disorders were evaluated. About 14% of the children with ID in special schools or day care centers, and 40% of the children with ID in residential care showed a definite psychiatric disorder. The most frequently diagnosed disorders were adjustment disorders, hyperkinetic disorders and conduct disorders, as well as emotional problems and pervasive developmental disorders. Children with severe intellectual disability had more additional somatic disorders and were more impaired in their psychosocial functions. The results show the need for psychiatric services for children and adolescents with intellectual disability and psychiatric disorders. The development and implementation of integrative and interdisciplinary models is necessary to allow for adequate medical care for these patients.

Profiles of referrals to a psychiatric service: a descriptive study of survivors of the Nairobi US Embassy terrorist bomb blast.

PubMed

Ndetei, D M; Omar, A; Mutiso, V N; Ongecha, F A; Kokonya, D A

2009-11-01

To document the socio-demographic characteristics and psychiatric profiles of the survivors of the Nairobi United States Embassy terrorist bomb blast referred to a psychiatric and psychotherapy (counselling) service. This was a descriptive cross-sectional study. Clinical interviews and structured questionnaires for post-traumatic stress disorder (PTSD) and stress were administered. Survivors of the bomb blast referred to a psychiatric and psychotherapy service one year or more after the bombing were included in the study. These survivors had been treated using psychopharmacotherapy and individualised (not group) therapy/counselling. Eighty-three consecutive referrals to a psychiatric service participated in this study. There were more males and the sample was generally well educated. The referrals made contact with the referring agency for a number of reasons including seeking psychological, financial and medical assistance. All the patients reported varying degrees of psychiatric symptoms and functional impairment on various aspects of social occupational functioning. High scores for PTSD and other related stress were recorded one or more years after the bombing. Although the survivors indicated that initial counselling following the blast had helped them, they still scored high on PTSD suggesting that clinically, the initial counselling had little, if any impact on the development of PTSD. There is need for a holistic approach to the management of psychotrauma in individuals.

Community Reintegration for People with Psychiatric Disabilities: Challenging Systemic Barriers to Service Provision and Public Policy through Participatory Action Research

ERIC Educational Resources Information Center

Mirza, Mansha; Gossett, Andrea; Chan, Nathan Kai-Cheong; Burford, Larry; Hammel, Joy

2008-01-01

People with psychiatric disabilities represent a growing group within the population of nursing home residents in the USA. Despite a preference for living in community-based settings, the availability of supportive services for community living is hindered by barriers at both the service provision and public policy levels. Therefore, understanding…

Economic Impact of Childhood Psychiatric Disorder on Public Sector Services in Britain: Estimates from National Survey Data

ERIC Educational Resources Information Center

Snell, Tom; Knapp, Martin; Healey, Andrew; Guglani, Sacha; Evans-Lacko, Sara; Fernandez, Jose-Luis; Meltzer, Howard; Ford, Tamsin

2013-01-01

Background: Approximately one in ten children aged 5-15 in Britain has a conduct, hyperactivity or emotional disorder. Methods: The British Child and Adolescent Mental Health Surveys (BCAMHS) identified children aged 5-15 with a psychiatric disorder, and their use of health, education and social care services. Service costs were estimated for each…

A Quasi-Experimental Study of Trauma-Informed Psychiatric Residential Treatment for Children and Adolescents

ERIC Educational Resources Information Center

Boel-Studt, Shamra Marie

2017-01-01

Purpose: The purpose of this study was to examine the effectiveness of a trauma-informed approach that was adapted for psychiatric residential treatment (PRT) for children aged 5-17. Methods: Data were extracted from case files of 100 youths who received traditional PRT and 105 youths who received trauma-informed PRT (TI-PRT). Outcome measures…

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

PubMed

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

2007-01-01

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

Receiving treatment, labor force activity, and work performance among people with psychiatric disorders: results from a population survey.

PubMed

Waghorn, Geoffrey; Chant, David

2011-12-01

Standard treatments for psychiatric disorders such as schizophrenia, depression and anxiety disorders are generally expected to benefit individuals, employers, and the wider community through improvements in work-functioning and productivity. We repeated a previous secondary investigation of receiving treatment, labor force activity and self-reported work performance among people with ICD-10 psychiatric disorders, in comparison to people with other types of health conditions. Data were collected by the Australian Bureau of Statistics in 2003 repeating a survey administered in 1998 using representative multistage sampling strategies. The 2003 household probability sample consisted of 36,241 working age individuals. Consistent with the previous secondary investigation based on the 1998 survey administration, receiving treatment was consistently associated with non-participation in the labor force, and was negatively associated with work performance. At a population level, receiving treatment was negatively associated with labor force activity and work performance. The stability of these results in two independent surveys highlights the need to investigate the longitudinal relationships between evidence-based treatments for psychiatric conditions as applied in real-world settings, and labor force participation and work performance outcomes.

Choice-making among Medicaid HCBS and ICF/MR recipients in six states.

PubMed

Lakin, K Charlie; Doljanac, Robert; Byun, Soo-Yong; Stancliffe, Roger; Taub, Sarah; Chiri, Giuseppina

2008-09-01

Choice in everyday decisions and in support-related decisions was addressed among 2,398 adults with intellectual and developmental disabilities receiving Medicaid Home and Community Based Services (HCBS) and Intermediate Care Facility (ICF/MR) services and living in non family settings in six states. Everyday choice in daily life and in support-related choice was considerably higher on average for HCBS than for ICF/MR recipients, but after controlling for level of intellectual disability, medical care needs, mobility, behavioral and psychiatric conditions, and self-reporting, we found that choice was more strongly associated with living in a congregate setting than whether that setting was HCBS- or ICF/MR-financed. Marked differences in choice were also evident between states.

Current status of psychiatric rehabilitation in Portugal: A national survey.

PubMed

Teixeira, Carina; Santos, Eduardo; Abreu, Manuel Viegas; Rogers, E Sally

2015-09-01

This article reports on the current state of psychiatric rehabilitation in Portugal. A paper-and-pencil survey was sent to 70 institutions to inquire about the provision of psychiatric rehabilitation services and programs. With a response rate of 40%, 14% of institutions indicated that supported education was provided, 36% offered nonmainstream vocational training, and 29% provided supported employment; none provided evidence-based Individual Placement and Support. Permanent group homes in the community (29%) followed by transitional group homes on institutional grounds (18%) were the most common residential services, with supported housing services (14%) offered less frequently. Finally, 93% of institutions offered occupational activities, 61% provided multifamily psychoeducation, and 36% provided single-family psychoeducation. Despite recent national initiatives promoting effective psychiatric rehabilitation services, supported employment, supported education, and supported housing are not widely implemented in Portugal. To achieve better outcomes for clients, it is critical that evidence-based and promising practices be extensively disseminated. (c) 2015 APA, all rights reserved).

The development of a 'best practice' service for women in a medium-secure psychiatric setting: treatment components and evaluation.

PubMed

Long, Clive G; Fulton, Barbara; Hollin, Clive R

2008-01-01

The inadequacy of inpatient facilities for women with severe psychiatric and co-morbid difficulties has been repeatedly documented. The establishment of effective therapeutic programmes for women in medium psychiatric facilities is also in their infancy, and little research has been undertaken. This article describes the development of a 'best practice' psychological treatment programme for women with a dual diagnosis. Emphasis is placed on the need to develop further intensive gender-specific services using an established model for effective therapeutic service development. In addition to a detailed description of the group therapy programme, staff training initiatives, methods for ensuring treatment integrity and a methodology for service evaluation is given. Copyright (c) 2008 John Wiley & Sons, Ltd.

Socio-economic status and geographies of psychiatric inpatient service use. Places, provision, power and well-being.

PubMed

Curtis, Sarah

2007-01-01

This editorial briefly summarises some aspects of research on socio-economic status and use of mental health services that have particular relevance for the theme of this issue of Epidemiologia e Psichiatria Sociale. This discussion takes a view from the perspective of health geography, which examines how the relationships between individuals and their social and physical environment result in variations in health and health care use. Three particular issues are considered here. First, the geographical distribution and organisation of psychiatric services may interact with social and economic factors in ways that are important for service use. Second, increasingly sophisticated ecological modelling strategies have elucidated the associations between socio-economic factors and service use at the population level. Third, more intensive, qualitative research complements these statistical analyses and encouraged reflection on the socio-economic processes, within psychiatric care settings, as well as in wider society, which influence service use.

[Policies and innovation in mental healthcare: limits to decoupling from the performance of the SUS].

PubMed

Ribeiro, José Mendes; Inglez-Dias, Aline

2011-12-01

We studied Brazilian policies on mental health with respect to normative, supply and demand and financing aspects. We concluded that the sustainability of innovations in psychiatric reform depends on enhanced financing and integration with primary care community services, on the overall performance of SUS and the reduction of autonomous and exclusive services in primary care. There is high and rising pressure in demand for services measured in DALY and the incidence of disease. The reduction observed in psychiatric beds was accompanied by the systemic reduction, though with selective reduction for psychiatric hospitalizations. CAPS services have institutional limits due to the model adopted of direct public administration and local government capacity. Secondary data available show that: (i) SUS has a virtual monopoly on general outpatient and hospital services; (ii) mental health specialists belong mostly to SUS; (iii) most mental health services are outpatient services; (iv) few CAPS have day-bed services available; and (v) there is reduced federal financing for these innovations.

Characteristics of users of consumer-run drop-in centers versus clubhouses.

PubMed

Mowbray, Carol T; Woodward, Amanda Toler; Holter, Mark C; MacFarlane, Peter; Bybee, Deborah

2009-07-01

Clubhouses and consumer-run drop-in centers (CRDIs) are two of the most widely implemented models of consumer-centered services for persons with serious mental illness. Differences in structure and goals suggest that they may be useful to different types of consumers. Information on what types of consumers use which programs would be useful in service planning. This study analyzes data from the authors' NIMH-funded research on 31 geographically matched pairs of clubhouses and CRDIs involving more than 1,800 consumers to address the following question: are there significant differences in the characteristics and outcomes of members of clubhouses versus CRDIs? Results from multilevel analyses indicated that clubhouse members were more likely to be female, to receive SSI/SSDI, to report having a diagnosis of schizophrenia, and to live in dependent care; and they reported both a greater number of lifetime hospitalizations and current receipt of higher intensity traditional MH services. Controlling for differences in demographic characteristics, psychiatric history, and mental health service receipt, clubhouse members also reported higher quality of life and were more likely to report being in recovery. CRDI consumers were more likely to have substance abuse histories. Possible reasons for the differences are discussed. The results suggest that CRDIs are a viable alternative to more traditional mental health services for individuals who might not otherwise receive mental health services.

The impact of clinical conditions and social factors on the psychological distress of cancer patients: an explorative study at a consultation and liaison service in a rural general hospital.

PubMed

Valdes-Stauber, Juan; Vietz, Eva; Kilian, Reinhold

2013-09-20

In recent decades, increasing attention has been paid to the subjective dimension of cancer, especially to psychosocial screening procedures, major psychiatric disorders but also psychological and psychosocial distress, and finally to met needs of oncologic patients. This study aims first to describe cancer patients in a rural hospital attended by a psycho-oncological consultation-liaison team, second to assess predictors for psychological distress in cancer patients, and finally to identify predictors for recommendation of further psychosocial support. The sample (n = 290) comprises a full survey of patients at breast and bowel cancer services (n=209) and patients referred by other medical and surgical services because of psychosocial impairment (n = 81). All patients were assessed by means of the PO-Bado (Psycho-Oncological Basic Documentation) expert rating scale. Assessment of predictors for psychological distress was conducted by multivariate regression models and assessment for predictors for need for outpatient psychosocial support by a logistic regression analysis. All analyses were conducted using STATA 12. Most members of the assessed sample (average age 65, 82% women) were not severely impaired from a functional and psychological point of view. A total of 14% had received psychiatric treatment before. Mood swings, anxiety, grief, and fatigue were the most important distress symptoms. Selectively referred patients vs. full survey patients of cancer centres, as well as bowel vs. breast cancer patients show a higher level of psychological and physical distress. Fatigue, assessed metastases, and functional limitations were the best predictors for psychological burden. Referral mode, gender, age, family problems, fatigue, and previous psychiatric treatment were associated with further need of psychosocial support. Psycho-oncological consultation and liaison services may offer support to patients in an early stage of cancer, especially in cancer centres. Because of selectively referred patients show a higher burden, the use of basic screening instruments could be meaningful. Fatigue, metastases status, and functional limitations may better predict psychological distress than pain, duration of illness, psychosocial conditions or previous psychiatric treatment. More attention has to be paid to outpatient follow-up with older cancer patients, those with family problems, and those suffering from significant fatigue.

Completed suicides among the Inuit of northern Quebec, 1982–1996: a case–control study

PubMed Central

Boothroyd, Lucy J.; Kirmayer, Laurence J.; Spreng, Sheila; Malus, Michael; Hodgins, Stephen

2001-01-01

Background The rate of completed suicide among Inuit in Canada has been alarmingly high in recent years, and the suicide rate among Inuit in northern Quebec has increased since 1982. Our objectives were to describe the characteristics of Inuit people who died by suicide in Nunavik between 1982 and 1996, and to identify the antecedents and correlates of completed suicide. Methods We carried out a case–control study of 71 people who died by suicide between 1982 and 1996 and 71 population-based living control subjects matched for sex, community of residence and age within 1 year. Comprehensive medical charts were reviewed for data on sociodemographic characteristics, medical and psychiatric history, childhood separations and family history, and use of health care services. Results Most of the case subjects were single males aged 15 to 24 years. The two principal means of suicide were hanging (in 39 cases [54.9%]) and gunshot (in 21 cases [29.6%]). About 33% had been in contact with medical personnel in the month before their death. The case subjects were significantly more likely than the control subjects to have received a lifetime psychiatric diagnosis (one or more of depression, personality disorder or conduct disorder) (odds ratio [OR] 4.3 [95% confidence interval (CI) 1.2–15.2]) and to have had a history of psychiatric symptoms, disorder (including solvent sniffing) or treatment (OR 3.5 [95% CI 1.4–8.7]). The case subjects had experienced more severe types of nonpsychiatric illnesses and injuries than the control subjects (p = 0.04). The case subjects had more lifetime contacts with health care services than the control subjects (p = 0.01) and were more likely than the control subjects to have had contact with health care services in the year before death of the case subject (p = 0.03), even when psychiatric diagnoses were controlled for in conditional regression analysis (OR 1.02 [95% CI 1.01–1.04] and 5.0 [95% CI 1.07–23.7] respectively). Interpretation Since case subjects had frequent contact with health care services, frontline medical personnel may be in a position to identify people at risk for suicide. PMID:11584562

Black South African psychiatric recipients: have they been overlooked under the recent democratization?

PubMed

Jones, Lani V

2009-01-01

This article examines the literature on service accessibility, utilization, and treatment needs for Black South African adults with psychiatric disabilities and highlights the paucity of empirical studies in these areas. Current research draws attention to the finding that Black South Africans essentially have been neglected or ignored in the mental health system, suggesting that the government should formulate and implement programs and policies to ensure the effective delivery of psychiatric services. A framework for practice is warranted in which traditional health practices are parallel to mainstream westernized psychiatric care that emphasizes culturally relevant care and naturally occurring community supports rather than large psychiatric institutions. It is suggested here that "psychosocial competence" may provide a resonant and particularly useful framework for practice in this population.

[Kinshicho Model for Community Care by Multifunctional Vertical Integration of Psychiatric Care].

PubMed

Kubota, Akira

2015-01-01

The future of psychiatric community care in Japan requires a medical team for outpatient care to offer support and take responsibility for a region; respecting human rights and supporting high risk patients who have concluded a long-period of hospitalized or repeated involuntary commitment, and for people who suffer from social withdraws over a long period of time. There are over 3,000 private psychiatric outpatient clinics in Japan. Over 400 of them are multifunctional psychiatric outpatient clinics that provide daycare services and outreach activities. In the future, if systematized those clinics entrusted by an administrative organ with performing as a "community mental health center". Multifunctional vertical integration of psychiatric care is possible in Japan to create a catchment area with 24 hours phone service and continued free access.

Contracting between public agencies and private psychiatric inpatient facilities.

PubMed

Fisher, W H; Dorwart, R A; Schlesinger, M; Davidson, H

1991-08-01

Purchasing human services through contracts with private providers has become an increasingly common practice over the past 20 years. Using data from a national survey of psychiatric inpatient facilities, this paper examines the extent to which psychiatric units in privately controlled general hospitals and private psychiatric specialty hospitals (N = 611) participate in contractual arrangements to provide services to governmental bodies. It also examines how the likelihood of such a practice is affected by hospital characteristics (general or specialty, for profit or nonprofit) and features of hospitals' environments, including the competitiveness of the market for psychiatric inpatient care and the population's need for services in the hospital's county. The findings indicate that nonprofit psychiatric specialty hospitals were more likely than other types of hospitals to enter into such contracts, and that forces such as local competition and need for services were not predictors of such involvement. Contracting was shown to have a significant impact on the level of referrals a hospital accepted, but these levels were also affected by competition and need. Among hospitals with public contracts, referral acceptance from public agencies was unaffected by these factors, but they did have a significant effect on referral acceptance by hospitals without public contracts. These data suggest that public agencies contracting for services with private hospitals may represent a means by which "public sector" patients may gain access to private providers. Further, this mechanism may impose sufficient structure and regulation on the acceptance of such patients that many concerns of hospital administrators regarding patients who are costly and difficult to treat and discharge can be allayed.

28 CFR 549.42 - Involuntary admission.

Code of Federal Regulations, 2010 CFR

2010-07-01

... SERVICES Administrative Safeguards for Psychiatric Treatment and Medication § 549.42 Involuntary admission. A court determination is necessary for involuntary hospitalization for psychiatric treatment. A sentenced inmate, not currently committed for psychiatric treatment, who is not able or willing to...

Estimating psychiatric manpower requirements based on patients' needs.

PubMed

Faulkner, L R; Goldman, C R

1997-05-01

To provide a better understanding of the complexities of estimating psychiatric manpower requirements, the authors describe several approaches to estimation and present a method based on patients' needs. A five-step method for psychiatric manpower estimation is used, with estimates of data pertinent to each step, to calculate the total psychiatric manpower requirements for the United States. The method is also used to estimate the hours of psychiatric service per patient per year that might be available under current psychiatric practice and under a managed care scenario. Depending on assumptions about data at each step in the method, the total psychiatric manpower requirements for the U.S. population range from 2,989 to 358,696 full-time-equivalent psychiatrists. The number of available hours of psychiatric service per patient per year is 14.1 hours under current psychiatric practice and 2.8 hours under the managed care scenario. The key to psychiatric manpower estimation lies in clarifying the assumptions that underlie the specific method used. Even small differences in assumptions mean large differences in estimates. Any credible manpower estimation process must include discussions and negotiations between psychiatrists, other clinicians, administrators, and patients and families to clarify the treatment needs of patients and the roles, responsibilities, and job description of psychiatrists.

WORK INTEREST AS A PREDICTOR OF COMPETITIVE EMPLOYMENT: POLICY IMPLICATIONS FOR PSYCHIATRIC REHABILITATION

PubMed Central

Macias, Cathaleene; DeCarlo, Lawrence T.; Wang, Qi; Frey, Jana; Barreira, Paul

2015-01-01

Consumers with serious mental illness (N=166) enrolling in two community-based mental health programs, a vocational Program of Assertive Community Treatment and a clubhouse certified by the International Center for Clubhouse Development (ICCD), were asked about their interest in work. About one third of the new enrollees expressed no interest in working. Equivalent supported employment services were then offered to all participants in each program. Stated interest in work and receipt of vocational services were statistically significant predictors of whether a person would work and how long it would take to get a job. Two thirds of those interested in work and half of those with no initial interest obtained a competitive job if they received at least one hour of vocational service. Once employed, these two groups held comparable jobs for the same length of time. These findings demonstrate the importance of making vocational services continuously available to all people with serious mental illness, and the viability of integrating these services into routine mental health care. PMID:11577655

Characteristics of patients seen by visiting psychiatrists through Medicare in a rural community mental health service with an established telemedicine service.

PubMed

Bidargaddi, Niranjan; Schrader, Geoffrey; Smith, David; Carson, Dean; Strobel, Jörg

2017-06-01

We aimed to determine characteristics of patients receiving Medicare-funded face-to-face consultations by psychiatrists in a rural service with an established telemedicine service. For this study, 55 case-managed patients from four rural community mental health teams in South Australia provided information through questionnaires regarding psychological symptoms, quality of life, body mass index (BMI) and gave access to their Medicare data. In a logistic regression, it was found that being younger was more likely associated with a Medicare psychiatric consultation ( p<0.05). Participants with at least one recorded visit to a Medicare psychiatrist consultation also tended to have lower levels of psychological distress at the end of the 4-year period, have a higher BMI, and more general practitioner consultations. The study provides clinicians and policy makers with preliminary information on the subtle differences in clinical profile of patients seen by Medicare-funded psychiatrists within an established state-managed telepsychiatry service.

Work interest as a predictor of competitive employment: policy implications for psychiatric rehabilitation.

PubMed

Macias, C; DeCarlo, L T; Wang, Q; Frey, J; Barreira, P

2001-03-01

Consumers with serious mental illness (N = 166) enrolling in two community-based mental health programs, a vocational Program of Assertive Community Treatment and a clubhouse certified by the International Center for Clubhouse Development (ICCD), were asked about their interest in work. About one third of the new enrollees expressed no interest in working. Equivalent supported employment services were then offered to all participants in each program. Stated interest in work and receipt of vocational services were statistically significant predictors of whether a person would work and how long it would take to get a job. Two thirds of those interested in work and half of those with no initial interest obtained a competitive job if they received at least one hour of vocational service. Once employed, these two groups held comparable jobs for the same length of time. These findings demonstrate the importance of making vocational services continuously available to all people with serious mental illness, and the viability of integrating these services into routine mental health care.

A Longitudinal Analysis of the Influence of a Peer Run Warm Line Phone Service on Psychiatric Recovery.

PubMed

Dalgin, Rebecca Spirito; Dalgin, M Halim; Metzger, Scott J

2018-05-01

This article focuses on the impact of a peer run warm line as part of the psychiatric recovery process. It utilized data including the Recovery Assessment Scale, community integration measures and crisis service usage. Longitudinal statistical analysis was completed on 48 sets of data from 2011, 2012, and 2013. Although no statistically significant differences were observed for the RAS score, community integration data showed increases in visits to primary care doctors, leisure/recreation activities and socialization with others. This study highlights the complexity of psychiatric recovery and that nonclinical peer services like peer run warm lines may be critical to the process.

The Experience of Psychiatric Care of Adolescents with Anxiety-based School Refusal and of their Parents: A Qualitative Study.

PubMed

Sibeoni, Jordan; Orri, Massimiliano; Podlipski, Marc-Antoine; Labey, Mathilde; Campredon, Sophie; Gerardin, Priscille; Revah-Levy, Anne

2018-01-01

Anxiety-based school refusal in adolescence is a complex, sometimes difficult to treat disorder that can have serious academic and psychiatric consequences. The objective of this qualitative study was to explore how teens with this problem and their parents experience the psychiatric care received. This qualitative multicenter study took place in France, where we conducted semi-structured interviews with adolescents receiving psychiatric care for anxiety-based school refusal and with their parents. Data collection by purposive sampling continued until we reached theoretical sufficiency. Data analysis was thematic. This study included 20 adolescents aged 12 to 18 years and 21 parents. Two themes emerged from the analysis: (1) the goals of psychiatric care with two sub-themes, " self-transformation " and problem solving ; and, (2) the therapeutic levers identified as effective with two sub-themes: time and space and relationships . Our results show a divergence between parents and teens in their representations of care and especially of its goals. Therapeutic and research implications about the terms of return to school within psychiatric care and also the temporality of care are discussed.

Screening for emotional disorders in patients with cancer using the Brief Symptom Inventory (BSI) and the BSI-18 versus a standardized psychiatric interview (the World Health Organization Composite International Diagnostic Interview).

PubMed

Grassi, Luigi; Caruso, Rosangela; Mitchell, Alex J; Sabato, Silvana; Nanni, Maria Giulia

2018-06-01

Given the adverse consequences of psychiatric and psychosocial morbidity on the quality of life for patients with cancer, prompt detection of psychological symptoms is mandatory. The authors examined the properties and accuracy of the Brief Symptom Inventory (the 53-item version [BSI] and the 18-item version [BSI-18]) for the detection of psychiatric morbidity compared with the World Health Organization Composite International Diagnostic Interview (CIDI) for International Classification of Diseases-10th Revision psychiatric diagnoses. A convenience sample of 498 patients with newly diagnosed cancer who were recruited in cancer outpatient services participated in the CIDI interview and in BSI and BSI-18 assessments. The prevalence of psychiatric morbidity was 39.75%. When participants were classified as cases using the BSI standard case rule, agreement with the CIDI was potentially acceptable (sensitivity, 72.7%; specificity, 88.7%). In contrast, the accuracy of the BSI-18 in identifying cases was poor according to the standard case rule, with very low sensitivity (29.3%) (misclassification rate, 28.7%). By using a first alternative case-rule system (a BSI-18 global severity index [GSI] T-score ≥57), sensitivity marginally improved (45%), whereas a second alternative case-rule system (a GSI T-score ≥50) significantly increased sensitivity (77.3%). In receiver operating characteristic curve analysis, a further cutoff GSI T-score ≥48 exhibited good discrimination levels (sensitivity, 82.3%; specificity, 72.4%). There were some differences in GSI cutoff T-scores according to the International Classification of Diseases-10th Revision diagnosis and sex. The BSI appeared to have acceptable diagnostic accuracy compared with a standardized psychiatric interview. For the BSI-18, it is mandatory to use alternative case-rule systems, to identify patients with psychiatric morbidity. Cancer 2018;124:2415-26. © 2018 American Cancer Society. © 2018 American Cancer Society.

[Psychiatric comorbidities and quality of life in adult individuals with high potential: Relationships with self-esteem].

PubMed

Lancon, Christophe; Martinelli, Marion; Michel, Pierre; Debals, Matthias; Auquier, Pascal; Guedj, Eric; Boyer, Laurent

2015-05-01

The objectives of this study were: 1) to describe the psychiatric comorbidities in adult individuals with high potential; 2) to assess self-esteem and quality of life in comparison with general population; 3) to study the relationships between intelligent quotient (IQ), self-esteem, psychiatric comorbidities and quality of life. This cross-sectional study was conducted in the psychiatric department of a public university hospital (Marseille, France). An outpatient hospital service has been specifically opened to test intelligence since 2012. During a period of six months, it was proposed to all the major individuals with high intellectual potential to receive a psychiatric evaluation using the Mini International Neuropsychiatric Interview (MINI) and to complete self-report questionnaires assessing depression (Beck scale), anxiety (STAI), self-esteem (Rosenberg scale) and quality of life (SF-36). Relationships between IQ, self-esteem, psychiatric comorbidities and quality of life were analyzed using a Bayesian path analysis. Twenty-eight subjects were included, 8 had an IQ between 115 and 130, and 20 had an IQ>130. Fifty-seven percent of individuals had generalized anxiety, 21.4% a current major depressive episode, and 75% a past major depressive episode. Subjects had a low self-esteem and quality of life levels significantly lower than those in the French general population. Subjects with higher self-esteem levels had more depressive (β=0.726, P<0.001) and anxiety (β=0.335, P<0.001) disorders, associated with lower quality of life levels (β=-0.447, P<0.001 and β=-0.276, P=0.012), suggesting that self-esteem was defensive and inadequate. Our study found a high frequency of psychiatric disorders associated with low levels of self-esteem and quality of life. A psychological treatment focusing on self-esteem may have a beneficial effect on anxiety, depression and quality of life. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

The cost-effectiveness of psychotherapy for the major psychiatric diagnoses.

PubMed

Lazar, Susan G

2014-09-01

Psychotherapy is an effective and often highly cost-effective medical intervention for many serious psychiatric conditions. Psychotherapy can also lead to savings in other medical and societal costs. It is at times the firstline and most important treatment and at other times augments the efficacy of psychotropic medication. Many patients are in need of more prolonged and intensive psychotherapy, including those with personality disorders and those with chronic complex psychiatric conditions often with severe anxiety and depression. Many patients with serious and complex psychiatric illness have experienced severe early life trauma in an atmosphere in which family members or caretakers themselves have serious psychiatric disorders. Children and adolescents with learning disabilities and those with severe psychiatric disorders can also require more than brief treatment. Other diagnostic groups for whom psychotherapy is effective and cost-effective include patients with schizophrenia, anxiety disorders (including posttraumatic stress disorder), depression, and substance abuse. In addition, psychotherapy for the medically ill with concomitant psychiatric illness often lowers medical costs, improves recovery from medical illness, and at times even prolongs life compared to similar patients not given psychotherapy. While "cost-effective" treatments can yield savings in healthcare costs, disability claims, and other societal costs, "cost-effective" by no means translates to "cheap" but instead describes treatments that are clinically effective and provided at a cost that is considered reasonable given the benefit they provide, even if the treatments increase direct expenses. In the current insurance climate in which Mental Health Parity is the law, insurers nonetheless often use their own non-research and non-clinically based medical necessity guidelines to subvert it and limit access to appropriate psychotherapeutic treatments. Many patients, especially those who need extended and intensive psychotherapy, are at risk of receiving substandard care due to inadequate insurance reimbursement. These patients remain vulnerable to residual illness and the concomitant sequelae in lost productivity, dysfunctional interpersonal and family relationships, comorbidity including increased medical and surgical services, and increased mortality.

Validity of police contacts as a performance indicator for the public mental health care system in Amsterdam: an open cohort study.

PubMed

Lauriks, S; Buster, M C A; de Wit, M A S; Arah, O A; Hoogendoorn, A W; Peen, J; Klazinga, N S

2018-06-01

The Public Mental Health Care (PMHC) system is a network of public services and care- and support institutions financed from public funds. Performance indicators based on the registration of police contacts could be a reliable and useful source of information for the stakeholders of the PMHC system to monitor performance. This study aimed to provide evidence on the validity of using police contacts as a performance indicator to assess the continuity of care in the PMHC system. Data on services received, police contacts and detention periods of 1928 people that entered the PMHC system in the city of Amsterdam were collected over a period of 51 months. Continuity of care was defined as receiving more than 90 days of uninterrupted service. The associations between police contacts and continuity were analyzed with multilevel Poisson and multivariate linear regression modeling. Clients had on average 2.12 police contacts per person-year. Clients with police contacts were younger, more often single, male, and more often diagnosed with psychiatric or substance abuse disorders than clients without police contacts. Incidence rates of police contacts were significantly lower for clients receiving continuous care than for clients receiving discontinuous care. The number of police contacts of clients receiving PMHC coordination per month was found to be a significant predictor of the percentage of clients in continuous care. The number of police contacts of clients can be used as a performance indicator for an urban PMHC system to evaluate the continuity of care in the PMHC system.

Psychiatric and substance use disorders in HIV/hepatitis C virus (HCV)-coinfected patients: does HCV clearance matter? [Agence Nationale de Recherche sur le SIDA et les Hépatites Virales (ANRS) HEPAVIH CO13 cohort].

PubMed

Michel, L; Lions, C; Winnock, M; Lang, J-P; Loko, M-A; Rosenthal, E; Marchou, B; Valantin, M-A; Morlat, P; Roux, P; Sogni, P; Spire, B; Poizot-Martin, I; Lacombe, K; Lascoux-Combe, C; Duvivier, C; Neau, D; Dabis, F; Salmon-Ceron, D; Carrieri, M P

2016-11-01

The objective of this nested study was to assess the prevalence of psychiatric disorders in a sample of HIV/hepatitis C virus (HCV)-coinfected patients according to their HCV status. The nested cross-sectional study, untitled HEPAVIH-Psy survey, was performed in a subset of HIV/HCV-coinfected patients enrolled in the French Agence Nationale de Recherche sur le SIDA et les Hépatites Virales (ANRS) CO13 HEPAVIH cohort. Psychiatric disorders were screened for using the Mini International Neuropsychiatric Interview (MINI 5.0.0). Among the 286 patients enrolled in the study, 68 (24%) had never received HCV treatment, 87 (30%) were treatment nonresponders, 44 (15%) were currently being treated and 87 (30%) had a sustained virological response (SVR). Of the 286 patients enrolled, 121 patients (42%) screened positive for a psychiatric disorder other than suicidality and alcohol/drug abuse/dependence, 40 (14%) screened positive for alcohol abuse/dependence, 50 (18%) screened positive for drug abuse/dependence, 50 (17.5%) were receiving an antidepressant treatment and 69 (24%) were receiving an anxiolytic. Patients with an SVR did not significantly differ from the other groups in terms of psychiatric disorders. Patients receiving HCV treatment screened positive less often for an anxiety disorder. The highest rate of drug dependence/abuse was among HCV treatment-naïve patients. Psychiatric disorders were frequent in HIV/HCV-coinfected patients and their rates were comparable between groups, even for patients achieving an SVR. Our results emphasize the need for continuous assessment and care of coinfected patients, even after HCV clearance. Drug addiction remains an obstacle to access to HCV treatment. Despite the recent advent and continued development of directly acting antiviral agents (DAAs), it is still crucial to offer screening and comprehensive care for psychiatric and addictive disorders. © 2016 British HIV Association.

Mobile phone text message reminders: Measuring preferences of people with antipsychotic medication.

PubMed

Kauppi, Kaisa; Kannisto, Kati A; Hätönen, Heli; Anttila, Minna; Löyttyniemi, Eliisa; Adams, Clive E; Välimäki, Maritta

2015-10-01

Mobile technology use, including Short Messaging Service (SMS) text messaging, has increased in health care services. Preferences regarding the type or timing of text messages sent by healthcare providers to people with antipsychotic medication have not yet been fully investigated. This study examines the relationship between patients' demographic characteristics and the tailored messages they select. The study ("Mobile.Net", 27704027) includes a structured analysis of a random sub-sample of participants who received messages for 12months. The data were collected in 24 sites and 45 psychiatric hospitals in Finland and analyzed with descriptive statistics and Poisson regression models. The study sample involved 562 people on antipsychotic medication, and a total of 2112 text messages (2 to 25 monthly) were analysed. Regarding message content, there was no significant variation in the proportions relating to 'medication', 'treatment appointments' or 'free time'. Monday was the most popular day to receive messages and morning was preferred to later in the day. Age was most closely associated with 'number of messages' and 'time of messages'. Older women and younger men preferred higher numbers of messages (p=0.0031). Participants preferred positive, encouraging and slightly humorous messages. The findings suggest that messages may be acceptable for difficult to access groups in follow-up. This type of intervention may be useful for various types of patients especially for younger males. To further support the evidence about factors related to message utilization and use, it is important to evaluate the effectiveness of text messages in psychiatric care. Copyright © 2015. Published by Elsevier B.V.

Homicide of infants: a cross-sectional study.

PubMed

Flynn, Sandra M; Shaw, Jenny J; Abel, Kathryn M

2007-10-01

To describe the sociodemographic, clinical, and forensic characteristics of people convicted of killing infants, including their outcome in court and the gender differences in these characteristics. A consecutive case series of people convicted of infant homicide in England and Wales (1996-2001). Information on social demographic and clinical characteristics of perpetrators was collected from psychiatric reports prepared for court. Detailed clinical information was gathered from questionnaires completed by mental health teams for those in contact with mental health services. Of the 2660 identified perpetrators that were convicted of homicide, 112 (4%) were convicted of infant homicide. Fathers killed 56 infants (50%); mothers killed 35 (31%). Forty-nine infants (44%) were killed within 3 months of birth, and 87 (78%) within 6 months. Seventeen perpetrators (24%) had symptoms of mental illness at the time of the offense. Thirty-eight (34%) had a lifetime history of mental illness. In total, 16 (14%) had been under the care of mental health services. Ten women (29%) were diagnosed with affective disorder, and 25 men (53%) had a history of alcohol or drug misuse. Men were more likely to have previous convictions for violence compared to women (p = .01). Most male perpetrators received a custodial sentence (N = 71, 96%), whereas 28 women (74%) received community sentences or hospital disposals. This study highlights the need for increased perinatal assessment and parenting support to encourage parents to seek help. Further research using a psychological autopsy methodology focusing on criminological and psychiatric antecedents may improve our understanding of why these deaths occur and prevent future tragedies.

New Frontiers in Psychiatric Technology.

ERIC Educational Resources Information Center

Fuzessery, Zoltan, Ed.

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

A pilot program in rural telepsychiatry for deaf and hard of hearing populations.

PubMed

Crowe, Teresa; Jani, Suni; Jani, Sushma; Jani, Niranjan; Jani, Raja

2016-03-01

Access to mental health care in deaf communities is limited by cultural considerations, availability of translators, and technological considerations. Telepsychiatry can mitigate the deaf community's lack of access to care by allowing for deaf individuals in remote communities access to care with facilities that cater to their needs. Community Behavioral Health, Arundel Lodge, and Gallaudet University worked in conjunction to test three hypotheses: 1.Telepsychiatry will be as effective as traditional face-to-face psychotherapy with deaf adults who have chronic mental illness.2.Patients living in remote locations will report an improvement in accessibility to mental health services.3.Patients who receive telepsychiatry will report a comparable level of satisfaction of services to those receiving traditional services. The patient sample consisted of 24 participants, 13 women, 11 men. Telepsychiatry sessions were scheduled based on each patient's individual treatment plan against a control group who saw their providers face to face. The telepsychiatry and in-person groups were slightly different at baseline. Analysis of the data revealed no significant difference in coping abilities and psychiatric symptoms between those receiving face-to-face psychotherapy and those receiving telepsychiatry. The quality and outcome of care was equal to in-person for the telepsychiatry in deaf patients. Since telepsychiatry does not compromise the quality of care, it is a good means of reaching out to members of the deaf community that cannot readily access mental health resources that meet their needs.

Co-morbidity and patterns of care in stimulant-treated children with ADHD in the Netherlands.

PubMed

Faber, Adrianne; Kalverdijk, Luuk J; de Jong-van den Berg, Lolkje T W; Hugtenburg, Jacqueline G; Minderaa, Ruud B; Tobi, Hilde

2010-02-01

This study aimed at investigating the use of psychosocial interventions and psychotropic co-medication among stimulant-treated children with attention-deficit hyperactivity disorder (ADHD) in relation to the presence of psychiatric co-morbidity. Stimulant users younger than 16 years were identified in 115 pharmacies and a questionnaire was sent to their stimulant prescribing physician. Of 773 questionnaires sent out, 556 were returned and were suitable for analysis (72%). The results are based on 510 questionnaires concerning stimulant-treated children for whom a diagnosis of ADHD was reported. Of the 510 children diagnosed with ADHD, 31% had also received one or more other psychiatric diagnoses, mainly pervasive developmental disorder or oppositional defiant disorder/conduct disorder. We found an association between the presence of co-morbidity and the use of psychosocial interventions for the child (P < 0.001) and the parents (P < 0.001). In the ADHD-only group, 26% did not receive any form of additional interventions, while psychosocial interventions varied from 8 to 18% in children with ADHD and psychiatric co-morbidity. The presence of diagnostic co-morbidity was also associated with the use of psychotropic co-medication (overall, P = 0.012) and antipsychotics (P < 0.001). Stimulant-treated youths with ADHD and psychiatric co-morbidity received more psychosocial interventions and psychotropic co-medication than children with ADHD-only. The type of psychosocial interventions and psychotropic co-medication received by the children and their parents, depended on the specific co-morbid psychiatric disorder being present.

The EEOC charge priority policy and claimants with psychiatric disabilities.

PubMed

Ullman, M D; Johnsen, M C; Moss, K; Burris, S

2001-05-01

In June 1995 the U.S. Equal Employment Opportunity Commission (EEOC) instituted a new charge priority policy. Under the new policy, charges are classified as one of three priority levels during or immediately after intake. Only charges assigned a high priority receive a full investigation. This paper examines the effect of the charge priority policy on individuals with psychiatric disabilities who filed Americans With Disabilities Act (ADA) charges with the EEOC. Using data extracted from the EEOC's charge data system, the authors analyzed all 66,298 ADA claims prioritized and closed between June 1995 and March 1998. The z test for difference in proportions and the generalized estimating equations procedure were used. The primary outcome measure was the priority assignment received by ADA claimants. Charges that received a high priority assignment were more likely to result in benefits for claimants. Charges filed by claimants with psychiatric disabilities were significantly less likely to be assigned a high priority than charges filed by other claimants. Claimants with psychiatric disabilities were also significantly less likely to benefit from their claims. The strong relationship between being assigned high priority and receiving benefits as a result of filing a charge demonstrates the importance of accurate priority categorization. The finding that people with psychiatric disabilities are less likely than others to benefit from their claims is cause for concern, particularly given the fact that the accuracy of the charge prioritization system has not been validated.

Cost effectiveness of interpersonal community psychiatric treatment for people with long-term severe non-psychotic mental disorders: protocol of a multi-centre randomized controlled trial.

PubMed

van Veen, Mark; Koekkoek, Bauke; Mulder, Niels; Postulart, Debby; Adang, Eddy; Teerenstra, Steven; Schoonhoven, Lisette; van Achterberg, Theo

2015-05-02

This study aims for health gain and cost reduction in the care for people with long-term non-psychotic psychiatric disorders. Present care for this population has a limited evidence base, is often open ended, little effective, and expensive. Recent epidemiological data shows that 43.5% of the Dutch are affected by mental illness during their life. About 80% of all patients receiving mental health services (MHS) have one or more non-psychotic disorders. Particularly for this group, long-term treatment and care is poorly developed. Care As Usual (CAU) currently is a form of low-structured treatment/care. Interpersonal Community Psychiatric Treatment (ICPT) is a structured treatment for people with long-term, non-psychotic disorders, developed together with patients, professionals, and experts. ICPT uses a number of evidence-based techniques and was positively evaluated in a controlled pilot study. Multi-centre cluster-randomized clinical trial: 36 professionals will be randomly allocated to either ICPT or CAU for an intervention period of 12 months, and a follow-up of 6 months. 180 Patients between 18-65 years of age will be included, who have been diagnosed with a non-psychotic psychiatric disorder (depressive, anxiety, personality or substance abuse disorder), have long-term (>2 years) or high care use (>1 outpatient contact per week or >2 crisis contacts per year or >1 inpatient admission per year), and who receive treatment in a specialized mental health care setting. The primary outcome variable is quality of life; secondary outcomes are costs, recovery, general mental health, therapeutic alliance, professional-perceived difficulty of patient, care needs and social contacts. No RCT, nor cost-effectiveness study, has been conducted on ICPT so far. The empirical base for current CAU is weak, if not absent. This study will fill this void, and generate data needed to improve daily mental health care. Netherlands Trial Register (NTR): 3988 . Registered 13th of May 2013.

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

Code of Federal Regulations, 2014 CFR

2014-10-01

... provide the nursing care necessary under each patient's active treatment program. (e) Standard... 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...

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

Code of Federal Regulations, 2012 CFR

2012-10-01

... provide the nursing care necessary under each patient's active treatment program. (e) Standard... 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...

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

Code of Federal Regulations, 2013 CFR

2013-10-01

... provide the nursing care necessary under each patient's active treatment program. (e) Standard... 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...

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

Code of Federal Regulations, 2011 CFR

2011-10-01

... provide the nursing care necessary under each patient's active treatment program. (e) Standard... 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...

42 CFR 409.62 - Lifetime maximum on inpatient psychiatric care.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 2 2010-10-01 2010-10-01 false Lifetime maximum on inpatient psychiatric care. 409.62 Section 409.62 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICARE PROGRAM HOSPITAL INSURANCE BENEFITS Scope of Hospital Insurance Benefits § 409...

Risk of recurrent overdose associated with prescribing patterns of psychotropic medications after nonfatal overdose

PubMed Central

Okumura, Yasuyuki; Nishi, Daisuke

2017-01-01

Objective We aimed to estimate risk of recurrent overdose associated with psychosocial assessment by psychiatrists during hospitalization for nonfatal overdose and prescribing patterns of psychotropic medications after discharge. Methods A retrospective cohort study was conducted using a nationwide claims database in Japan. We classified patients aged 19–64 years hospitalized for nonfatal overdose between October 2012 and September 2013 into two cohorts: 1) those who had consulted a psychiatrist prior to overdose (n=6,790) and 2) those who had not (n=4,950). All patients were followed up from 90 days before overdose until 365 days after discharge. Results Overall, 15.3% of patients with recent psychiatric treatment had a recurrent overdose within 365 days, compared with 6.0% of those without psychiatric treatment. Psychosocial assessment during hospital admission had no significant effect on subsequent overdose, irrespective of treatment by psychiatrists before overdose. There was a dose–response relationship for the association of benzodiazepine prescription after overdose with subsequent overdose in either cohort, even after accounting for average daily dosage of benzodiazepines before overdose and other confounders. In patients with recent psychiatric treatment, the cumulative proportion of recurrent overdose at 365 days was 27.7% for patients receiving excessive dosages of benzodiazepines, 22.0% for those receiving high dosages, 15.3% for those receiving normal dosages, and 7.6% for those receiving no benzodiazepines. In patients without psychiatric treatment, the cumulative proportion of recurrent overdose at 365 days was 24.3% for patients receiving excessive dosages of benzodiazepines, 18.0% for those receiving high dosages, 9.0% for those receiving normal dosages, and 4.1% for those receiving no benzodiazepines. Conclusion Lower dose of benzodiazepines after overdose is associated with lower risk of subsequent overdose. PMID:28293108

Forensic Psychiatric Evaluation for Military Absenteeism in Taiwan.

PubMed

Tzeng, Nian-Sheng; Chen, Chih-Kang; Wang, Tzong-Shi; Chang, Hsin-An; Kao, Yu-Chen; Yeh, Hui-Wen; Chiang, Wei-Shan; Huang, San-Yuan

2016-09-01

The relationship between military absenteeism and mental health problems has been noted; however, factors affecting military absenteeism by enlisted personnel have not been studied systematically. In a medical center in Taiwan, we performed a chart review of 26 forensic psychiatric evaluations of enlisted personnel who were absent without leave (AWOL) or deserted their service from 1994 to 2014. The findings showed that many of these recruits had a lower level of education (50.00% had just nine years of education), intellectual disability (46.15%), depressive disorders (30.76%), and suicidal ideation (53.85%). Depressive disorder was overrepresented in comparison with findings in a previous study. Further study is needed to confirm whether psychiatric screening before service enlistment and early psychiatric intervention for service members with mental illness or emotional disturbance could help in the prevention of desertion or going AWOL. © 2016 American Academy of Psychiatry and the Law.

[Level of Development of Clinical Ethics Consultation in Psychiatry - Results of a Survey Among Psychiatric Acute Clinics and Forensic Psychiatric Hospitals].

PubMed

Gather, Jakov; Kaufmann, Sarah; Otte, Ina; Juckel, Georg; Schildmann, Jan; Vollmann, Jochen

2018-04-17

The aim of this article is to assess the level of development of clinical ethics consultation in psychiatric institutions in North Rhine-Westphalia. Survey among medical directors, directors of nursing and administrative directors of all psychiatric acute clinics and forensic psychiatric hospitals in North Rhine-Westphalia. 113 persons working in psychiatric acute clinics responded (reponse rate: 48 %) and 13 persons working in forensic psychiatric hospitals (response rate 54 %). We received at least one response from 89 % of all psychiatric acute clinics and from 100 % of all forensic psychiatric hospitals. 90 % of the responding psychiatric acute clinics and 29 % of the responding forensic psychiatric hospitals have already implemented clinical ethics consultation. Clinical ethics consultation is more widespread in psychiatric institutions than was hitherto assumed. Future medical ethics research should therefore give greater attention to the methodology and the quality of clinical ethics consultation in psychiatric practice. © Georg Thieme Verlag KG Stuttgart · New York.

[The experience with the information expert systems in forensic psychiatric services within the Russian Federation].

PubMed

Sannikov, A G

2008-01-01

The assessment of the effectiveness of the informatization of the forensic psychiatric expertise service in the Tyumen oblast based on the data of the medical sociological research carried out by means of total questionnaire design of the forensic psychiatrists applied in repetition-free mode. The following basic positive outcomes of the informatization of the forensic psychiatric service are marked: the optimization of clinical, registering-accounting and managerial activities of the expert commissions; enhancement of the expertise staff's self-appraisal related to the mastering of information technologies; employees' formed will to implement the IT-technologies for the purpose of professional development. Besides the assessment of the effectiveness of the specialized service's informatization the results of the research can provide information on the optimal structure of the medical information systems.

Cost-effectiveness of an early assessment service for young people with early psychosis in Hong Kong.

PubMed

Wong, Kenny K; Chan, Sherry K W; Lam, May M L; Hui, Christy L M; Hung, Se F; Tay, Margaret; Lee, K H; Chen, Eric Y H

2011-08-01

The Early Assessment Service for Young People with Early Psychosis (EASY) was developed in Hong Kong in 2001 to provide a comprehensive and integrated approach for early detection and intervention for young people suffering from first episode psychosis. The present study examined the cost-effectiveness of the service over a period of 24 months compared to standard care. This is a historical control study. Sixty-five patients who presented to the EASY service in 2001 with first episode psychosis were individually matched (on age, sex and diagnosis) with 65 patients who received standard psychiatric care in a precursor service (pre-EASY) between 1999 and 2000. A retrospective cost-effectiveness analysis was conducted over a period of 24 months. The overall average cost of service utilization per patient and the effects on hospitalization rate were compared using bootstrapping analysis. Cost per point improvement in Positive and Negative Syndrome Scale (PANSS) was also computed with sensitivity analysis. Only direct costs were analysed in the current study. There was no significant difference in service utilization between the EASY and pre-EASY standard care groups. The cost-effectiveness acceptability curve, which was used to explore uncertainty in estimates of cost and effects, suggested that there was a probability of at least 94% that the EASY model was more cost-effective than the pre-EASY service in reducing psychiatric inpatient admissions. EASY patients also showed superior results in average cost per unit improvement in PANSS. EASY is likely to be more cost-effective in improving outcomes, particularly in reducing hospitalization and improving clinical symptoms among young people with first episode psychosis. This study provides a perspective from the east Asian region, and supports further development of similar services, particularly in the local setting. However, further studies with a longer follow up period and larger sample size are required to verify these findings.

Gender differences in service utilization among Operations Enduring Freedom, Iraqi Freedom, and New Dawn Veterans Affairs patients with severe mental illness and substance use disorders.

PubMed

Painter, Janelle M; Brignone, Emily; Gilmore, Amanda K; Lehavot, Keren; Fargo, Jamison; Suo, Ying; Simpson, Tracy; Carter, Marjorie E; Blais, Rebecca K; Gundlapalli, Adi V

2018-02-01

Severe mental illness (SMI) and substance use disorders (SUD) are among the more chronic and costly mental health conditions treated in the Department of Veterans Affairs (VA). Service use patterns of returning veterans with SMI and SUD have received little attention. We examined gender differences in the utilization of VA services among a national sample of Operations Enduring Freedom, Iraqi Freedom, and New Dawn (OEF/OIF/OND) VA patients with SMI, SUD, and their comorbidity (SMI/SUD) in their first year of established VA care (N = 24,166). Outpatient services and acute-residential stays were modeled using negative binomial and logistic regression, respectively. Among all diagnostic categories, men used outpatient services less often than did women, including primary care (adjusted rate ratio [ARR] = .71, 95% confidence interval CI [.68, .74]), mental health (ARR = .85, 95% CI [.80, .91]), and addiction (ARR = .91, 95% CI [.83, .99]) services. For emergency department (ED) and psychiatric inpatient services, gender interacted significantly with diagnosis. The combination of SMI/SUD compared to either SMI or SUD conferred greater risk of ED utilization among men than women (adjusted odds ratio [AOR] = 2.09, 95% CI [1.24, 3.51], and 1.95, 95% CI [1.17, 3.26], respectively). SMI versus SUD conferred greater risk of psychiatric inpatient utilization among men than women (AOR = 1.83, 95% CI [1.43, 2.34]). Our findings point to gender differences in outpatient and acute service utilization among OEF/OIF/OND VA patients with some of the more chronic and costly mental health conditions. Further investigation of health care utilization patterns is needed to understand factors driving these gender differences to ensure that veterans have appropriate access to the services they need. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Inpatient treatment of major depression in Austria between 1989 and 2009: impact of downsizing of psychiatric hospitals on admissions, suicide rates and outpatient psychiatric services.

PubMed

Vyssoki, B; Willeit, M; Blüml, V; Höfer, P; Erfurth, A; Psota, G; Lesch, O M; Kapusta, N D

2011-09-01

During the last 20 years Austrian psychiatric services underwent fundamental changes, as a focus was set on downsizing psychiatric hospitals. Little is known about how restructuring of mental health services affected patients with major depression and suicide rates. Monthly hospital discharges from all hospitals in Austria with the diagnosis of unipolar major depression as primary reason for inpatient treatment were obtained for the time period between 1989 and 2008. These data were correlated with relevant parameters from the general health system, such as number of hospital beds, suicide rate, density of psychotherapists and sales of antidepressants. While the number of psychiatric beds was reduced by almost 30%, the total annual numbers of inpatient treatment episodes for depression increased by 360%. This increase was stronger for men than for women. Further on this development was accompanied by a decrease in the suicide rate and an improvement in the availability of professional outpatient mental health service providers. Only aggregated patient data and no single case histories were available for this study. The validity of the correct diagnosis of unipolar major depression must be doubted, as most likely not all patients were seen by a clinical expert. Our data show that although inpatient treatment for unipolar major depression dramatically increased, reduction of psychiatric beds did not lead to an increase of suicide rates. Copyright © 2011 Elsevier B.V. All rights reserved.

Interactional aspects of care during hospitalization: perspectives of family caregivers of psychiatrically ill in a tertiary care setting in India.

PubMed

Dinakaran, P; Mehrotra, Seema; Bharath, Srikala

2014-12-01

There are very few studies on user-perspectives about mental health care services that explore perspectives of family caregivers in India. An exploratory study was undertaken to understand the perceived importance of various aspects of interactions with mental health service providers during hospitalization, from the perspectives of family caregivers. In addition, it also aimed at documenting their actual experience of interactional aspects of care during the hospitalization of their relatives. The study was conducted on fifty family caregivers of patients with varied psychiatric diagnoses hospitalized in a tertiary psychiatric care setting in South India. Measures of Interactional aspects of care were developed to assess perceived importance of six different interactional domains of care and the actual experience of care in these domains. Provision of informational inputs and addressing of concerns raised emerged as the domains of care given highest importance. The item pertaining to 'sharing with the caregiver about different alternatives for treatment' received negative ratings in terms of actual experience by maximum number of participants (18%). Significant differences on perceived importance of four domains of interactional aspects of care (dignity, confidentiality and fairness, addressing concerns raised, informational inputs and prompt attention and consistent care) emerged between caregiver subgroups based on educational level of the caregiver, socio-economic status, hospitalization history and broad diagnostic categories. In addition, the care givers of patients with psychoses assigned significantly more positive ratings on actual experience for all the domains of interactional aspects of care. The findings have implications for further research and practice. Copyright © 2014 Elsevier B.V. All rights reserved.

[Medical students and their attitude to psychiatry].

PubMed

den Held, O M; Hegge, I R H J; van Schaik, D J F; van Balkom, A J L M

2011-01-01

The attitudes of medical students to psychiatry are important for the future care of patients with psychiatric (co)morbidity. Up till now the attitude of medical students to psychiatry has not been investigated in the Netherlands and the Dutch-speaking part of Belgium. To measure the attitude of third year medical students towards psychiatry by means of the ATP-30. This is a validated instrument, used internationally. To determine the extent to which medical students' attitudes were influenced by the psychiatry curriculum and by some sociodemographic determinants and which aspects of a career – according to earlier Dutch research – made students decide to opt for a particular specialism. Our research was of the prospective cohort type; without controls. The design was a pre- and post design. Attitudes to psychiatry were generally positive (n = 262, ATP score: 106.1, sd 10.9, ATP score ≤ 90 was regarded as negative) and improved after students received instruction in psychiatry. Men were less positive than women. Students who previously had positive experiences with the psychiatric services had higher scores. Foreign students, mainly from non-Western countries, had lower scores. After these foreign students had completed their studies in the Netherlands, there was no longer any significant difference between the scores of the two groups. Attitudes to psychiatry are positive within our cohort. Tuition has a positive effect on students' attitudes. The less positive score of the foreign students at the start of their course is probably due to the fact that they were not familiar with psychiatry and psychiatric services.

Association of Family Structure to Later Criminality: A Population-Based Follow-Up Study of Adolescent Psychiatric Inpatients in Northern Finland

ERIC Educational Resources Information Center

Ikaheimo, Olli; Laukkanen, Matti; Hakko, Helina; Rasanen, Pirkko

2013-01-01

The influence of family structure on criminality in adolescents is well acknowledged in population based studies of delinquents, but not regarding adolescent psychiatric inpatients. The association of family structure to criminality was examined among 508 adolescents receiving psychiatric inpatient treatment between 2001 and 2006. Family structure…

Suicide within 12 months of contact with mental health services: national clinical survey

PubMed Central

Appleby, Louis; Shaw, Jenny; Amos, Tim; McDonnell, Ros; Harris, Catherine; McCann, Kerry; Kiernan, Katy; Davies, Sue; Bickley, Harriet; Parsons, Rebecca

1999-01-01

Objective To describe the clinical circumstances in which psychiatric patients commit suicide. Design National clinical survey. Setting England and Wales. Subjects A two year sample of people who had committed suicide, in particular those who had been in contact with mental health services in the 12 months before death. Main outcome measures Proportion of suicides in people who had had recent contact with mental health services; proportion of suicides in inpatients; proportion of people committing suicide and timing of suicide within three months of hospital discharge; proportion receiving high priority under the care programme approach; proportion who were recently non-compliant and not attending. Results 10 040 suicides were notified to the study between April 1996 and March 1998, of whom 2370 (24%; 95% confidence interval 23% to 24%) had had contact with mental health services in the year before death. Data were obtained on 2177, a response rate of 92%. In general these subjects had broad social and clinical needs. Alcohol and drug misuse were common. 358 (16%; 15% to 18%) were psychiatric inpatients at the time of death, 21% (17% to 25%) of whom were under special observation. Difficulties in observing patients because of ward design and nursing shortages were both reported in around a quarter of inpatient suicides. 519 (24%; 22% to 26%) suicides occurred within three months of hospital discharge, the highest number occurring in the first week after discharge. 914 (43%; 40% to 44%) were in the highest priority category for community care. 488 (26% excluding people whose compliance was unknown; 24% to 28%) were non-compliant with drug treatment while 486 (28%; 26% to 30%) community patients had lost contact with services. Most people who committed suicide were thought to have been at no or low immediate risk at the final service contact. Mental health teams believed suicide could have been prevented in 423 (22%; 20% to 24%) cases. Conclusions Several suicide prevention measures in mental health services are implied by these findings, including measures to improve compliance and prevent loss of contact with services. Inpatient facilities should remove structural difficulties in observing patients and fixtures that can be used in hanging. Prevention of suicide after discharge may require earlier follow up in the community. Better suicide prevention in psychiatric patients is likely to need measures to improve the safety of mental health services as a whole, rather than specific measures for people known to be at high risk. Key messagesAround a quarter of people who commit suicide have been in contact with mental health services in the year before death—over 1000 cases annuallyOf these cases, 16% are psychiatric inpatients and 24% have been discharged from inpatient care in the previous three monthsProblems of observation caused by ward design and nursing shortages are common in cases of inpatient suicideSuicide in former inpatients occurs most commonly in the week after dischargeNon-compliance with treatment and loss of contact with services are common before suicide PMID:10231250

Delusional infestation is typically comorbid with other psychiatric diagnoses: review of 54 patients receiving psychiatric evaluation at Mayo Clinic.

PubMed

Hylwa, Sara A; Foster, Ashley A; Bury, Jessica E; Davis, Mark D P; Pittelkow, Mark R; Bostwick, J Michael

2012-01-01

Delusional infestation, which encompasses both delusions of parasitosis and delusions of infestation with inanimate objects (sometimes called Morgellons disease), has been said to represent a distinct and encapsulated delusion, that is, a stand-alone diagnosis. Anecdotally, we have observed that patients with delusional infestation often have one or more psychiatric comorbid conditions and that delusional infestation should not be regarded as a stand-alone diagnosis. The purpose of this study was to identify whether patients with delusional infestation have psychiatric comorbid conditions. We therefore identified patients who had been formally evaluated in the Department of Psychiatry during their visit to Mayo Clinic. We retrospectively searched for and reviewed the cases of all patients with delusional infestation seen from 2001 through 2007 at Mayo Clinic, Rochester, Minnesota, and who underwent psychiatric evaluation. The diagnoses resulting from psychiatric evaluation were analyzed. During the 7-year study period, 109 patients seen for delusional infestation at Mayo Clinic were referred to the Department of Psychiatry, 54 (50%) of whom actually followed through with psychiatric consultation. Of these 54 patients, 40 (74%) received additional active psychiatric diagnoses; 14 patients (26%) had delusional infestation alone. Abnormal personality traits were rarely documented. Most patients with delusional infestation have multiple coexisting or underlying psychiatric disorders. Therefore, evaluation by a psychiatrist, when possible, is advised for all patients with delusional infestation. Copyright © 2012 The Academy of Psychosomatic Medicine. Published by Elsevier Inc. All rights reserved.

Psychiatric services in primary care settings: a survey of general practitioners in Thailand

PubMed Central

Lotrakul, Manote; Saipanish, Ratana

2006-01-01

Background General Practitioners (GPs) in Thailand play an important role in treating psychiatric disorders since there is a shortage of psychiatrists in the country. Our aim was to examine GP's perception of psychiatric problems, drug treatment and service problems encountered in primary care settings. Methods We distributed 1,193 postal questionnaires inquiring about psychiatric practices and service problems to doctors in primary care settings throughout Thailand. Results Four hundred and thirty-four questionnaires (36.4%) were returned. Sixty-seven of the respondents (15.4%) who had taken further special training in various fields were excluded from the analysis, giving a total of 367 GPs in this study. Fifty-six per cent of respondents were males and they had worked for 4.6 years on average (median = 3 years). 65.6% (SD = 19.3) of the total patients examined had physical problems, 10.7% (SD = 7.9) had psychiatric problems and 23.9% (SD = 16.0) had both problems. The most common psychiatric diagnoses were anxiety disorders (37.5%), alcohol and drugs abuse (28.1%), and depressive disorders (29.2%). Commonly prescribed psychotropic drugs were anxiolytics and antidepressants. The psychotropic drugs most frequently prescribed were diazepam among anti-anxiety drugs, amitriptyline among antidepressant drugs, and haloperidol among antipsychotic drugs. Conclusion Most drugs available through primary care were the same as what existed 3 decades ago. There should be adequate supply of new and appropriate psychotropic drugs in primary care. Case-finding instruments for common mental disorders might be helpful for GPs whose quality of practice was limited by large numbers of patients. However, the service delivery system should be modified in order to maintain successful care for a large number of psychiatric patients. PMID:16867187

Characteristics of unrecognised bipolar disorder in patients treated for major depressive disorder in China: general versus psychiatric hospitals.

PubMed

Chen, F Z; Xiang, Y T; Lu, Z; Wang, G; Hu, C; Kilbourne, A M; Ungvari, G S; Fang, Y R; Si, T M; Yang, H C; Lai, K Yc; Hu, J; Chen, Z Y; Huang, Y; Sun, J; Wang, X P; Li, H C; Zhang, J B; Zhang, X Y; Chiu, H F K

2013-12-01

Bipolar disorder is often misdiagnosed as major depressive disorder. Such misdiagnosis partly depends on the type of treatment setting. This study compared general hospital psychiatric units with psychiatric hospitals in China with respect to basic demographic and clinical characteristics of patients with unrecognised bipolar disorder who are treated for major depressive disorder. Patients treated for major depressive disorder were consecutively examined in 13 health centres (6 general hospital psychiatric units and 7 psychiatric hospitals) in China. Their socio-demographic and clinical features were recorded using a standardised protocol and data collection procedure. The DSM-IV diagnoses were established using the Mini-International Neuropsychiatric Interview. Of the 1487 patients included in the study, 309 (20.8%) were diagnosed with bipolar disorder. There was no significant difference between general hospital psychiatric units and psychiatric hospitals in the ratio of all types of unrecognised bipolar disorders (χ2 = 0.008, degrees of freedom = 1, p = 0.9) and bipolar II disorders (χ2 = 3.1, degrees of freedom = 1, p = 0.08). The proportions of unrecognised bipolar I disorders (χ2 = 4.1, degrees of freedom = 1, p = 0.04) differed significantly between the 2 types of study site. Multivariate analyses showed that patients with bipolar I disorders with more seasonal depressive episodes were more likely to receive treatment in general hospital psychiatric units (odds ratio = 3.3, 95% confidence interval = 1.1-9.8). Patients with bipolar I disorders receiving treatment in general hospital psychiatric units had different clinical characteristics compared to their counterparts treated in psychiatric hospitals in China.

The Use of Psychiatric Service Dogs in the Treatment of Veterans with PTSD

DTIC Science & Technology

2009-10-01

treatment provider, the client and an expert on service dog functions. Some design issues were raised in the February 2009 CRMRP meeting that...TITLE: The Use of psychiatric Service Dogs in the Treatment of Veterans with PTSD PRINCIPAL INVESTIGATOR: Craig Love, Ph.D... designated by other documentation.   REPORT DOCUMENTATION PAGE Form Approved OMB No. 0704-0188 Public reporting burden for this collection of

[Psychiatric care act of Ukraine and issues concerning reformation of the mental health protection service].

PubMed

Moskalenko, V F; Gorban', E N; Tabachnikov, S I; Syropiatov, O G; Shtengelov, V V

2000-01-01

An analysis was performed of the conception and content of a new Psychiatric Care Act by making a comparison with data from published literature and the present-day status of the mental health protection service. The main features of the crisis of psychiatry in Ukraine are characterized together with possible ways of resolving it. Main trends in reformation of the psychiatric service are identified that are to be secured by relevant acts of departmental and interdepartmental character based on law. Priority is emphasized to defence of the patients' rights and liberties together with a need for a guarantee of a highly skilled medical care to be provided for mental patients.

[The "Psychiatrie-Enquete" - the German Report on the State of Psychiatry in 1975].

PubMed

Finzen, Asmus

2015-10-01

Forty years ago an expert-commission submitted a report on the deplorable state of German psychiatric care, called the "Psychiatrie-Enquete" to the Bundestag, the German parliament. The Report initiated a substantial change of Psychiatric services in the country. Inhuman treatment and living conditions were superseded. Mental hospitals were not completely abolished. But they lost their importance in favour of decentralized psychiatric services including departments at general hospitals, day hospitals and outpatient services. Custodial care was largely successfully developed into therapeutic and rehabilitative care. This article attempts a mildly critical evaluation of the Enquête 40 years after. © Georg Thieme Verlag KG Stuttgart · New York.

Replacing revolving door: a collaborative approach to treating individuals in crisis.

PubMed

Lauer, Michelle; Brownstein, Rose

2008-06-01

The Crisis Assessment and Psychiatric Emergency Services (CAPES) unit was designed to improve the quality of psychiatric treatment, contain costs, and provide relief to overburdened psychiatric inpatient and emergency services in Delaware. This innovative program is the result of collaboration between public and private agencies to treat individuals in crisis. The myriad factors that contributed to a broken system and instigated Delaware's search for a solution are discussed in this article. The CAPES unit has resulted in improved communication among providers, decreased committal rates, better linkage to appropriate levels of care, increased safety, and improved coordination of services. Clinical implications for nursing practice include providing more holistic care in a safer environment.

Overlooked and Underserved: “Action Signs” for Identifying Children With Unmet Mental Health Needs

PubMed Central

Goldman, Eliot; Offord, David; Costello, Elizabeth J.; Friedman, Robert; Huff, Barbara; Crowe, Maura; Amsel, Lawrence; Bennett, Kathryn; Bird, Hector; Conger, Rand; Fisher, Prudence; Hoagwood, Kimberly; Kessler, Ronald C.; Roberts, Robert

2011-01-01

OBJECTIVE: The US Surgeon General has called for new approaches to close the mental health services gap for the large proportion of US children with significant mental health needs who have not received evaluation or services within the previous 6 to 12 months. In response, investigators sought to develop brief, easily understood, scientifically derived “warning signs” to help parents, teachers, and the lay public to more easily recognize children with unmet mental health needs and bring these children to health care providers' attention for evaluation and possible services. METHOD: Analyses of epidemiologic data sets from >6000 children and parents were conducted to (1) determine the frequency of common but severely impairing symptom profiles, (2) examine symptom profile frequencies according to age and gender, (3) evaluate positive predictive values of symptom profiles relative to Diagnostic and Statistical Manual of Mental Disorders diagnoses, and (4) examine whether children with 1 or more symptom profiles receive mental health services. RESULTS: Symptom-profile frequencies ranged from 0.5% to 2.0%, and 8% of the children had 1 or more symptom profile. Profiles generated moderate-to-high positive predictive values (52.7%–75.4%) for impairing psychiatric diagnoses, but fewer than 25% of children with 1 or more profiles had received services in the previous 6 months. CONCLUSIONS: Scientifically robust symptom profiles that reflect severe but largely untreated mental health problems were identified. Used as “action signs,” these profiles might help increase public awareness about children's mental health needs, facilitate communication and referral for specific children in need of evaluation, and narrow the child mental health services gap. PMID:22025589

Effects of psychotropic drugs and psychiatric illness on vocational aptitude and interest assessment.

PubMed

Helmes, E; Fekken, G C

1986-07-01

This study examined the vocational aptitude and interest scores of 326 inpatients at a large urban psychiatric hospital. The inpatient group performed significantly below the adult normative mean on eight of nine General Aptitude Test Battery (GATB) aptitude measures; the single exception was Verbal Aptitude. Further, GATB aptitude scores (adjusted for age and education) were significantly lower for patients who were receiving (N = 210) psychotropic medication than for patients who were not receiving (N = 114) psychotropic medication, again with the exception of Verbal Aptitude. Differentiation of patients into subsamples who were receiving particular drugs or drug combinations indicated that phenothiazines in combination with Anti-Parkinsonians were associated with the poorest GATB performances. Interestingly, self-reported vocational interests were not related in any systematic fashion to receiving medication. A variety of explanations that may account for these findings, including drug side-effects and severity or type of psychiatric disorder, were investigated. Implications for vocational counselors were discussed.

Impact of a crisis assessment and treatment service on admissions into an acute psychiatric unit.

PubMed

Adesanya, Adesina

2005-06-01

To assess the impact of a regional/rural crisis assessment and treatment service (CAT) on admissions into an acute adult inpatient psychiatric facility. Relevant data for admissions into an acute adult inpatient psychiatric facility in the 18 month periods before and after the establishment of a CAT were compared. Data extracted from available clinical records were transferred into an appropriately structured pro forma for statistical analysis. There were 69 and 53 index inpatient unit admissions in the two time periods. The majority of these were for single, unemployed men aged in their 30s. Although statistically non-significant, the results appear to suggest that there were proportionately fewer readmissions and that admissions were likely to be influenced by illness severity and diagnostic considerations in the period following the establishment of the CAT. The establishment of CAT did not appear to have had much impact on the duration of psychiatric hospitalization. Crisis assessment and treatment services operating within a regional/rural integrated mental health setting appear to have only limited impact on hospitalization for psychiatric crisis presentations. There is a need for further studies looking at a broader range of outcome variables in the assessment of the impact of CAT on psychiatric hospitalization in such settings.

78 FR 12219 - Excepted Service-Appointment of Persons With Intellectual Disabilities, Severe Physical...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-02-22

... Intellectual Disabilities, Severe Physical Disabilities, and Psychiatric Disabilities AGENCY: U.S. Office of... physical disabilities, and psychiatric disabilities. The regulation removes an unnecessary burden for these... appointment of people with mental retardation, severe physical disabilities, and psychiatric disabilities. As...

[Suicidal behaviour and attempted suicide occurring during assessment by the outreach psychiatric emergency service].

PubMed

de Winter, R F P; de Groot, M H; van Dassen, M; Deen, M L; de Beurs, D P

The outreach emergency psychiatric service plays an important role in recognising, arranging interventions and preventing suicide and suicidal behaviour. However, little is known about the assessments that members of the emergency team make when faced with patients showing suicidal behaviour.
AIM: To describe the relationships that are revealed between patient characteristics, suicidal thoughts and attempted suicide during assessments made by the emergency psychiatric service in The Hague.
METHOD: The emergency service kept a detailed record of 14,705 consultations. We compared the characteristics of patients who had suicidal thoughts with those of patients who had no such thoughts and we also compared the characteristics of patients who had attempted to commit suicide with those of patients who had not. We drew these comparisons by using logistic regression models, adjusting for clustering.
RESULTS: 32.2% of the patients showed signs of suicidal behaviour and 9.2 % appeared likely to attempt suicide. Suicidal behaviour occurred most often in patients with depression. Suicidal patients were more often admitted to hospital than were non-suicidal patients and they were more likely to have been referred by a general practitioner or a general hospital. Medication was the most frequent means employed in attempts to commit suicide.
CONCLUSION: In about one third of the consultations of the outreach emergency psychiatric service, the patient showed suicidal behaviour. The actions and the policy of the emergency psychiatric service with regard to suicidal behaviour were diverse and dependent on factors that could change over the course of time.

Suicide amongst psychiatric in-patients who abscond from the ward: a national clinical survey.

PubMed

Hunt, Isabelle M; Windfuhr, Kirsten; Swinson, Nicola; Shaw, Jenny; Appleby, Louis; Kapur, Nav

2010-02-03

Suicide prevention by mental health services requires an awareness of the antecedents of suicide amongst high risk groups such as psychiatric in-patients. The goal of this study was to describe the social and clinical characteristics of people who had absconded from an in-patient psychiatric ward prior to suicide, including aspects of the clinical care they received. We carried out a national clinical survey based on a 10-year (1997-2006) sample of people in England and Wales who had died by suicide. Detailed data were collected on those who had been in contact with mental health services in the year before death. There were 1,851 cases of suicide by current psychiatric in-patients, 14% of all patient suicides. 1,292 (70%) occurred off the ward. Four hundred and sixty-nine of these patients died after absconding from the ward, representing 25% of all in-patient suicides and 38% of those that occurred off the ward. Absconding suicides were characterised by being young, unemployed and homeless compared to those who were off the ward with staff agreement. Schizophrenia was the most common diagnosis, and rates of previous violence and substance misuse were high. Absconders were proportionally more likely than in-patients on agreed leave to have been legally detained for treatment, non-compliant with medication, and to have died in the first week of admission. Whilst absconding patients were significantly more likely to have been under a high level of observation, clinicians reported more problems in observation due to either the ward design or other patients on the ward. Measures that may prevent absconding and subsequent suicide amongst in-patients might include tighter control of ward exits, and more intensive observation of patients, particularly in the early days of admission. Improving the ward environment to provide a supportive and less intimidating experience may contribute to reduced risk.

Evaluating DSM-5 Insomnia Disorder and the Treatment of Sleep Problems in a Psychiatric Population

PubMed Central

Seow, Lee Seng Esmond; Verma, Swapna Kamal; Mok, Yee Ming; Kumar, Sunita; Chang, Sherilyn; Satghare, Pratika; Hombali, Aditi; Vaingankar, Janhavi; Chong, Siow Ann; Subramaniam, Mythily

2018-01-01

Study Objectives: With the introduction of insomnia disorder in Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), greater emphasis has been placed on the diagnosis and treatment of sleep disorder even in the presence of a coexisting mental disorder. The current study seeks to explore the clinical picture of insomnia in the context of psychiatric disorders commonly associated with sleep complaints by assessing the prevalence and correlates of DSM-5 insomnia disorder, and examining the extent to which insomnia symptoms have been addressed in this population. Methods: Four hundred treatment-seeking outpatients suffering from depressive, bipolar affective, anxiety, and schizophrenia spectrum disorders were recruited. DSM-5 insomnia was established using the modified Brief Insomnia Questionnaire. Differences in sociodemographic factors, clinical status, impairment outcomes, and mental health services utilization were compared. Information on patients' help-seeking experiences for insomnia-related symptoms was collected to determine the treatment received and treatment effectiveness. Results: Almost one-third of our sample (31.8%) had DSM-5 insomnia disorder. Those with insomnia disorder had significantly higher impairment outcomes than their counterparts but no group difference was observed for mental health services utilization. Findings based on past treatment contact for sleep problems suggest that diagnosis and treatment of insomnia is lacking in this population. Conclusions: With the new calling from DSM-5, clinicians treating psychiatric patients should view insomnia less as a symptom of their mental illnesses and treat clinical insomnia as a primary disorder. Patients should also be educated on the importance of reporting and treating their sleep complaints. Nonmedical (cognitive and behavioral) interventions for insomnia need to be further explored given their proven clinical effectiveness. Citation: Seow LSE, Verma SK, Mok YM, Kumar S, Chang S, Satghare P, Hombali A, Vaingankar J, Chong SA, Subramaniam M. Evaluating DSM-5 insomnia disorder and the treatment of sleep problems in a psychiatric population. J Clin Sleep Med. 2018;14(2):237–244. PMID:29394962

Gender differences in the effects of community violence on mental health outcomes in a sample of low-income youth receiving psychiatric care.

PubMed

Javdani, Shabnam; Abdul-Adil, Jaleel; Suarez, Liza; Nichols, Sara R; Farmer, A David

2014-06-01

Previous research suggests that community violence impacts mental health outcomes, but much of this research has not (a) distinguished between different types of community violence, (b) examined gender differences, and (c) focused on youth living in urban poverty. The current study addresses these questions. Participants were 306 youth (23 % girls) and one parent/guardian receiving outpatient psychiatric services for disruptive behavior disorders in a large urban city. Youth and parents reported on youth's experience of different types of community violence (being a direct victim, hearing reports, and witnessing violence), and whether violence was directed toward a stranger or familiar. Outcomes included youth externalizing, internalizing, and posttraumatic stress symptoms assessed via parent and youth reports. Being a direct victim of violence accords risk for all mental health outcomes similarly for both boys and girls. However, gender differences emerged with respect to indirect violence, such that girls who hear reports of violence against people they know are at increased risk for all assessed mental health outcomes, and girls who witness violence against familiars are at increased risk for externalizing mental health symptoms in particular. There are gender differences in violence-related mental health etiology, with implications for intervention assessment and design.

Families living with parental mental illness and their experiences of family interventions.

PubMed

Afzelius, M; Plantin, L; Östman, M

2018-03-01

WHAT IS KNOWN ON THE SUBJECT?: Coping with parental mental illness in families can be challenging for both children and parents. Providing evidence-based family interventions to families where a parent has a mental illness can enhance the relationships in the family. Although psychiatric research has shown that evidence-based family interventions may improve the communication and understanding of parental mental illness, there is a lack in this area of research from an everyday clinical context. WHAT DOES THIS PAPER ADD TO EXISTING KNOWLEDGE?: Our study reinforces the fact that parents with mental illnesses are searching for support from psychiatric services in order to talk to their children about their illness. The finding that under-age children comply when they are told by their parents to join an intervention in psychiatric services supporting the family is something not observed earlier in research. This study once more illuminates the fact that partners of a person with parental mental illness are seldom, in an obvious way, included in family support interventions. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Psychiatric services, and especially mental health nurses, have an important task in providing families with parental mental illness with support concerning communication with their children and in including the "healthy" partner in family support interventions. Introduction Although research has shown that evidence-based family interventions in research settings improve the communication and understanding of parental mental illness, there is a lack of knowledge about interventions in an everyday clinical context. Aim This study explores how families with parental mental illness experience family interventions in a natural clinical context in psychiatric services. Method Five families with children aged 10-12 were recruited from psychiatric services in southern Sweden and interviewed in a manner inspired by naturalistic inquiry and content analysis. Both family and individual interviews were performed. Results In striving to lead an ordinary life while coping with the parental mental illness, these families sought the support of the psychiatric services, especially in order to inform their children about the mental illness. Despite different family interventions, the family members felt supported and reported that the number of conflicts in the family had decreased. The parents were appreciative of help with child-rearing questions, and the children experienced a calmer family atmosphere. However, the partner of the person with mental illness experienced being left without support. Implications for practice Our study shows that psychiatric services, and especially mental health nurses, are in a position to more regularly offer family interventions in supporting the children and the healthy partners. © 2017 John Wiley & Sons Ltd.

Pressures We Face in Running Counseling Centers on College and University Campuses

ERIC Educational Resources Information Center

Meilman, Philip W.

2016-01-01

In this article, Georgetown University Counseling and Psychiatric Service director Philip Meilman discusses two distinct emerging pressures faced by directors of college and university counseling centers. The first of these is the pressure to provide more of, and an increasing range of, counseling and psychiatric services. The second is related:…

Homeless and Housed Inpatients with Schizophrenia: Disparities in Service Access upon Discharge from Hospital

ERIC Educational Resources Information Center

Burra, Tara A.; Hwang, Stephen W.; Rourke, Sean B.; Stergiopoulos, Vicky

2012-01-01

This study examines differences in services available at the time of discharge for homeless and housed psychiatric inpatients. Participants diagnosed with schizophrenia or schizoaffective disorder were recruited from a general hospital psychiatric inpatient unit. Thirty homeless individuals and 21 housed controls (matched for diagnosis, gender,…

Emergency Psychiatric Services for Individuals with Intellectual Disabilities: Caregivers' Perspectives

ERIC Educational Resources Information Center

Weiss, Jonathan A.; Lunsky, Yona; Gracey, Carolyn; Canrinus, Maaike; Morris, Susan

2009-01-01

Background: Strains on the mental health system and inaccessible services for individuals with intellectual disabilities (ID) often force caregivers to bring individuals with ID to the emergency department (ED) when in psychiatric crisis. The purpose of this study was to understand the experience of caregivers and adults with ID and mental health…

A retrospective analysis of the association between providing nicotine replacement therapy at admission and motivation to quit and nicotine withdrawal symptoms during an inpatient psychiatric hospitalization.

PubMed

Okoli, Chizimuzo T C; Al-Mrayat, Yazan D; Shelton, Charles I; Khara, Milan

2018-06-07

Psychiatric patients have high tobacco use prevalence, dependence, and withdrawal severity. A tobacco-free psychiatric hospitalization necessitates the management of nicotine withdrawal (NW) for tobacco using patients. NW management often requires the provision of approved nicotine replacement therapy (NRT) to patients, which may also motivate tobacco users towards cessation. However, few studies have examined the associations between providing NRT, motivation to quit, and NW among psychiatric patients. To examine the associations between providing NRT at admission and motivation to quit smoking and severity of NW symptoms. A retrospective review of the medical records of 255 tobacco using patients on whom NW was assessed during their hospital stay. The time when NRT was provided (i.e., at admission vs. not provided vs. on the unit), motivation to quit smoking, and 8-item Minnesota Nicotine Withdrawal Scale were assessed. The primary NW symptom was 'craving' (65.1%); reporting of 'anxiety' varied by psychiatric diagnosis. Providing NRT at admission was not associated with motivation to quit. Patients receiving NRT on the unit (i.e., delayed receipt) had significantly higher NW than those who received NRT at admission. In multivariate analyses, receiving NRT on the unit was significantly associated with greater NW severity (β = .19, p = .002). Among psychiatric patients, providing NRT at admission is associated with greater severity of NW. The provision of NRT for NW management may be considered as standard practice during tobacco-free psychiatric stays. Future studies may consider the effect of other tobacco treatment medications (such as varenicline, bupropion) on managing NW. Copyright © 2018 Elsevier Ltd. All rights reserved.

[Burden of relatives and their expectations towards psychiatric institutions. A review of the literature and own results].

PubMed

Schmid, R; Spiessl, H; Vukovich, A; Cording, C

2003-03-01

This article aimed to provide an overview regarding the burden of relatives of mentally ill patients and their expectations towards psychiatric institutions. The literature was selected from Medline covering the years 1996 - 2002. 342 articles were reviewed, 145 of which were described in this review. The burden of relatives are manifold and can be classified into the following categories: time spent on caring, financial difficulties, occupational restrictions, detrimental effects on relatives own physical and psychological well-being, reduction in leisure activities, negative effects on social relationships, experiences of discrimination and refusal, deficiencies in information about illness, feelings of not being taken seriously, insufficient service support, long distance to mental health service, emotional burdens of caregivers and difficulties with the patients behaviour. The expectations of the relatives mainly refer to the categories "relationship between staff and relatives", "information about illness" and "establishing of institutions required". The various burdens of relatives and their expectations towards psychiatric services point to necessary improvements of mental health services in the sense of a consumer-oriented psychiatric care.

Satisfaction of patients hospitalised in psychiatric hospitals: a randomised comparison of two psychiatric-specific and one generic satisfaction questionnaires

PubMed Central

Peytremann-Bridevaux, Isabelle; Scherer, Frédy; Peer, Laurence; Cathieni, Federico; Bonsack, Charles; Cléopas, Agatta; Kolly, Véronique; Perneger, Thomas V; Burnand, Bernard

2006-01-01

Background While there is interest in measuring the satisfaction of patients discharged from psychiatric hospitals, it might be important to determine whether surveys of psychiatric patients should employ generic or psychiatry-specific instruments. The aim of this study was to compare two psychiatric-specific and one generic questionnaires assessing patients' satisfaction after a hospitalisation in a psychiatric hospital. Methods We randomised adult patients discharged from two Swiss psychiatric university hospitals between April and September 2004, to receive one of three instruments: the Saphora-Psy questionnaire, the Perceptions of Care survey questionnaire or the Picker Institute questionnaire for acute care hospitals. In addition to the comparison of response rates, completion time, mean number of missing items and mean ceiling effect, we targeted our comparison on patients and asked them to answer ten evaluation questions about the questionnaire they had just completed. Results 728 out of 1550 eligible patients (47%) participated in the study. Across questionnaires, response rates were similar (Saphora-Psy: 48.5%, Perceptions of Care: 49.9%, Picker: 43.4%; P = 0.08), average completion time was lowest for the Perceptions of Care questionnaire (minutes: Saphora-Psy: 17.7, Perceptions of Care: 13.7, Picker: 17.5; P = 0.005), the Saphora-Psy questionnaire had the largest mean proportion of missing responses (Saphora-Psy: 7.1%, Perceptions of Care: 2.8%, Picker: 4.0%; P < 0.001) and the Perceptions of Care questionnaire showed the highest ceiling effect (Saphora-Psy: 17.1%, Perceptions of Care: 41.9%, Picker: 36.3%; P < 0.001). There were no differences in the patients' evaluation of the questionnaires. Conclusion Despite differences in the intended target population, content, lay-out and length of questionnaires, none appeared to be obviously better based on our comparison. All three presented advantages and drawbacks and could be used for the satisfaction evaluation of psychiatric inpatients. However, if comparison across medical services or hospitals is desired, using a generic questionnaire might be advantageous. PMID:16938136

Gender and age group differences in suicide risk associated with co-morbid physical and psychiatric disorders in older adults.

PubMed

Vasiliadis, Helen-Maria; Lamoureux-Lamarche, Catherine; Gontijo Guerra, Samantha

2017-02-01

It is unclear whether health service use influences the association between psychiatric and physical co-morbidity and suicide risk in older adults. Controls were older adults (n = 2,494) participating in a longitudinal study on the health of the elderly carried out between 2004 and 2007, in Quebec. The cases were all suicide decedents (n = 493) between 2004 and 2007, confirmed by the Quebec Coroner's office. Multivariate analyses were carried out to test the association between suicide and the presence of psychiatric and physical illnesses controlling for health service use and socio-demographic factors by gender and age group. Interaction terms were also tested between suicide and co-morbidity on outpatient service use. The presence of physical illnesses only, was associated with a reduced risk of suicide across all sex and age groups. The presence of a mental disorder only was associated with an increased risk of suicide overall and specifically in females and those aged 70 to 84 years of age. Suicide risk was lower in those with a psychiatric and physical co-morbidity and consulting mental health services. Increased mental health follow-up in older adults with psychiatric illnesses is needed for the detection of suicidal behavior and reducing suicide risk in males. Further research should focus on the mitigating effect of the presence of physical illnesses on stigma and health service use and the presence of social support in the elderly.

A prospective examination of service use by abused and neglected children followed up into adulthood.

PubMed

Yanos, Philip T; Czaja, Sally J; Widom, Cathy Spatz

2010-08-01

This study sought to determine whether abused and neglected children are more likely than those without childhood maltreatment to use health and social services as adults and whether psychiatric status mediates or moderates the relationship. A prospective cohort design was used. Individuals with documented cases of physical and sexual abuse and neglect (ages 0-10) and nonvictimized children matched on age, sex, and race-ethnicity were interviewed in adulthood (mean age 41 years). Past-year service use (general medical, mental health, substance abuse, and social) was assessed during 2003-2004 interviews (maltreated group, N=458; control group, N=349). Psychiatric status (posttraumatic stress disorder [PTSD], drug abuse, and major depressive disorder) was assessed during 1989-1995 (mean age 29) by structured interview. Individuals with histories of childhood abuse and neglect were significantly more likely than their control group counterparts to use mental health services (odds ratio [OR]=1.60, 95% confidence interval [CI]=1.04-2.45) and social services (OR=2.95, CI=2.19-3.97) in adulthood. Psychiatric status in young adulthood (PTSD and major depressive disorder) partially mediated the relationship between childhood maltreatment and use of mental health services, whereas major depression and drug abuse moderated the relationship between maltreatment and use of any services and general medical services. In adulthood, individuals with documented histories of childhood abuse and neglect are more likely than persons without such histories to use some types of services, and psychiatric status mediates and moderates these relationships. Findings have implications for the provision of services to persons with childhood abuse and neglect.

Elderly Koreans who consider suicide: Role of healthcare use and financial status.

PubMed

Park, Sang-Mi; Moon, Sang-Sik

2016-10-30

This study investigated associations between the use of healthcare services and financial status and suicidal ideation (SI) in the past year among elderly people. Additionally, this study explored gender differences in such associations. Cross-sectional data of 1743 elderly people aged 65 years and above, who participated in the 2009 Korea National Health and Nutrition Examination Survey, were analyzed. The results showed that lack of preventive care and failure to obtain necessary healthcare services during the last 12 months had a significant effect on SI, especially among elderly women. Low financial status (i.e., receipt of National Basic Livelihood Security (NBLS) assistance) was significantly associated with SI among elderly men. The findings of this study emphasize the need for community-based suicide intervention services, especially for elderly men who receive NBLS and elderly women who do not undergo medical checkups and fail to obtain necessary medical services. Multiple intervention approaches, including the provision of community-based geriatric psychiatric services, improved social support, links with general hospital services, and local monitoring programs, are likely to be useful. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

The Experience of Psychiatric Care of Adolescents with Anxiety-based School Refusal and of their Parents: A Qualitative Study

PubMed Central

Sibeoni, Jordan; Orri, Massimiliano; Podlipski, Marc-Antoine; Labey, Mathilde; Campredon, Sophie; Gerardin, Priscille; Revah-Levy, Anne

2018-01-01

Objective Anxiety-based school refusal in adolescence is a complex, sometimes difficult to treat disorder that can have serious academic and psychiatric consequences. The objective of this qualitative study was to explore how teens with this problem and their parents experience the psychiatric care received. Methods This qualitative multicenter study took place in France, where we conducted semi-structured interviews with adolescents receiving psychiatric care for anxiety-based school refusal and with their parents. Data collection by purposive sampling continued until we reached theoretical sufficiency. Data analysis was thematic. Results This study included 20 adolescents aged 12 to 18 years and 21 parents. Two themes emerged from the analysis: (1) the goals of psychiatric care with two sub-themes, “self-transformation” and problem solving; and, (2) the therapeutic levers identified as effective with two sub-themes: time and space and relationships. Conclusion Our results show a divergence between parents and teens in their representations of care and especially of its goals. Therapeutic and research implications about the terms of return to school within psychiatric care and also the temporality of care are discussed. PMID:29375632

Competency of psychiatric residents in the treatment of people with severe mental illness before and after a community psychiatry rotation.

PubMed

Randall, Melinda; Romero-Gonzalez, Mauricio; Gonzalez, Gerardo; Klee, Anne; Kirwin, Paul

2011-01-01

psychiatric rehabilitation is an evidence-based service with the goal of recovery for people with severe mental illness. Psychiatric residents should understand the services and learn the principles of psychiatric rehabilitation. This study assessed whether a 3-month rotation in a psychiatric rehabilitation center changes the competency level of second-year psychiatric residents in evidence-based treatment of severe mental illness. the study is a prospective, case-control comparison using the validated Competency Assessment Instrument (CAI), which measures 15 provider competencies critical to recovery, rehabilitation, and empowerment for people with severe mental illness, providing a score for each competency. Participants were second-year psychiatric residents attending a 3-month rotation at the Community Reintegration Program, a psychiatric rehabilitation day program. The authors administered the CAI at the beginning and the end of the residents' 3-month rotation in order to assess change in their competency in psychiatric rehabilitation. The authors also administered the CAI to a comparison group of second-year psychiatric residents who did not rotate through the Community Reintegration Program, and therefore had no formal training in psychiatric rehabilitation. a 3-month rotation in psychiatric rehabilitation significantly improved residents' competency in the domains of goal functioning, client preferences, holistic approach, skills, and team value relative to nonrotating residents. a brief community psychiatry rotation in the second year of residency likely improves some skills in the treatment of people with severe mental illness. Future research should evaluate year-long electives and public psychiatry fellowships.

Remote mood monitoring for adults with bipolar disorder: An explorative study of compliance and impact on mental health service use and costs.

PubMed

Simon, J; Budge, K; Price, J; Goodwin, G M; Geddes, J R

2017-09-01

Remote monitoring of mood disorders may be an effective and low resource option for patient follow-up, but relevant evidence remains very limited. This study explores real-life compliance and health services impacts of mood monitoring among patients with bipolar disorder in the UK. Patients with a diagnosis of bipolar disorder who were registered users of the True Colours monitoring system for at least 12months at study assessment were included in this retrospective cohort study (n=79). Compliance was measured as the proportion of valid depression and mania scale messages received in comparison to their expected numbers over the first 12months of monitoring. Mental health service use data were extracted from case notes, costed using national unit costs, and compared 12months before (pre-TC period) and 12months after (TC period) patients' engagement with monitoring. Associations with relevant patient factors were investigated in a multiple regression model. Average compliance with monitoring was 82%. Significant increases in the annual use and costs of psychiatrist contacts and total mental health services were shown for patients newly referred to the clinic during the pre-TC period but not for long-term patients of the clinic. Psychiatric medication costs increased significantly between the pre-TC and TC periods (£235, P=0.005) unrelated to patients' referral status. Remote mood monitoring has good compliance among consenting patients with bipolar disorder. We found no associations between observed changes in mental health service costs and the introduction of monitoring except for the increase in psychiatric medication costs. Copyright © 2017 The Authors. Published by Elsevier Masson SAS.. All rights reserved.

Psychosocial risk factors and treatment of new onset and recurrent depression during the post-partum period.

PubMed

Kettunen, Pirjo; Hintikka, Jukka

2017-07-01

When developing maternity care services, it is important to know how psychosocial factors affect the course of post-partum depression (PPD), and how depressed mothers are treated. The aim of this study is to assess how adverse childhood experiences, poor present support and violence, and low socioeconomic status (SES) associate with PPD, specifically in new onset and recurrent post-partum depression. The second aim is to assess the treatment received for PPD. This is a cross-sectional study. The study group comprises 104 mothers with a current episode of PPD, and a control group of 104 mothers without an episode. The Structured Clinical Interview for DSM-IV Axis I Disorders was used for data collection. Psychosocial risk factors, treatment issues, and the course of depression were assessed with a structured self-report questionnaire. In age-adjusted multivariate analyses, adverse childhood experiences, a low level of present support in close relationships, and a poor SES were associated significantly with PPD. Childhood adversity was associated with both new onset and recurrent depression. Nevertheless, a low level of support and a poor SES were also associated with recurrent depression. A quarter of mothers with a major depressive episode in the post-partum period attended psychiatric services. In mothers with new onset depression, the proportion was only 5%. There is an urgent need to develop the diagnostics of depression in maternity care services. An awareness of psychosocial risk factors might help in this. More depressed mothers should be referred to psychiatric services.

Parental monitoring as a moderator of the effect of family sexual communication on sexual risk behavior among adolescents in psychiatric care.

PubMed

Nappi, Carla M; Thakral, Charu; Kapungu, Chisina; Donenberg, Geri R; DiClemente, Ralph; Brown, Larry

2009-10-01

Authors examined if parental monitoring moderated effects of family sexual communication on sexual risk behavior among adolescents in psychiatric care. Seven hundred and eighteen parents reported upon quality of family discussions about sex-related topics and degree to which they monitor teen behavior. Adolescents reported the frequency of their own safe sex practices. Parental monitoring moderated the family communication quality-sexual risk behavior relationship among African American families. African American parents who perceived themselves as capable of open family sexual communication and frequent monitoring had adolescents who reported decreased sexual risk behavior. The moderator model was not supported among Caucasian and Hispanic families and findings did not depend upon gender. For African Americans, findings support the influential role of family processes in development of teen sexual risk behavior and suggest, for parents of teens receiving mental health services, learning communication and monitoring skills may be critical to their adolescent's sexual health.

Psychiatric epidemiology and international mental health as a career in cultural psychiatry.

PubMed

Kohn, Robert

2011-04-01

Psychiatric epidemiology is one of the many paths to a career in cultural psychiatry. Psychiatric epidemiology has made numerous substantive contributions to cultural psychiatry. Areas in which psychiatric epidemiologists have contributed to cultural psychiatry include the undertaking of cross-national comparisons, studying the mental health of populations of importance to cultural psychiatry, studying risk factors that are of cultural importance such as immigration and social class, studying trauma, examining the role of stigma in cultural settings, and investigating cultural influences on mental health service delivery. This article highlights examples from the author's own research examining cross-national comparisons, trauma, and mental health service delivery. Research is vital to enable the field of cultural psychiatry to be a vibrant, evidence-based discipline within psychiatry.

Cognitive and psychosocial function in retired professional hockey players.

PubMed

Esopenko, Carrie; Chow, Tiffany W; Tartaglia, Maria Carmela; Bacopulos, Agnes; Kumar, Priya; Binns, Malcolm A; Kennedy, James L; Müller, Daniel J; Levine, Brian

2017-06-01

The relationship between repeated concussions and neurodegenerative disease has received significant attention, particularly research in postmortem samples. Our objective was to characterise retired professional ice hockey players' cognitive and psychosocial functioning in relation to concussion exposure and apolipoprotein ε4 status. Alumni athletes (N=33, aged 34-71 years) and an age-matched sample of comparison participants (N=18) were administered measures of cognitive function and questionnaires concerning psychosocial and psychiatric functioning. No significant group differences were found on neuropsychological measures of speeded attention, verbal memory or visuospatial functions, nor were significant differences observed on computerised measures of response speed, inhibitory control and visuospatial problem solving. Reliable group differences in cognitive performance were observed on tests of executive and intellectual function; performance on these measures was associated with concussion exposure. Group differences were observed for cognitive, affective and behavioural impairment on psychosocial questionnaires and psychiatric diagnoses. There was no evidence of differential effects associated with age in the alumni athletes. Possession of an apolipoprotein ε4 allele was associated with increased endorsement of psychiatric complaints, but not with objective cognitive performance. We found only subtle objective cognitive impairment in alumni athletes in the context of high subjective complaints and psychiatric impairment. Apolipoprotein ε4 status related to psychiatric, but not cognitive status. These findings provide benchmarks for the degree of cognitive and behavioural impairment in retired professional athletes and a point of comparison for future neuroimaging and longitudinal studies. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Clinical service use as people with Attention Deficit Hyperactivity Disorder transition into adolescence and adulthood: a prospective longitudinal study.

PubMed

Eklund, Hanna; Cadman, Tim; Findon, James; Hayward, Hannah; Howley, Deirdre; Beecham, Jennifer; Xenitidis, Kiriakos; Murphy, Declan; Asherson, Philip; Glaser, Karen

2016-07-11

While Attention Deficit Hyperactivity Disorder (ADHD) often persists into adulthood, little is known about the needs and service use among adolescents and young adults with ADHD. The present study followed-up a cohort diagnosed with ADHD as children and assessed their: 1) needs, 2) correlates of contact with clinical services, and 3) experiences of transition from child to adult health services. Ninety one young people aged 14-24 were recruited from the UK subset of the International Multi-Centre ADHD Genetics (IMAGE) Project. Affected young people and parents conducted face-to-face interviews and self-completion questionnaires including a modified version of the Client Services Receipt Inventory, The Barkley's ADHD rating scale, The Clinical Interview Schedule-Revised, and the Zarit Burden Interview. Changes in key need characteristics (e.g. ADHD symptoms and impairments) over a 3-year period were examined using fixed effect models. Generalised Estimating Equations (GEE) were used to explore how key characteristics (such as ADHD symptoms) were associated with contact with clinical services across the three years. At baseline 62 % met diagnostic criteria for ADHD and presented with a range of ADHD related impairments, psychiatric comorbidities, and significant caregiver burden. While ADHD symptoms and related impairments lessened significantly over the three years, psychiatric comorbidities and caregiver burden remained stable. The strongest correlate of contact with clinical services was age (OR 0.65 95 % CI 0.49-0.84) with the odds of reported contact with clinical services decreasing by 35 % for each year increase in age at baseline and by 25 % for each year increase in age over time. Only 9 % of the sample had experienced a transfer to adult services, with the majority reporting unmet needs in healthcare transition. Despite continuing needs, few were in contact with adult health services or had received sufficient help with transition between child and adult health services. The main determinant of health service use for adolescents and young adults with ADHD is age - not needs. Service models should address the needs of ADHD individuals who are no longer children.

Mental Health Manpower and the Psychiatric Technician.

ERIC Educational Resources Information Center

National Association of Psychiatric Technology, Sacramento, CA.

Dynamic changes are taking place in the field of mental health care which have a great effect on those people who provide the primary services of patient care, rehabilitation, and training. In recognition of these changes, the National Association of Psychiatric Technology selected "Mental Health Manpower and the Psychiatric Technician"…

A Psychiatric Primer for Programs Serving People with Developmental Disabilities. Monograph #101.

ERIC Educational Resources Information Center

Dal Pozzo, Earlene; Bernstein, Gail S.

Intended for personnel in programs serving persons with developmental disabilities, the booklet provides basic information about the major psychiatric disorders and their treatment. Five sections cover: the major disorders; medications--uses and problems; assessment; cooordination of services; and psychiatric emergencies. Major disorders such as…

Psychiatric Treatment of Eczema: A Controlled Trial

PubMed Central

Brown, D. G.; Bettley, F. R.

1971-01-01

Seventy-two patients with eczema were randomly allotted to one of two treatment groups: A, those receiving dermatological treatment only, and B, those receiving the same dermatological treatment plus psychiatric treatment, limited where possible to four months. Cases were followed up at six-monthly dermatological assessments, 57 (79%) for 18 months. The findings suggest that in the presence of overt emotional disturbance, of new psychological or psychophysiological symptoms preceding the rash by up to a year, and of high motivation for it, brief psychiatric treatment improves the outcome in eczema (the proportion clear at 18 months was about doubled), whereas in their absence such treatment may worsen it, especially in the short term. PMID:5090759

Challenges to HIV prevention in psychiatric settings: Perceptions of South African mental health care providers

PubMed Central

Collins, Pamela Y.

2009-01-01

Mental health services in South Africa increasingly feel the brunt of the AIDS epidemic. Despite the high prevalence of infection in the psychiatric setting, HIV risk reduction interventions targeting South Africans with psychiatric illness remain few and far between. The attitudes of mental health care providers about sexual relations and HIV among people with mental illness continue to influence the extent to which these issues are addressed in care settings. This study examines these attitudes through the use of a semi-structured interview administered to 46 mental health care providers in four provinces of South Africa. I found that personal, contextual and political factors in the clinic and the hospital create barriers to integrating prevention activities. In particular, providers face at least three challenges to intervening in the epidemic among their patients: their own views of psychiatric illness, the transitions occurring in the mental health care system, and shifting social attitudes toward sexuality. Barriers operate at the individual level, the institutional level, and the societal level. At the individual level providers’ perceptions of psychiatric symptoms shape their outlook on intervention with psychiatric patients. At the institutional level disruptive transitions in service delivery relegate HIV services to lesser importance. At the societal level, personal beliefs about sexuality and mental illness have remained slow to change despite major political changes. Minimizing barriers to implementing HIV prevention services requires institutional and health care policies that ensure adequate resources for treating people with mental illness and for staff development and support. PMID:16647793

Perinatal mental health service provision in Switzerland and in the UK.

PubMed

Amiel Castro, Rita T; Schroeder, Katrin; Pinard, Claudia; Blöchlinger, Patricia; Künzli, Hansjörg; Riecher-Rössler, Anita; Kammerer, Martin

2015-01-01

The epidemiology of maternal perinatal-psychiatric disorders as well as their effect on the baby is well recognised. Increasingly well researched specialised treatment methods can reduce maternal morbidity, positively affect mother-baby bonding and empower women's confidence as a mother. Here, we aimed to compare guidelines and the structure of perinatal-psychiatric service delivery in the United Kingdom and in Switzerland from the government's perspective. Swiss cantons provided information regarding guidelines and structure of service delivery in 2000. A subsequent survey using the same questionnaire was carried out in 2007. In the UK, similar information was accessed through published reports from 2000-2012. Guidelines for perinatal psychiatry exist in the UK, whereas in Switzerland in 2000 none of the 26 cantons had guidelines, and in 2007 only one canton did. Joint mother-baby admissions on general psychiatric wards were offered by 92% of the Swiss cantons. In the UK, pregnant women and joint mother-baby admissions are only advised onto specialised perinatal-psychiatric units. In Switzerland, in 2007, three specialised units (max. 24 beds) were in place corresponding to 1 unit per 2.5 million people, while in the UK there were 22 mother-baby units (168 beds) in 2012 (1 unit per 2.8 million). In the UK, less than 50% of trusts provided specialised perinatal-psychiatric health care. The main difference between the UK and Switzerland was the absence of guidelines, regular assessment and plans for future development of perinatal psychiatry in Switzerland. There are still geographical differences in the provision of perinatal-psychiatric services in the UK.

Factors predicting use of mental health and social services by children 6-16 years old: findings from the Ontario Child Health Study.

PubMed

John, L H; Offord, D R; Boyle, M H; Racine, Y A

1995-01-01

Correlates of mental health and social service utilization are examined based on Ontario Child Health Study data. Findings indicate that psychiatric disorder as a predictor of service use may be confounded by school performance and parental use of services, thus calling into question the extent to which program planning should be based on prevalence rates of child psychiatric disorder. Children from low-income families tend to make greater use of available services, suggesting that programs need to be tailored more specifically to their needs.

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

... 42 Public Health 2 2010-10-01 2010-10-01 false Reduction of inpatient psychiatric benefit days available in the initial benefit period. 409.63 Section 409.63 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICARE PROGRAM HOSPITAL INSURANCE BENEFITS Scope of...

Profiting and providing less care: comprehensive services at for-profit, nonprofit, and public opioid treatment programs in the United States.

PubMed

Bachhuber, Marcus A; Southern, William N; Cunningham, Chinazo O

2014-05-01

Opioid use disorders are frequently associated with medical and psychiatric comorbidities (eg, HIV infection and depression), as well as social problems (eg, lack of health insurance). Comprehensive services addressing these conditions improve outcomes. To compare the proportion of for-profit, nonprofit, and public opioid treatment programs offering comprehensive services, which are not mandated by government regulations. Cross-sectional analysis of opioid treatment programs offering outpatient care in the United States (n=1036). Self-reported offering of communicable disease (HIV, sexually transmitted infections, and viral hepatitis) testing, psychiatric services (screening, assessment and diagnostic evaluation, and pharmacotherapy), and social services support (assistance in applying for programs such as Medicaid). Mixed-effects logistic regression models were developed to adjust for several county-level factors. Of opioid treatment programs, 58.0% were for profit, 33.5% were nonprofit, and 8.5% were public. Nonprofit programs were more likely than for-profit programs to offer testing for all communicable diseases [adjusted odds ratios (AOR), 1.7; 95% confidence interval (CI), 1.2, 2.5], all psychiatric services (AOR, 8.0; 95% CI, 4.9, 13.1), and social services support (AOR, 3.3; 95% CI, 2.3, 4.8). Public programs were also more likely than for-profit programs to offer communicable disease testing (AOR, 6.4; 95% CI, 3.5, 11.7), all psychiatric services (AOR, 25.8; 95% CI, 12.6, 52.5), and social services support (AOR, 2.4; 95% CI, 1.4, 4.3). For-profit programs were significantly less likely than nonprofit and public programs to offer comprehensive services. Interventions to increase the offering of comprehensive services are needed, particularly among for-profit programs.

A little goes a long way: the impact of distal social support on community integration and recovery of individuals with psychiatric disabilities.

PubMed

Townley, Greg; Miller, Henry; Kloos, Bret

2013-09-01

Although an extensive body of literature highlights the important role of social support for individuals with psychiatric disabilities, definitions of support tend to be restricted-focusing on intimate relationships such as friend and family networks and ignoring the role of casual relationships existing naturally in the community. This mixed-methods study of 300 consumers of mental health services in the Southeastern US aims to better understand the impact of community supports, termed distal supports, on community integration and recovery from mental illness. Qualitative content analysis, tests of group mean differences, and hierarchical linear regression analyses revealed the following: (1) participants primarily reported receiving tangible support (e.g., free medication/discounted goods) from distal supports rather than emotional support (e.g., displays of warmth/affection) or informational support (e.g., provision of advice); (2) women and older participants reported more distal supports than men or younger participants; and (3) distal supports played a unique role in predicting community integration and recovery even after accounting for the influence of traditional support networks. Results highlight the importance of considering diverse types of social support in naturally occurring settings when designing treatment plans and interventions aimed at encouraging community participation and adaptive functioning for individuals with psychiatric disabilities.

The relational dimension of care for maternity blues and its relation to decompensation of a psychiatric disorder during the intermediate postpartum period in Cameroon.

PubMed

Mboua, C P; Nkoum, B A; Abessouguié, S P

2016-08-01

In a setting such as Cameroon, where perinatal care offers few services for women with psychiatric problems during pregnancy, delivery, and the immediate postpartum period, the development of the relational dimension of care may help prevent severe psychiatric disorders . This study evaluates the role of the relational dimension of perinatal and early postpartum care (providing perinatal counseling and a space to speak) on women with blues on the intermediate-term outcomes of decompensation, in view of the importance of the emotional issues occurring in the perinatal period. Data collection used both diagnostic and clinical methods on a sample of 50 women from three hospitals in Cameroon who gave birth during the study period and agreed to participate. Of the 38 diagnosed with blues, 10 were available for observation during the intermediate post-partum: they were sorted into an experimental group that received perinatal counseling (n=5) and a control group that did not. The results suggest the importance to women with blues of a space for talking during the post-partum period. In particular, the quality of this counseling, in terms of the emotional responses of the nursing staff, determines the outcome of this management and can help to reduce the outset of depression and decompensation.

Reliability and validity of a treatment adherence measure for child psychiatric rehabilitation.

PubMed

Williams, Nathaniel J; Green, Philip

2012-09-01

Treatment adherence, defined as the degree to which practitioners implemented prescribed program principles and activities and avoided proscribed activities, has been an area of growing interest in mental health services for children with severe emotional and behavioral disorders. This study evaluated the reliability and validity of a treatment adherence measure for child psychiatric rehabilitation (CPSR). Parents of children receiving CPSR (n = 79) or psychotherapy (n = 27) completed the Children's Psychosocial Rehabilitation Treatment Adherence Measure (CTAM) and a measure of 2-week session impact. Psychiatric rehabilitation (PSR) supervisors identified PSR practitioners with reputations for high or low adherence to the model. The CTAM's discriminant validity was assessed by using known-groups procedures and predictive validity by examining its relationship to 2-week session impact. The CTAM demonstrated excellent internal consistency (α = .92), discriminant validity (p = .002, d = .72; p = .021, d = .59), and predictive validity (B = 2.24, SE = .31, p < .001), accounting for 28% of the child-level variance in 2-week session impact. Findings suggest the CTAM is a reliable and valid measure of treatment adherence for CPSR programs with a skill-teaching focus. Providers and agencies should take steps to enhance treatment adherence because it may be an important predictor of children's short-term response to CPSR. (PsycINFO Database Record (c) 2012 APA, all rights reserved).

Genetic counseling for schizophrenia: a review of referrals to a provincial medical genetics program from 1968–2007

PubMed Central

Hunter, MJ; Hippman, Catriona; Honer, William G; Austin, Jehannine C.

2014-01-01

Purpose Recent studies have shown that individuals with schizophrenia and their family members are interested in genetic counseling, but few have received this service. We conducted an exploratory, retrospective study to describe (a) the population of individuals who were referred to the provincial program for genetic counseling for a primary indication of schizophrenia, and (b) trends in number of referrals between 1968 and 2007. Methods Referrals for a primary indication of schizophrenia were identified through the provincial program database. Charts were reviewed and the following information was recorded: discipline of referring physician, demographics, psychiatric diagnosis, referred individual’s and partner’s (if applicable) family history, and any current pregnancy history. Data were characterized using descriptive statistics. Results Between 1968 and 2007, 288 referrals were made for a primary indication of schizophrenia. Most referrals were made: (a) for individuals who had a first-degree family member with schizophrenia, rather than for affected individuals, (b) for preconception counseling, and (c) by family physicians (69%), with only 2% by psychiatrists. Conclusions In British Columbia, individuals affected with schizophrenia and their family members are rarely referred for psychiatric genetic counseling. There is a need to identify barriers to psychiatric genetic counseling and develop strategies to improve access. PMID:20034078

Utilization of psychiatric inpatient care in Greece: a nationwide study (1984-1996).

PubMed

Madianos, M G; Zacharakis, C; Tsitsa, C

2000-01-01

This report examines the trends in the utilization of psychiatric inpatient care for the period 1984-1996, when the implementation of the psychiatric reform programme was initiated in Greece. Admissions in public mental hospitals declined by 7.2%. However discharges have been increased by 30.6% with a parallel decrease of the length of stay by 53.7% followed by an increase in discharges of patients diagnosed as suffering from schizophrenia and affective psychoses by 61.1% and 123.8% respectively. In the private sector a remarkable reduction in both admissions and discharges was noticed. Admissions in psychiatric departments of general hospitals for the same years have been increased by 1054.1%. It seems that the recent deinstitutionalization process resulted in increasing trends in the discharges of patients suffering from psychoses. Additionally, a substantial increase in the number of extramural psychiatric services and rehabilitation places between 1994-1996 was observed. The demand for the mental health care services expressed as the urbanization index was found to be related with mental health professionals and the extramural units ratios. The higher degree of urbanism is, the greater the number of extramural services exist. The models explained variance reached 50.6%.

The Psychiatric Patient as a Health Resource Consumer: Costs Associated with Electroconvulsive Therapy

PubMed Central

Selva-Sevilla, Carmen; Gonzalez-Moral, Maria Luisa; Tolosa-Perez, Maria Teresa

2016-01-01

Background: Clinical practice protocols should consider both the psychological criteria related to a patient’s satisfaction as a consumer of health services and the economic criteria to allocate resources efficiently. An electroconvulsive therapy (ECT) program was implemented in our hospital to treat psychiatric patients. The main objective of this study was to determine the cost associated with the ECT sessions implemented in our hospital between 2008 and 2014. A secondary objective was to calculate the cost of sessions that were considered ineffective, defined as those sessions in which electrical convulsion did not reach the preset threshold duration, in order to identify possible ways of saving money and improving satisfaction among psychiatric patients receiving ECT. Methods: A descriptive analysis of the direct health costs related to ECT from the perspective of the public health system between 2008 and 2014 was performed using a retrospective chart review. All of the costs are in euros (2011) and were discounted at a rate of 3%. Based on the base case, a sensitivity analysis of the changes of those variables showing the greatest uncertainty was performed. Results: Seventy-six patients received 853 sessions of ECT. The cumulative cost of these sessions was €1409528.63, and 92.9% of this cost corresponded to the hospital stay. A total of €420732.57 (29.8%) was inefficiently spent on 269 ineffective sessions. A sensitivity analysis of the economic data showed stable results to changes in the variables of uncertainty. Conclusion: The efficiency of ECT in the context outlined here could be increased by discerning a way to shorten the associated hospital stay and by reducing the number of ineffective sessions performed. PMID:27303347

The Psychiatric Patient as a Health Resource Consumer: Costs Associated with Electroconvulsive Therapy.

PubMed

Selva-Sevilla, Carmen; Gonzalez-Moral, Maria Luisa; Tolosa-Perez, Maria Teresa

2016-01-01

Clinical practice protocols should consider both the psychological criteria related to a patient's satisfaction as a consumer of health services and the economic criteria to allocate resources efficiently. An electroconvulsive therapy (ECT) program was implemented in our hospital to treat psychiatric patients. The main objective of this study was to determine the cost associated with the ECT sessions implemented in our hospital between 2008 and 2014. A secondary objective was to calculate the cost of sessions that were considered ineffective, defined as those sessions in which electrical convulsion did not reach the preset threshold duration, in order to identify possible ways of saving money and improving satisfaction among psychiatric patients receiving ECT. A descriptive analysis of the direct health costs related to ECT from the perspective of the public health system between 2008 and 2014 was performed using a retrospective chart review. All of the costs are in euros (2011) and were discounted at a rate of 3%. Based on the base case, a sensitivity analysis of the changes of those variables showing the greatest uncertainty was performed. Seventy-six patients received 853 sessions of ECT. The cumulative cost of these sessions was €1409528.63, and 92.9% of this cost corresponded to the hospital stay. A total of €420732.57 (29.8%) was inefficiently spent on 269 ineffective sessions. A sensitivity analysis of the economic data showed stable results to changes in the variables of uncertainty. The efficiency of ECT in the context outlined here could be increased by discerning a way to shorten the associated hospital stay and by reducing the number of ineffective sessions performed.

28 CFR 549.41 - Voluntary admission and psychotropic medication.

Code of Federal Regulations, 2010 CFR

2010-07-01

... INSTITUTIONAL MANAGEMENT MEDICAL SERVICES Administrative Safeguards for Psychiatric Treatment and Medication... admitted for psychiatric treatment and medication when, in the professional judgment of qualified health...

Service innovation: a comparison of two approaches for physical screening of psychiatric inpatients.

PubMed

Harrison, Mark Richard; McMillan, Catherine Frances; Dickinson, Timothy

2012-06-01

Psychiatric medications have clear links to obesity, diabetes, dyslipidaemia, hypertension, hyperprolactinaemia and movement disorders. These disorders are a common cause of morbidity and mortality in psychiatric patients but physical screening by health services is often haphazard. We report the findings of an audit of physical screening across two hospital wards. Each ward undertook a process of service improvement. One ward modified the admissions proforma and the other developed a discharge screening clinic. The effectiveness of each of these interventions was then compared through a reaudit of practice across both wards. At baseline, screening was performed inconsistently and infrequently. On average, the modified admissions proforma increased screening rates by 4.7% compared to 30.7% for discharge screening clinics. The discharge screening clinic demonstrated statistically significant improvements in screening rates and effectively delivered health promotion advice. Discharge screening clinics are significantly more likely than improved admissions procedures to detect clinically significant abnormalities. If these abnormalities are detected and treated then the long-term physical health of psychiatric patients may be improved.

The Impact of Organizational Factors and Government Policy on Psychiatric Nurses' Family-Focused Practice With Parents Who Have Mental Illness, Their Dependent Children, and Families in Ireland.

PubMed

Grant, Anne; Reupert, Andrea

2016-05-01

Government policy and organizational factors influence family-focused practice (FFP) in adult mental health services. However, how these aspects shape psychiatric nurses' practice with parents who have mental illness, their dependent children, and families is less well understood. Drawing on the findings of a qualitative study, this article explores the way in which Irish policy and organizational factors might influence psychiatric nurses' FFP, and whether (and how) FFP might be further promoted. A purposive sample of 14 psychiatric nurses from eight mental health services completed semi-structured interviews. The analysis was inductive and presented as thematic networks. Both groups described how policies and organizational culture enabled and/or hindered FFP, with differences between community and acute participants seen. This study indicates a need for policies and organizational supports, including child and family skills training, to promote a whole family approach in adult mental health services. © The Author(s) 2016.

Psychiatric admissions fall following the Christchurch earthquakes: an audit of inpatient data.

PubMed

Beaglehole, Ben; Bell, Caroline; Beveridge, John; Frampton, Chris

2015-04-01

Following the devastating earthquake in Christchurch, New Zealand, there was the widespread perception that the demand for inpatient mental health services would increase. However, our clinical observation was to the contrary, with substantial reductions in inpatient utilisation being noted. We therefore examined psychiatric bed occupancy and admission data to improve understanding of the impact of the disaster on mental health services. We audited acute psychiatric bed occupancy and admission rates prior to and following a major earthquake. After the earthquake, total bed occupancy reduced from an average of 93% to 79%. Daily admissions also reduced by 20.2% for the 30 days following the earthquake. All diagnostic groups, with the exception of the 'Schizophrenia, schizotypal and delusional disorders' category, contributed to the reduction. No rebound to increased occupancy or admissions was seen over the study period. The study confirmed our clinical observation that demand for acute inpatient psychiatric services were markedly reduced after the February 2011 earthquake. © The Royal Australian and New Zealand College of Psychiatrists 2014.

Prevalence of psychiatric morbidity in United States military spouses: The Millennium Cohort Family Study.

PubMed

Steenkamp, Maria M; Corry, Nida H; Qian, Meng; Li, Meng; McMaster, Hope Seib; Fairbank, John A; Stander, Valerie A; Hollahan, Laura; Marmar, Charles R

2018-05-10

Approximately half of US service members are married, equating to 1.1 million military spouses, yet the prevalence of psychiatric morbidity among military spouses remains understudied. We assessed the prevalence and correlates of eight mental health conditions in spouses of service members with 2-5 years of service. We employed baseline data from the Millennium Cohort Family Study, a 21-year longitudinal survey following 9,872 military-affiliated married couples representing all US service branches and active duty, Reserve, and National Guard components. Couples were surveyed between 2011 and 2013, a period of high military operational activity associated with Operation Iraqi Freedom and Operation Enduring Freedom. Primary outcomes included depression, anxiety, posttraumatic stress disorder (PTSD), panic, alcohol misuse, insomnia, somatization, and binge eating, all assessed with validated self-report questionnaires. A total of 35.90% of military spouses met criteria for at least one psychiatric condition. The most commonly endorsed conditions were moderate-to-severe somatization symptoms (17.63%) and moderate-to-severe insomnia (15.65%). PTSD, anxiety, depression, panic, alcohol misuse, and binge eating were endorsed by 9.20%, 6.65%, 6.05%, 7.07%, 8.16%, and 5.23% of spouses, respectively. Having a partner who deployed with combat resulted in higher prevalence of anxiety, insomnia, and somatization. Spouses had lower prevalence of PTSD, alcohol misuse, and insomnia but higher rates of panic and binge eating than service members. Both members of a couple rarely endorsed having the same psychiatric problem. One third of junior military spouses screened positive for one or more psychiatric conditions, underscoring the need for high-quality prevention and treatment services. © 2018 Wiley Periodicals, Inc.

Racial/ethnic minority children's use of psychiatric emergency care in California's Public Mental Health System.

PubMed

Snowden, Lonnie R; Masland, Mary C; Libby, Anne M; Wallace, Neal; Fawley, Kya

2008-01-01

We examined rates and intensity of crisis services use by race/ethnicity for 351,174 children younger than 18 years who received specialty mental health care from California's 57 county public mental health systems between July 1998 and June 2001. We used fixed-effects regression for a controlled assessment of racial/ethnic disparities in children's use of hospital-based services for the most serious mental health crises (crisis stabilization services) and community-based services for other crises (crisis intervention services). African American children were more likely than were White children to use both kinds of crisis care and made more visits to hospital-based crisis stabilization services after initial use. Asian American/Pacific Islander and American Indian/Alaska Native children were more likely than were White children to use hospital-based crisis stabilization services but, along with Latino children, made fewer hospital-based crisis stabilization visits after an initial visit. African American children used both kinds of crisis services more than did White children, and Asian Americans/Pacific Islander and American Indians/Alaska Native children visited only when they experienced the most disruptive and troubling kind of crises, and made nonrecurring visits.

Neuro psychiatry 1943: the role of documentary film in the dissemination of medical knowledge and promotion of the U.K. psychiatric profession.

PubMed

Jones, Edgar

2014-04-01

In 1943, Basil Wright produced a documentary film about the treatment of servicemen and civilians with psychological disorders at Mill Hill Emergency Medical Service Hospital. Funded by the Ministry of Information, Neuro Psychiatry was shot to convince influential clinicians and policy makers in North America that the British had developed expertise in the management of psychiatric casualties. By emphasizing novel and apparently effective interventions and excluding severe or intractable cases from the film, Wright encouraged an optimistic sense of achievement. Filmed at a time when victory was considered an eventual outcome, the picture presented a health service to which all had access without charge. Children and unemployed women, two groups excluded under the 1911 National Insurance Act, had been required to pay for healthcare in the prewar period and were shown receiving free treatment from the Emergency Medical Service. However, the therapeutic optimism presented in the film proved premature. Most U.K. battle casualties arose in the latter half of the conflict and follow-up studies failed to confirm the positive outcome statistics reported in the film. Aubrey Lewis, clinical director of the hospital, criticized research projects conducted at Mill Hill for a lack of rigor. The cinematographic skills of Wright and director Michael Hankinson, together with their reformist agenda, created a clinical presentation that emphasized achievements without acknowledging the limitations not only of the therapies offered by doctors but also the resources available to a nation at war.

Neuro Psychiatry 1943: The Role of Documentary Film in the Dissemination of Medical Knowledge and Promotion of the U.K. Psychiatric Profession

PubMed Central

Jones, Edgar

2014-01-01

In 1943, Basil Wright produced a documentary film about the treatment of servicemen and civilians with psychological disorders at Mill Hill Emergency Medical Service Hospital. Funded by the Ministry of Information, Neuro Psychiatry was shot to convince influential clinicians and policy makers in North America that the British had developed expertise in the management of psychiatric casualties. By emphasizing novel and apparently effective interventions and excluding severe or intractable cases from the film, Wright encouraged an optimistic sense of achievement. Filmed at a time when victory was considered an eventual outcome, the picture presented a health service to which all had access without charge. Children and unemployed women, two groups excluded under the 1911 National Insurance Act, had been required to pay for healthcare in the prewar period and were shown receiving free treatment from the Emergency Medical Service. However, the therapeutic optimism presented in the film proved premature. Most U.K. battle casualties arose in the latter half of the conflict and follow-up studies failed to confirm the positive outcome statistics reported in the film. Aubrey Lewis, clinical director of the hospital, criticized research projects conducted at Mill Hill for a lack of rigor. The cinematographic skills of Wright and director Michael Hankinson, together with their reformist agenda, created a clinical presentation that emphasized achievements without acknowledging the limitations not only of the therapies offered by doctors but also the resources available to a nation at war. PMID:23134695

Outsourcing mental health care services? The practice and potential of community-based farms in psychiatric rehabilitation.

PubMed

Iancu, Sorana C; Zweekhorst, Marjolein B M; Veltman, Dick J; van Balkom, Anton J L M; Bunders, Joske F G

2015-02-01

Psychiatric rehabilitation supports individuals with mental disorders to acquire the skills needed for independent lives in communities. This article assesses the potential of outsourcing psychiatric rehabilitation by analysing care farm services in the Netherlands. Service characteristics were analysed across 214 care farms retrieved from a national database. Qualitative insights were provided by five case descriptions, selected from 34 interviews. Institutional care farms were significantly larger and older than private care farms (comprising 88.8% of all care farms). Private, independent care farms provide real-life work conditions to users who are relatively less impaired. Private, contracted care farms tailor the work activities to their capacities and employ professional supervisors. Institutional care farms accommodate for the most vulnerable users. We conclude that collaborations with independent, contracted and institutional care farms would provide mental health care organizations with a diversity in services, enhanced community integration and a better match with users' rehabilitation needs.

The Hospital as Predictor of Children's and Adolescents' Length of Stay

ERIC Educational Resources Information Center

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

2006-01-01

Objective: To predict psychiatric hospital length of stay (LOS) for a sample of Illinois Department of Children and Family Services wards across 4 fiscal years. Method: A prospective design was implemented using the Children's Severity of Psychiatric Illness scale, a reliable and valid measure of psychiatric severity, risk factors, youth…

Psychiatric Comorbidity in Autism Spectrum Disorder: Correspondence between Mental Health Clinician Report and Structured Parent Interview

ERIC Educational Resources Information Center

Stadnick, Nicole; Chlebowski, Colby; Baker-Ericzén, Mary; Dyson, Margaret; Garland, Ann; Brookman-Frazee, Lauren

2017-01-01

Publicly funded mental health services are critical in caring for children with autism spectrum disorder. Accurate identification of psychiatric comorbidity is necessary for effective mental health treatment. Little is known about psychiatric diagnosis for this population in routine mental health care. This study (1) examined correspondence…

The Isis Centre: a counselling service within the National Health Service.

PubMed Central

Agulnik, P; Holroyd, P; Mandelbrote, B

1976-01-01

A new centre has been established to provide readily accessible counselling, consultation, and mental health information. People may refer themselves or are recommended to attend by general practitioners or other agencies. The counsellors have varied backgrounds in paramedical or counselling services, and they are supported by psychiatrists. Of a sample of 100 clients, four were referred to one of the team's psychiatrists and 33 visited the centre only once. The centre's staff aim to adopt a flexible approach to the client and his problems, and formal psychiatric categories have not been found useful. Provision is made for people who want to solve their problems by discussion rather than medication and those for whom the existing psychiatric services may have little time to spare. Consequently, the approach adopted by the Isis Centre, whereby many people benefit from psychotherapy yet the psychiatrist deals directly with only a few selected cases, contributes towards meeting the great need for psychiatric services and using the psychiatrist's skills more effectively. PMID:947421

A 17-Month Review of the Care Model, Service Structure, and Design of THRIVE, a Community Mental Health Initiative in Northern Singapore.

PubMed

Cheang, K M; Cheok, C C S

2015-12-01

Effective delivery of psychiatric care requires the development of a range of services. The existing Singapore health care system provides a comprehensive range of psychiatric services based in restructured hospitals. The Ministry of Health Community Mental Health Masterplan (2012-2017) aims to build novel services for the community. This Masterplan envisions the development of ASCATs (Assessment Shared Care Teams) and COMITs (Community Intervention Teams) to build the capacity and capability for psychiatric care to be delivered outside the hospital in the community. A community mental health plan comprising a fast access clinic, internet-delivered self-help and building a community network of providers was devised for the North of Singapore through the THRIVE (Total Health Rich In Vitality and Energy) programme. This article provides an introduction to the care model, service structure and design of the THRIVE, and reviews its milestones and achievements from its inception in August 2012 until December 2013.

Do Inflammatory Bowel Disease patients with anxiety and depressive symptoms receive the care they need?

PubMed

Bennebroek Evertsz', F; Thijssens, N A M; Stokkers, P C F; Grootenhuis, M A; Bockting, C L H; Nieuwkerk, P T; Sprangers, M A G

2012-02-01

Inflammatory Bowel Disease (IBD) patients with anxiety and/or depressive symptoms may not receive the care they need. Provision of care requires insight into the factors affecting these psychiatric symptoms. The study was designed to examine the extent to which: (1) IBD patients with anxiety and/or depressive symptoms receive mental treatment and (2) clinical and socio-demographic variables are associated with these symptoms. 231 adult IBD patients (79% response rate), attending a tertiary care center, completed standardized measures on anxiety and depressive symptoms (HADS), quality of life (SF-12) and mental health care use (TIC-P). Diagnosis and disease activity were determined by the gastroenterologist. 43% had high levels of anxiety and/or depressive symptoms, indicative of a psychiatric disorder (HADS ≥ 8), of whom 18% received psychological treatment and 21% used psychotropic medication. In multivariate analysis, high disease activity was associated with anxiety (OR=2.72 | p<0.03) and depression (OR=3.36 | p<0.01), while Crohn's disease was associated with anxiety (OR=2.60 | p<0.03). Despite high levels of anxiety and depressive symptoms and poor quality of life, psychiatric complaints in IBD patients were undertreated. Screening for and treatment of psychiatric symptoms should become an integral part of IBD medical care. Copyright © 2011 European Crohn's and Colitis Organisation. Published by Elsevier B.V. All rights reserved.

Psychiatric treatment received by primary care patients with panic disorder with and without agoraphobia

PubMed Central

Marcks, Brook A.; Weisberg, Risa B.; Keller, Martin B.

2013-01-01

Objective Although the majority of individuals with panic disorder first present to the primary care setting, little is known about the psychiatric treatment primary care patients with the disorder typically receive. The purpose of the current study was to explore characteristics of treatment received by those with panic disorder with and without agoraphobia, examine demographic and clinical predictors of receiving treatment, and explore treatment barriers. Methods This study uses data from the Primary Care Anxiety Project (PCAP), which is a naturalistic, longitudinal study of anxiety disorders in primary care patients. This study presents data on 235 PCAP participants diagnosed with panic disorder with (N=150) or without agoraphobia (N=85) at the study intake assessment. Results Many patients with panic disorder were not receiving psychiatric treatment at study intake, with those without agoraphobia being less likely to receive treatment. Psychotropic medications were the treatment of choice, with SSRIs/SNRIs being the most commonly received class of medications. Only 39% of those with panic disorder with agoraphobia and 24% of those without agoraphobia were receiving psychotherapy, and use of empirically supported interventions was rare. The most common treatment barriers were: not believing in utilizing medication/therapy for emotional problems and not receiving a treatment recommendation from one’s provider. Conclusions The findings suggest a need for better treatment dissemination, in addition to making interventions more accessible and/or adapting them to the particular needs of primary care patients. PMID:19487354

Temporal changes in the incidence of treated psychiatric and neurodevelopmental disorders during adolescence: an analysis of two national Finnish birth cohorts.

PubMed

Gyllenberg, David; Marttila, Mikko; Sund, Reijo; Jokiranta-Olkoniemi, Elina; Sourander, André; Gissler, Mika; Ristikari, Tiina

2018-03-01

Comprehensive overviews of the temporal changes in treated psychiatric and neurodevelopmental disorders during adolescence are scarce. We reviewed data from two national cohorts, 10 years apart, to establish the change in use of specialised services for psychiatric and neurodevelopmental diagnoses in Finland. We compared the nationwide register-based incidence of psychiatric and neurodevelopmental diagnoses between the 12th birthday and 18th birthday of adolescents born in Finland in 1987 and 1997. Adolescents who emigrated or died before their 12th birthday and those with missing covariate data were excluded, as were those who, when aged 11 years, had lived in a municipality belonging to a hospital district with obviously incomplete data reports during any follow-up years in our study. Our primary outcomes were time to incident specialised service use for any psychiatric or neurodevelopmental disorder and for 17 specific diagnostic classes. We also investigated whether adolescents who died by suicide had accessed specialised services before their deaths. The cumulative incidence of psychiatric or neurodevelopmental disorders increased from 9·8 in the 1987 cohort to 14·9 in the 1997 cohort (difference 5·2 percentage points [95% CI 4·8-5·5]) among girls, and from 6·2 in the 1987 cohort to 8·8 in the 1997 (2·6 percentage points [2·4-2·9]) among boys. The hazard ratio for the overall relative increase in neurodevelopment and psychiatric disorders in the 1997 cohort compared with the 1987 cohort was 1·6 (95% CI 1·5-1·8) among girls and 1·5 (1·4-1·6) among boys. Of the studied diagnostic classes, we noted significant (ie, p<0·001) relative increases for ten of 17 diagnoses among girls and 11 among boys. Of the adolescents who died by suicide before age 18, only five of 16 in the 1987 cohort and two of 12 in the 1997 cohort had used specialised services in the 6 months before their death. The large absolute rise in service use for psychiatric or neurodevelopmental disorders points to the need to deliver effective treatment to a rapidly increased patient population, whereas the relative increase in specific diagnoses should inform clinical practice. Despite increasing service use, identification of adolescents at risk of suicide remains a major public health priority. Academy of Finland, Brain and Behavior Research Foundation, Finnish Medical Foundation. Copyright © 2018 Elsevier Ltd. All rights reserved.

Changes in body weight and body mass index among psychiatric patients receiving lithium, valproate, or topiramate: an open-label, nonrandomized chart review.

PubMed

Chengappa, K N Roy; Chalasani, L; Brar, Jaspreet S; Parepally, H; Houck, Patricia; Levine, Joseph

2002-10-01

Subsets of psychiatric patients gain excess body weight while receiving mood-stabilizing agents such as lithium carbonate or valproate sodium. Patients who gain excess weight may discontinue therapy, with severe consequences. Among the newer anticonvulsant agents, topiramate is a candidate agent for bipolar disorder and is associated with weight loss when used as adjunctive treatment. This open-label, nonrandomized, chart-review study assessed changes in body weight and body mass index (BMI) in patients receiving topiramate, lithium, or valproate. Data were extracted from the medical charts of patients admitted in 1999 and 2000 to a state psychiatric hospital with either schizophrenia, schizoaffective disorder, bipolar disorder, or other psychiatric diagnoses who were prescribed valproate, lithium, or topiramate and were reviewed for changes in body weight and BMI. The use of concomitant psychotropic medicines was recorded (eg, antipsychotic agents, antidepressant agents, other mood stabilizers such as gabapentin or carbamazepine). Continuous variables were analyzed using a factorial analysis of variance and the Student t test. Contingency statistics were used to analyze categorical variables. A total of 214 patients were included in the chart review (123 men, 91 women; mean age, 39.4 years). Significantly more women than men received topiramate (P = 0.004). Patients receiving either lithium or valproate gained a mean (SD) of 6.3 (9.0) kg and 6.4 (9.0) kg, respectively, whereas patients receiving topiramate lost a mean 1.2 (6.3) kg (F = 11.54, df = 2,198; P < 0.001). Lithium- or valproate-treated patients experienced an increase in BMI (mean, 2.1 [3.0] for both groups), whereas topiramate-treated patients experienced a reduction in BMI (mean, -0.5 [2.4]); this result was statistically significant (F = 11.40, df = 2,198; P < 0.001). Finally, lithium- or valproate-treated patients gained >8% of their baseline body weight (8.2% [11.5%] for lithium-treated patients and 8.5% [11.9%] for valproate-treated patients), whereas topiramate-treated patients lost 0.7% (7.2%) of their body weight (F = 9.93, df= 2,198; P < 0.001). Controlled studies for the efficacy of topiramate therapy in various psychiatric conditions are awaited. These data indicate that patients receiving topiramate experience body weight loss and a reduction in BMI. This advantage of topiramate may promote long-term adherence to treatment among psychiatric patients and possibly decrease the medical risks associated with obesity.

New Research into General Psychiatric Services for Adults with Intellectual Disability and Mental Illness

ERIC Educational Resources Information Center

Chaplin, R.

2009-01-01

Background: There are a variety of models for the mental health care of adults with comorbid intellectual disability (ID) and mental illness. There has been a long-running debate as to whether this should be provided by general psychiatric or specialised ID services. A previous review concluded that there was no clear evidence to support either…

Psychiatric Emergency Services for the U.S. Elderly: 2008 and Beyond

PubMed Central

Walsh, Patrick G.; Currier, Glenn; Shah, Manish N.; Lyness, Jeffrey M.; Friedman, Bruce

2008-01-01

In 2011 the oldest baby boomers will turn age 65. Although healthcare researchers have started to examine the future preparedness of the healthcare system for the elderly, psychiatric emergency services (PES) have been widely overlooked. Research is needed to address PES need and demand by older patients, assess the consequences of this need/demand, and establish recommendations to guide PES planning and practice. The authors examined journal articles, review papers, textbooks, and electronic databases related to these topics. We outline the current PES environment in terms of facilities, characteristics, and visits, and discuss current geriatric patient PES use. Factors expected to impact future use are examined, including sociodemographic characteristics, psychiatric illness prevalence, cohort effects, medical comorbidity, mental healthcare resources and utilization, and stigma. Consequences of these on future psychiatric care and well-being of the elderly are then explored, specifically, greater acute services need, more suicide, strained delivery systems, increased hospitalization, and greater costs. The following are proposed to address likely future PES shortcomings: enhance service delivery, increase training, standardize and improve PES, prioritize finances, and promote research. The degree to which the geriatric mental healthcare “crisis” develops will be inversely related to the current system's response to predictable future needs. PMID:18757766

Euthanasia and Assisted Suicide of Patients With Psychiatric Disorders in the Netherlands 2011 to 2014.

PubMed

Kim, Scott Y H; De Vries, Raymond G; Peteet, John R

2016-04-01

Euthanasia or assisted suicide (EAS) of psychiatric patients is increasing in some jurisdictions such as Belgium and the Netherlands. However, little is known about the practice, and it remains controversial. To describe the characteristics of patients receiving EAS for psychiatric conditions and how the practice is regulated in the Netherlands. This investigation reviewed psychiatric EAS case summaries made available online by the Dutch regional euthanasia review committees as of June 1, 2015. Two senior psychiatrists used directed content analysis to review and code the reports. In total, 66 cases from 2011 to 2014 were reviewed. Clinical and social characteristics of patients, physician review process of the patients' requests, and the euthanasia review committees' assessments of the physicians' actions. Of the 66 cases reviewed, 70% (n = 46) were women. In total, 32% (n = 21) were 70 years or older, 44% (n = 29) were 50 to 70 years old, and 24% (n = 16) were 30 to 50 years old. Most had chronic, severe conditions, with histories of attempted suicides and psychiatric hospitalizations. Most had personality disorders and were described as socially isolated or lonely. Depressive disorders were the primary psychiatric issue in 55% (n = 36) of cases. Other conditions represented were psychotic, posttraumatic stress or anxiety, somatoform, neurocognitive, and eating disorders, as well as prolonged grief and autism. Comorbidities with functional impairments were common. Forty-one percent (n = 27) of physicians performing EAS were psychiatrists. Twenty-seven percent (n = 18) of patients received the procedure from physicians new to them, 14 of whom were physicians from the End-of-Life Clinic, a mobile euthanasia clinic. Consultation with other physicians was extensive, but 11% (n = 7) of cases had no independent psychiatric input, and 24% (n = 16) of cases involved disagreement among consultants. The euthanasia review committees found that one case failed to meet legal due care criteria. Persons receiving EAS for psychiatric disorders in the Netherlands are mostly women and of diverse ages, with complex and chronic psychiatric, medical, and psychosocial histories. The granting of their EAS requests appears to involve considerable physician judgment, usually involving multiple physicians who do not always agree (sometimes without independent psychiatric input), but the euthanasia review committees generally defer to the judgments of the physicians performing the EAS.

Evaluating DSM-5 Insomnia Disorder and the Treatment of Sleep Problems in a Psychiatric Population.

PubMed

Seow, Lee Seng Esmond; Verma, Swapna Kamal; Mok, Yee Ming; Kumar, Sunita; Chang, Sherilyn; Satghare, Pratika; Hombali, Aditi; Vaingankar, Janhavi; Chong, Siow Ann; Subramaniam, Mythily

2018-02-15

With the introduction of insomnia disorder in Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), greater emphasis has been placed on the diagnosis and treatment of sleep disorder even in the presence of a coexisting mental disorder. The current study seeks to explore the clinical picture of insomnia in the context of psychiatric disorders commonly associated with sleep complaints by assessing the prevalence and correlates of DSM-5 insomnia disorder, and examining the extent to which insomnia symptoms have been addressed in this population. Four hundred treatment-seeking outpatients suffering from depressive, bipolar affective, anxiety, and schizophrenia spectrum disorders were recruited. DSM-5 insomnia was established using the modified Brief Insomnia Questionnaire. Differences in sociodemographic factors, clinical status, impairment outcomes, and mental health services utilization were compared. Information on patients' help-seeking experiences for insomnia-related symptoms was collected to determine the treatment received and treatment effectiveness. Almost one-third of our sample (31.8%) had DSM-5 insomnia disorder. Those with insomnia disorder had significantly higher impairment outcomes than their counterparts but no group difference was observed for mental health services utilization. Findings based on past treatment contact for sleep problems suggest that diagnosis and treatment of insomnia is lacking in this population. With the new calling from DSM-5, clinicians treating psychiatric patients should view insomnia less as a symptom of their mental illnesses and treat clinical insomnia as a primary disorder. Patients should also be educated on the importance of reporting and treating their sleep complaints. Nonmedical (cognitive and behavioral) interventions for insomnia need to be further explored given their proven clinical effectiveness. © 2018 American Academy of Sleep Medicine

A measure of South Africa's health care.

PubMed

de Selincourt, K

Nurses provide the bulk of health care in South Africa. For example, in 1 of the biggest and poorest townships Khayelitsha, nurses treat malnourished mothers and children and offer primary health care services. Physicians tend to work in township clinics on a part-time basis and supervise nurse-advised treatments over the telephone. Most physicians do not speak the language of the people living in the township which is Xhosa. Thus they often depend on a nurse to serve as interpreter for Xhosa-speaking patients which takes the nurse away from her duties. Some clinics never receive physician supervision or services. Nurses spend much of their time sharing their skills and knowledge with clients. Nutrition workers and other staff back up nurses at the clinics. They sometimes are mothers whose children were at one time malnourished. Since they have the basic skills and knowledge, clinic staff provide treatment for straightforward conditions such as scabies. Nurses working in hospital in Khayelitsha also have many responsibilities. For example, they do the initial psychiatric assessment and decide whether to send a patient immediately to Valkenburg Psychiatric Hospital or to schedule the patient for an appointment with the physician at the satellite psychiatric clinic at Khayelitsha Hospital where psychiatrists come only twice/week. They sometimes make home visits which results in them also providing primary care. Unlike nurses not working in the hospital, the nurses at the hospital have good medical support. Both black and white nurses in South Africa work in the same clinics despite the country's policy of separateness. A shortage of nurses is 1 reason for this integration. Black nurses still encounter discrimination when applying for jobs and, until recently, made less money for the same work than white nurses.

28 CFR 549.40 - Use of psychotropic medications.

Code of Federal Regulations, 2010 CFR

2010-07-01

... MEDICAL SERVICES Administrative Safeguards for Psychiatric Treatment and Medication § 549.40 Use of psychotropic medications. Psychotropic medication is to be used only for a diagnosable psychiatric disorder or...

Design in mind: eliciting service user and frontline staff perspectives on psychiatric ward design through participatory methods.

PubMed

Csipke, Emese; Papoulias, Constantina; Vitoratou, Silia; Williams, Paul; Rose, Diana; Wykes, Til

2016-01-01

Psychiatric ward design may make an important contribution to patient outcomes and well-being. However, research is hampered by an inability to assess its effects robustly. This paper reports on a study which deployed innovative methods to capture service user and staff perceptions of ward design. User generated measures of the impact of ward design were developed and tested on four acute adult wards using participatory methodology. Additionally, inpatients took photographs to illustrate their experience of the space in two wards. Data were compared across wards. Satisfactory reliability indices emerged based on both service user and staff responses. Black and minority ethnic (BME) service users and those with a psychosis spectrum diagnosis have more positive views of the ward layout and fixtures. Staff members have more positive views than service users, while priorities of staff and service users differ. Inpatient photographs prioritise hygiene, privacy and control and address symbolic aspects of the ward environment. Participatory and visual methodologies can provide robust tools for an evaluation of the impact of psychiatric ward design on users.

Design in mind: eliciting service user and frontline staff perspectives on psychiatric ward design through participatory methods

PubMed Central

Csipke, Emese; Papoulias, Constantina; Vitoratou, Silia; Williams, Paul; Rose, Diana; Wykes, Til

2016-01-01

Abstract Background: Psychiatric ward design may make an important contribution to patient outcomes and well-being. However, research is hampered by an inability to assess its effects robustly. This paper reports on a study which deployed innovative methods to capture service user and staff perceptions of ward design. Method: User generated measures of the impact of ward design were developed and tested on four acute adult wards using participatory methodology. Additionally, inpatients took photographs to illustrate their experience of the space in two wards. Data were compared across wards. Results: Satisfactory reliability indices emerged based on both service user and staff responses. Black and minority ethnic (BME) service users and those with a psychosis spectrum diagnosis have more positive views of the ward layout and fixtures. Staff members have more positive views than service users, while priorities of staff and service users differ. Inpatient photographs prioritise hygiene, privacy and control and address symbolic aspects of the ward environment. Conclusions: Participatory and visual methodologies can provide robust tools for an evaluation of the impact of psychiatric ward design on users. PMID:26886239

Barriers to mental health service use among distressed family caregivers of lung cancer patients.

PubMed

Mosher, C E; Given, B A; Ostroff, J S

2015-01-01

Although family caregivers of patients with lung and other cancers show high rates of psychological distress, they underuse mental health services. This qualitative study aimed to identify barriers to mental health service use among 21 distressed family caregivers of lung cancer patients. Caregivers had not received mental health services during the patient's initial months of care at a comprehensive cancer centre in New York City. Thematic analysis of interview data was framed by Andersen's model of health service use and Corrigan's stigma theory. Results of our analysis expand Andersen's model by providing a description of need variables (e.g. psychiatric symptoms), enabling factors (e.g. finances), and psychosocial factors associated with caregivers' non-use of mental health services. Regarding psychosocial factors, caregivers expressed negative perceptions of mental health professionals and a desire for independent management of emotional concerns. Additionally, caregivers perceived a conflict between mental health service use and the caregiving role (e.g. prioritising the patient's needs). Although caregivers denied stigma associated with service use, their anticipated negative self-perceptions if they were to use services suggest that stigma may have influenced their decision to not seek services. Findings suggest that interventions to improve caregivers' uptake of mental health services should address perceived barriers. © 2014 John Wiley & Sons Ltd.

[Psychiatric manifestations of lupus erythematosus systemic and Sjogren's syndrome].

PubMed

Ampélas, J F; Wattiaux, M J; Van Amerongen, A P

2001-01-01

We present one case of Sjögren's syndrome (SS) secondary to systemic lupus erythematosus (SLE) with predominant psychiatric manifestations, treated with success by cyclophosphamide. From this case, we review the psychiatric aspects of these two autoimmune diseases as described in the literature and we present the etiopathogenic hypothesis and treatment of the psychiatric disorders. Case report--In August 1996, a 38 year old man was admitted in our psychiatric department for agitation. Primary SS had been diagnosed in July 1996. He had previously attempted to suicide but was never hospitalized in a psychiatric department. During the hospitalization in our department, the patient had auditive hallucinations and felt persecuted. He received loxapine 400 mg/day and was remitted in a few days. He was discharged to a convalescent home with the diagnosis of brief psychotic disorder. In October 1996, he was readmitted to our department for agitation. He had shown agitated behavior and aggression in the convalescent home. There were no hallucinations and no affective disorders. He became calm rapidly and was discharged home a few days later. In November 1996, he was found in a coma by a neighbor. He was admitted to an intensive care unit. The lumbar punction revealed blood cells. Cerebral computer tomography showed subarachnoid hemorrhage. The diagnosis was meningeal hemorrhage due to vasculitis. After regaining consciousness, the patient complained of reduced visual acuity. This was believed to be due to retrobulbar neuritis and the patient's vision improved slightly with corticosteroids. The third hospitalization in our department occurred in February 1997 for depression. The patient had shut himself away for days in his apartment. He had suicidal ideas. His mood improved progressively under fluoxetine 40 mg/day. He was discharged to a convalescent home with the diagnosis of major depressive disorder. The fourth and last admission in our department occurred in June 1997. There were disturbances of memory and orientation. He felt sad and guilty about accusation of sexual abuse on his daughter. He presented typical histrionic symptoms: he had catatonic attitudes only in public areas such as the corridors. Cerebral computer tomography and electroencephalogram were normal. There was no biological abnormality. Signs of confusion rapidly disappeared. He felt better after reintroduction of fluoxetine 40 mg/day. Diagnosis was non-specified depressive disorder, but this episode could be retrospectively seen as delirium. After being hospitalized on these four occasions in one year in our psychiatric department, the diagnosis of his systemic disease was revised by rheumatologists. The patient was diagnosed as suffering from systemic lupus erythematosus associated with secondary Sjögren's syndrome. From September 1997, he received cyclophosphamide 2 g intraveinously per month during 6 months. His vision improved dramatically. His ocular dryness became milder. His mood is now stable. He has not suffered from hallucinations or delusion since. Psychiatric disorders in SLE--During the course of SLE, the occurrence of psychiatric manifestations varies widely from 5 to 83%. They include psychotic disorders, major depressive disorders, subtle cognitive disorders and personality disorders of histrionic type. Etiopathogenic hypothesis are: direct activity of the disease on the central nervous system by autoantibodies (antiphospholipide and antiribosome P autoantibodies) (18, 19) or cytokines (interleukin 2, interleukin 6, alpha interferon) (38, 59), side-effects of glucocorticosteroids and hydroxychloroquine (16) or anxious reaction to a chronic and potentially lethal illness (43, 54). Nevertheless, immunologic and cerebral imagery research suggests that psychiatric disorders are related to vasculitis and non-inflammatory vasculopathy of the small cerebral blood vessels. The management of the patients should include treatment of the disease itself and specific psychotropic treatment. Glucocorticosteroids and especially intravenous infusions of immunosuppressive agents, such as cyclophosphamide, are effective. Psychotropic drugs must be used, making sure to avoid SLE-inducing drugs, like chlorpromazine, carbamazepine and lithium carbonate (19, 20, 45). In addition, psychologic care is essential. Psychiatric disorders in SS--During the course of the primary SS, the occurrence of psychiatric disorders is large as well: from 20 to 70% (47, 61, 62). They are mainly major depressive disorders, anxiety disorders, cognitive disorders and dementia. Brief psychotic disorders and delirium are rare. Etiopathogenic hypotheses are similar as those in SLE, with some differences: antiphospholipide and antiribosome P autoantibodies are not usually found in SS and anti-Ro (SSA) autoantibodies in serum are associated with psychiatric disorders (3-11, 61). According to Drosos et al. (29, 30), psychiatric disorders are explained by psychological distress. This slowly progressive fluctuating disease creates constant discomfort from dysphagia, dyspareunia and functional disability. Some of these manifestations can be treated by corticosteroids and psychotropic drugs. Drugs with anticholinergic side-effects, like phenothiazines, tricyclic antidepressants and hydroxyzine which can enhance the oral dryness have to be avoided. Social and psychological support is important too. The diversity of psychiatric morbidity in SLE and SS may be due to differences in patient selection and a lack of uniform clinical criteria. Studies which use standardized diagnostic criteria and control groups don't allow one to come to a conclusion about the relative prevalence of the psychiatric disorders in these autoimmune diseases. This will probably be resolved thanks to the recently published "American College of Rheumatology nomenclature and case definitions for neuropsychiatric lupus syndromes" (1). Finally, we can ask ourselves if there is a significant number of undiagnosed SLE and SS in psychiatric departments. Two studies report systematic search for SLE in psychiatric patients. In 1992, Hopkinson et al. (39) searched for several autoantibodies in serum samples of nearly 300 hospitalized psychiatric patients. In 1993, Van Dam et al. (65) did the same with more than 2,000 patients admitted to a psychiatric hospital. Hopkinson et al. found 1% undiagnosed SLE, which is much higher than in general population, and recommended to search SLE in every patient with a high erythrocyte sedimentation rate in psychiatric services. Results of the Van Dam et al. study suggest on the contrary, that SLE is not a common cause of admission to psychiatric hospitals. There is no study which report systematic search of Sjögren's syndrome in a psychiatric department. This is probably because most of patients receive or have recently received psychotropics with anticholinergic side-effects which is an exclusion criteria of SS. Psychiatrists should keep in mind that SLE and primary SS are potential causes of psychiatric manifestations when examining patients with multiple unexplained somatic complaints and psychiatric symptoms. They should then search for autoantibodies in the serum after careful physical examination. Diagnosis of SLE or SS could lead to a better adapted prescription of corticosteroids and/or immunosuppressive drugs and specific psychotropic drugs, making sure to avoid lupus-inducing drugs in SLE and drugs with anticholinergic effects in SS. The existence of psychiatric manifestations in SLE and SS constitutes an indisputable clinical reality that each practitioner must be able to recognize and treat.

'Forensic' labelling: an empirical assessment of its effects on self-stigma for people with severe mental illness.

PubMed

Livingston, James D; Rossiter, Katherine R; Verdun-Jones, Simon N

2011-06-30

Increasingly, specialized 'forensic' mental health services are being developed to address the criminogenic and clinical needs of people with mental illness who are involved in the criminal justice system. Theoretically, the construction of such specialized services can produce simultaneous positive benefits and negative consequences. This mixed methods study examined and compared the level of self-stigma that was experienced by people who receive compulsory community-based treatment services in the forensic (n=52) and civil (n=39) mental health systems of British Columbia, Canada. The quantitative findings indicate that 'forensic' labelling was not associated with elevated levels of self-stigma. Quantitative level of self-stigma was significantly associated with psychiatric symptom severity, history of incarceration, and history of homelessness. The qualitative findings suggest that access to high-quality, well-resourced forensic mental health services may, for some service users, come at the risk of increased exposure to social and structural stigma. Together, these findings reveal some of the strengths and weaknesses that are associated with organizing forensic mental health services using a specialized service delivery model. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

[Dependency levels and health care services' utilization in psychiatric hospitals in Aragon (Spain)].

PubMed

de Miguel, Marcos; Torrijos, Mónica; Abad, José María; Lou, Marta Luz

2004-01-01

To determine the characteristics of patients living in psychiatric hospitals in Aragon, to assess their dependency levels, and to analyze health care services' utilization by these patients. We performed a cross-sectional study between July 1 and November 31. The questionnaire used was the Resident Assessment Instrument- Mental Health (RAI-MH). The sample consisted of 437 patients living in public psychiatric hospitals in Aragon. These hospitals provide care to chronically mentally ill patients and to patients undergoing rehabilitation. The Resource Utilization Group (RUG-I) system was used to classify patients by their dependency levels for activities of daily life (ADL). Of the 437 patients, 259 (59.3%) were men with a mean age of 62.2 years. A total of 82.1% of the patients were classified as RUG-I group 1. Patients in groups 1 and 2 required more formal health care services. At least one visit by a psychiatrist was required by 25.3% of patients in group 1 and by 15.2% of those in group 2 compared with no visits by the other groups. Nursing interventions were more frequently required by patients in the more dependent groups. All of the of patients in groups 2 to 8 needed daily physical assistance for ADL vs. 26.3% of those in group 1. In the multivariate analysis, predictive variables were the hospital and type of unit. There is wide variation in health care services' utilization by patients living in psychiatric hospitals, which is related to dependency levels. Many psychiatric patients do not need formal psychiatric care. Health care professionals should assess the real needs of patients to provide each of them with appropriate care.

The Experiences of Fathers When Their Partners are Admitted with Their Infants to a Psychiatric Mother and Baby Unit.

PubMed

Reid, Holly; Wieck, Angelika; Matrunola, Andrew; Wittkowski, Anja

2017-07-01

Mothers with severe post-natal mental illness can be admitted with their infant to a psychiatric mother and baby unit (MBU) in the UK. MBUs provide specialist assessment, management and support. Partners of women admitted to MBUs are integral to their recovery but may show reduced wellbeing themselves, yet their support needs have not been investigated. This study aimed to identify how fathers experience the MBU and how they felt supported. A qualitative design was adopted by using a purposive sample of 17 fathers, recruited from a MBU during their partner's admission. Semi-structured interviews were used, and responses were analysed using an inductive thematic analysis. Four main themes were developed: (1) 'double whammy', (2) understanding the admission and illness, (3) support for fathers, and (4) personal stressors and coping. We identified the emotional struggle that fathers experienced when coping simultaneously with the arrival of a baby and their partner's illness. Furthermore, fathers sought support from many sources, but their knowledge of psychiatric services and mental illness was limited. Fathers felt uncertain about their partners' progression and when their partner would return home with their baby. The provision of an information pack and regular one-to-one meetings between fathers and MBU staff are recommended. Copyright © 2016 John Wiley & Sons, Ltd. Partners of mothers admitted to a psychiatric mother and baby unit have shown increased vulnerability to mental illness themselves; however, little is known about the support that these fathers need and receive during this time. Using interviews, this study sought to understand a) how fathers experienced the mental illness of their partner and the unit's services and b) how fathers could be better supported. Fathers face many emotional and practical challenges during their partner's admission and seek support from numerous sources, including the mother and baby unit. Fathers require more information from the mother and baby unit with regard to mental illness and the unit's services. Furthermore, the introduction of regular one-to-one updates between staff and fathers would provide an opportunity for fathers to understand how their partner is progressing and for staff to informally assess the father's wellbeing and outstanding support needs. Copyright © 2016 John Wiley & Sons, Ltd.

[Psychiatric disorders in adult form of Niemann-Pick disease type C].

PubMed

Maubert, A; Hanon, C; Sedel, F

2016-06-01

Niemann-Pick type C disease (NPC) is a rare genetic disease with an extremely heterogeneous clinical presentation. The adult form of this disease is usually expressed with neurological symptoms; however, non-specific psychiatric disorders are often associated. This article presents a retrospective study on a cohort of NPC patients diagnosed in France with the objectives of researching the presence of psychiatric disorders and qualifying these disorders. After carrying out a research within hospital records, a questionnaire was sent to patients or their relatives and their doctors. The cohort was made up of 22 patients. Fifty-two questionnaires were sent to 47 different doctors. We received 67% of answers from the doctors, with 42% of positive answers. The answer rate of the families was 27%. Among the 22 patients, we found the presence of psychiatric disorders in 86% of cases. Seventy-three percent of the patients presented behavior disorders. Among them, 27% exhibited psychomotor excitation or agitation, 23% aggressiveness, 18% intolerance to frustration, 27% sleep disorders and 23% apathy, listlessness and/or clinophilia. Fifty-five percent of patients presented psychotic symptoms, with 45% with delusions and 36% with hallucinations. Seventy-seven percent of patients presented with mood disorders: 36% suffered from depression and 27% from emotional lability or mood swings. Of the 22 patients, a diagnosis of psychiatric disease was made in 50% of cases. The main diagnoses were schizophrenia (27%) and depression (23%). The other diagnoses identified were acute delirium, dysthymia, infantile psychosis, intellectual disharmonic disability and personality disorder. The average age of emergence of the troubles was 17.1 years old for neurological symptoms and 20.9 years old for psychiatric symptoms. The median age was 18 years old for neurological symptoms and 20 years old for psychiatric ones. In 45% of cases, psychiatric occurred after neurological symptoms; in 27%, they occurred before and they were concomitant in 9%. In 50% of cases, psychiatric symptoms existed before the early diagnosis of NPC; in 9%, they occurred after and in 5%, they occurred during the diagnostic process. Fifty-five percent of the patients were followed by a psychiatrist, 50% of patients had been hospitalized at least once in a psychiatric department. Fifty-five percent of the patients received neuroleptics or antipsychotics, 41% received antidepressants, 41% received mood stabilizers or anticonvulsants, 45% received anxiolytics and 23% hypnotics. Whilst a small cohort, the low incidence of NPC (1/120,000 to 1/150,000) and the scale of a single-center study make the findings important. In our cohort, we found psychiatric disorders in most of the patients. The symptoms were varied and non-specific, and mainly found in late-onset forms of the disease. This incidence of disorder is much higher than the literature suggests, generally describing psychiatric disorders in approximately one third of NPC adult form. On the other hand, our results on schizophrenia are consistent with the updated recommendations for the diagnosis and management of NPC. According to our results, a retrospective study to develop a suspicion index to aid diagnosis of NPC suggests that psychotic symptoms are underestimated in this disease. In our cohort, we also found a significant rate of psychiatric hospitalizations and psychotropic drugs prescription that had not been previously described in the international literature. We did not have sufficient data on the effectiveness of symptomatic treatment in NPC; the literature was contradictory. It should be noted that despite the high rate of psychiatric patients in our cohort, only half of patients consulted a psychiatrist and a few of them have regular follow-up. To conclude, our study is in line with the current literature that suggests an under-estimation of psychiatric disorders in NPC, but also a likely under-diagnosis of NPC in psychiatric departments. All this data encourage us to keep alerting psychiatrists to identifying this disease in order to promote early and optimal care. Copyright © 2015 L'Encéphale, Paris. Published by Elsevier Masson SAS. All rights reserved.

Antidepressants Increase REM Sleep Muscle Tone in Patients with and without REM Sleep Behavior Disorder.

PubMed

McCarter, Stuart J; St Louis, Erik K; Sandness, David J; Arndt, Katlyn; Erickson, Maia; Tabatabai, Grace; Boeve, Bradley F; Silber, Michael H

2015-06-01

REM sleep behavior disorder (RBD) is associated with antidepressant treatment, especially in younger patients; but quantitative REM sleep without atonia (RSWA) analyses of psychiatric RBD patients remain limited. We analyzed RSWA in adults receiving antidepressants, with and without RBD. We comparatively analyzed visual, manual, and automated RSWA between RBD and control groups. RSWA metrics were compared between groups, and regression was used to explore associations with clinical variables. Tertiary-care sleep center. Participants included traditional RBD without antidepressant treatment (n = 30, 15 Parkinson disease [PD-RBD] and 15 idiopathic); psychiatric RBD receiving antidepressants (n = 30); and adults without RBD, including antidepressant-treated psychiatric (n = 30), untreated psychiatric (n = 15), and OSA (n = 60) controls. N/A. RSWA was highest in traditional and psychiatric RBD, intermediate in treated psychiatric controls, and lowest in untreated psychiatric and OSA controls (P < 0.01). RSWA distribution and type also differed between antidepressant-treated patients having higher values in anterior tibialis, and PD-RBD with higher submentalis and tonic RSWA. Psychiatric RBD had significantly younger age at onset than traditional RBD patients (P < 0.01). Antidepressant treatment was associated with elevated REM sleep without atonia (RSWA) even without REM sleep behavior disorder (RBD), suggesting that antidepressants, not depression, promote RSWA. Differences in RSWA distribution and type were also seen, with higher anterior tibialis RSWA in antidepressant-treated patients and higher tonic RSWA in Parkinson disease-RBD patients, which could aid distinction between RBD subtypes. These findings suggest that antidepressants may mediate different RSWA mechanisms or, alternatively, that RSWA type and distribution evolve during progressive neurodegeneration. Further prospective RSWA analyses are necessary to clarify the relationships between antidepressant treatment, psychiatric disease, and RBD. © 2015 Associated Professional Sleep Societies, LLC.

Psychiatric disorders and symptoms severity in pre-school children with cow's milk allergy.

PubMed

Topal, E; Catal, F; Soylu, N; Ozcan, O O; Celiksoy, M H; Babayiğit, A; Erge, D; Karakoç, H T E; Sancak, R

2016-01-01

Psychiatric disorders are seen frequently in atopic diseases. The present study aims to evaluate the frequency of psychiatric disorders and the severity of psychiatric symptoms in pre-school children with cow's milk allergy. The parents of the pre-school children with cow's milk allergy were interviewed in person and asked to fill out the Early Childhood Inventory-4 form. The cow's milk allergy group included 40 children (27 male, 13 female) with mean age, 44.5±14.7 months, and the control group included 41 children (25 male, 16 female) with mean age, 47.6±15.2 months. It was established that 65% of the group with cow's milk allergy received at least one psychiatric diagnosis, while 36.6% of the control group received at least one psychiatric diagnosis, with a statistically significant difference (p=0.02). Within the psychiatric disorders, attention deficit hyperactivity disorders (odds ratio: 4.9, 95% CI: 1.472-16.856, p=0.006), oppositional defiant disorder (odds ratio: 5.6, 95% CI: 1.139-28.128, p=0.026), and attachment disorder (odds ratio: 4.8, 95% CI: 1.747-13.506, p=0.004) were found significantly higher compared with the healthy control group. When the groups were compared in terms of psychiatric symptom severity scores, calculated by using the Early Childhood Inventory-4 form, attention deficit hyperactivity disorders severity (p=0.006) and oppositional defiant disorder severity (p=0.037) were found to be higher in the cow's milk allergy group. Psychiatric disorders are frequent and severe in pre-school children with cow's milk allergy. Copyright © 2016 SEICAP. Published by Elsevier España, S.L.U. All rights reserved.

Influence of psychiatric diagnosis on treatment uptake and interferon side effects in patients with hepatitis C.

PubMed

Wu, Jing Yuan J; Shadbolt, Bruce; Teoh, Narci; Blunn, Anne; To, Caroline; Rodriguez-Morales, Ilys; Chitturi, Shivakumar; Kaye, Graham; Rodrigo, Kalyana; Farrell, Geoff

2014-06-01

Pegylated-interferon-α/ribavirin (PEG-IFN/RBV) treatment can cure hepatitis C virus (HCV) infection but has frequent neuropsychiatric side-effects. Patients with pre-existing psychiatric illness may not be offered therapy. We established prevalence of self-reported psychiatric comorbidity among HCV-infected patients in a hospital-liver clinic, and determined the impact of such diagnoses on uptake and tolerance to PEG-IFN/RBV. All HCV cases referred for assessment in Australian Capital Territory/surrounding regions April 2004-March 2012 were entered into a clinical database. We conducted univariate and multivariate analyses of variables correlating with uptake of antiviral therapy and frequency of treatment-related side-effects. Of 773 referred patients, 235 (30%) described pre-existing psychiatric illness. Among these, 26% received antiviral therapy, compared with 30% of 538 without psychiatric comorbidity. History of depression (usually validated by liaison psychiatry) was associated with higher incidence of treatment-related neuropsychiatric side-effects (odds ratio 2.79 [1.35-5.70], P < 0.05) but did not affect treatment outcome. Twenty-seven patients reported schizophrenia: three (11%) received antiviral therapy, compared with 30% admitting depression and 20% with bipolar affective disorder (all assessed by psychiatrist). In most schizophrenia cases, the reason for not offering antiviral treatment was psychological illness, yet none of five treated (these three plus two others in a psychiatric rehabilitation facility) experienced worsening psychiatric symptoms. A history of depression is common with hepatitis C but does not affect initiation of antiviral treatment, despite substantially increased risk of psychiatric side-effects. In contrast, pre-existing schizophrenia appears to influence treatment decisions, despite little evidence that PEG-IFN/RBV exacerbates the psychiatric condition, and well-supervised antiviral therapy can have good outcomes.

Impact of Illness Management and Recovery Programs on Hospital and Emergency Room Use by Medicaid Enrollees

PubMed Central

Salyers, Michelle P.; Rollins, Angela L.; Clendenning, Daniel; McGuire, Alan B.; Kim, Edward

2011-01-01

Objective Illness management and recovery is a structured program that helps consumers with severe mental illness learn effective ways to manage illness and pursue recovery goals. This study examined the impact of the program on health service utilization. Methods This was a retrospective cohort study of five assertive community treatment (ACT) teams in Indiana that implemented illness management and recovery. With Medicaid claims data from July 1, 2003, to June 30, 2008, panel data were created with person-months as the level of analysis, resulting in 14,261 observations, for a total of 498 unique individuals. Zero-inflated negative binomial regression models were used to predict hospitalization days and emergency room visits, including covariates of demographic characteristics, employment status, psychiatric diagnosis, and concurrent substance use disorder. The main predictor variables of interest were receipt of illness management and recovery services, dropout from the program, and program graduation status. Results Consumers who received some illness management and recovery services had fewer hospitalization days than those receiving only ACT. Graduates had fewer emergency room visits than did ACT-only consumers. Conclusions This is the first study to examine the impact of illness management and recovery on service utilization. Controlling for a number of background variables, the study showed that illness management and recovery programs were associated with reduced inpatient hospitalization and emergency room use over and above ACT. PMID:21532077

Active ingredients in anti-stigma programmes in mental health.

PubMed

Pinfold, Vanessa; Thornicroft, Graham; Huxley, Peter; Farmer, Paul

2005-04-01

This paper draws upon a review of the relevant literature and the results of the recent Mental Health Awareness in Action (MHAA) programme in England to discuss the current evidence base on the active ingredients in effective anti-stigma interventions in mental health. The MHAA Programme delivered educational interventions to 109 police officers, 78 adults from different community groups whose working lives involved supporting people with mental health problems but who had received no mental health training and 472 schools students aged 14-15. Each adult target group received two intervention sessions lasting two hours. The two school lessons were 50 minutes each. Knowledge, attitudes and behavioural intent were assessed at baseline and follow-up. In addition focus groups were held with mental health service users to explore the impact of stigma on their lives and facilitators of educational workshops were interviewed to provide expert opinion on 'what works' to reduce psychiatric stigma. Personal contact was predictive of positive changes in knowledge and attitudes for the school students but not the police officers or community adult group. The key active ingredient identified by all intervention groups and workshop facilitators were the testimonies of service users. The statements of service users (consumers) about their experience of mental health problems and of their contact with a range of services had the greatest and most lasting impact on the target audiences in terms of reducing mental health stigma.

Use of inpatient psychiatric services on a U.S. Army combat support post during Operations Desert Shield and Desert Storm: the stress of non-deployment.

PubMed

Koshes, R J; Rothberg, J M

1994-06-01

We studied the utilization of inpatient psychiatric services during Operations Desert Shield and Desert Storm (the Persian Gulf War of 1990-1991) on a U.S. Army combat support post. Inpatient psychiatric admissions and dispositions for the post's catchment area were tallied before, during, and after Operations Desert Shield and Desert Storm. Subjects included active duty soldiers (deployed soldiers were not studied while they were away from the post), their families, and retirees. Overall, there was no increase in psychiatric hospitalizations for active duty soldiers, their family members, or retirees. However, coincident with the return of soldiers from Operations Desert Shield and Desert Storm, the psychiatric proportion of all hospitalizations increased in the subpopulation of soldiers not deployed who had served less than 1 year. These soldiers in training may be more susceptible to increased stress levels associated with the return of soldiers from war because of their inadequate group bonding.

Methodological challenges in evaluating the effectiveness of women's crisis houses compared with psychiatric wards: findings from a pilot patient preference RCT.

PubMed

Howard, Louise M; Leese, Morven; Byford, Sarah; Killaspy, Helen; Cole, Laura; Lawlor, Caroline; Johnson, Sonia

2009-10-01

There are several methodological difficulties to address when evaluating acute psychiatric services. This study explored potential methods in evaluating the effectiveness of women's crisis houses compared with psychiatric wards in a pilot patient preference randomized controlled trial. Women requiring voluntary admission to a psychiatric hospital or women's crisis house were asked to enter this pilot and different options for recruitment were explored, including different recruitment sites in the pathway to admission and methods for including women without capacity. Forty-one percent (n = 42) of women entering the study agreed to be randomized and 59% (n = 61) entered patient preference arms. Only 7% of women were recruited before admission and 1 woman without capacity entered the study, despite procedures to facilitate this. Recruitment of patients with acute psychiatric crises is therefore challenging; researchers evaluating acute services should establish a consensus on how ethically and practically to recruit patients in this setting.

Positive attitudes towards psychiatry among Chinese medical students.

PubMed

Williams, Joshua A; Liu, Ni; Afzal, Khalid; Cooper, Brian; Sherer, Renslow; Morgan, Ivy; Dong, Hongmei

2014-02-01

Increasingly positive attitudes have been reported among young people in China towards mental illness, but little is known about Chinese medical students' attitudes towards psychiatry, psychiatric services and patients. We administered a bilingual survey to Wuhan University medical students in the final years of their clinical training. Primary outcomes were composite scores on a 21-item attitudes toward psychiatry (ATP) survey and the number of correct responses to diagnostic questions following a series of three clinical case vignettes. Mean composite score on the ATP items was 78/105 (SD = 9.6), representing overall positive attitudes among the students. Female gender and having learned about more psychiatric disorders were positively associated with a higher mean ATP score and remained so after adjustment for relevant covariates. Chinese medical students reported positive attitudes towards psychiatry, openness with regard to psychiatric services, and respect for psychiatric patients. Learning about a broad spectrum of psychiatric diagnoses and greater clinical contact with patients may improve overall attitudes of Chinese medical students towards psychiatry and their ability to make accurate diagnoses.

Trends in acute mental health care: comparing psychiatric and substance abuse treatment programs.

PubMed

Timko, Christine; Lesar, Michelle; Calvi, Noël J; Moos, Rudolf H

2003-01-01

This study compared psychiatric and substance abuse acute care programs, within both inpatient and residential modalities of care, on organization and staffing, clinical management practices and policies, and services and activities. A total of 412 (95% of those eligible) Department of Veterans Affairs' programs were surveyed nationwide. Some 40% to 50% of patients in psychiatric and substance abuse programs, in both inpatient and residential venues of care, had dual diagnoses. Even though psychiatric programs had a sicker patient population, they provided fewer services, including basic components of integrated programs, than substance abuse programs did. Findings also showed that there is a strong emphasis on the use of clinical practice guidelines, performance monitoring, and obtaining client satisfaction and outcome data in mental health programs. The author's suggest how psychiatric programs might better meet the needs of acutely ill and dually diagnosed patients (e.g., by incorporating former patients as role models and mutual help groups, as substance abuse programs do; and by having policies that balance patient choice with program demand).

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…

Childhood Trauma and Psychiatric Disorders as Correlates of School Dropout in a National Sample of Young Adults

ERIC Educational Resources Information Center

Porche, Michelle V.; Fortuna, Lisa R.; Lin, Julia; Alegria, Margarita

2011-01-01

The effect of childhood trauma, psychiatric diagnoses, and mental health services on school dropout among U.S.-born and immigrant youth is examined using data from the Collaborative Psychiatric Epidemiology Surveys, a nationally representative probability sample of African Americans, Afro-Caribbeans, Asians, Latinos, and non-Latino Whites,…

Effect of timing of psychiatry consultation on length of pediatric hospitalization and hospital charges.

PubMed

Bujoreanu, Simona; White, Matthew T; Gerber, Bradley; Ibeziako, Patricia

2015-05-01

The purpose of this study was to evaluate the impact of timing of a psychiatry consultation during pediatric hospitalization on length of hospital stay and total hospitalization charges. The charts of 279 pediatric patients (totaling 308 consultations) referred to the psychiatry consultation liaison service at a freestanding tertiary pediatric hospital between January 1, 2010, and June 30, 2010 were retrospectively analyzed. The variables analyzed included the following: patient demographic characteristics; dates of admission, psychiatric consultation, and discharge; psychiatric diagnoses based on the psychiatric diagnostic evaluation; psychiatric treatment disposition; and illness severity and total charges associated with the medical stay. Earlier psychiatry consultation was associated with shorter length of stay and lower hospitalization charges after adjusting for psychiatric functioning, physical illness severity, and psychiatric disposition. Poorer psychiatric functioning and milder physical illness were associated with shorter referral time. Timely involvement of psychiatry consultation services during a medical or surgical hospitalization was associated with reductions in length of stay and total hospital charges in pediatric settings. These findings have important effects on quality of care via decreasing burden on the patient and family and on the medical system resources. Educating pediatric health care providers about the importance of early psychiatry consultation regardless of physical illness severity or psychiatric acuity will likely improve resource management for patients and hospitals. Copyright © 2015 by the American Academy of Pediatrics.

42 CFR 483.368 - Application of time out.

Code of Federal Regulations, 2010 CFR

2010-10-01

... Participation for the Use of Restraint or Seclusion in Psychiatric Residential Treatment Facilities Providing Inpatient Psychiatric Services for Individuals Under Age 21 § 483.368 Application of time out. (a) A...

The impact of facility relocation on patients' perceptions of ward atmosphere and quality of received forensic psychiatric care.

PubMed

Alexiou, Eirini; Degl' Innocenti, Alessio; Kullgren, Anette; Wijk, Helle

2016-08-01

In recent years, large groups of forensic psychiatric patients have been relocated into new medium- and maximum-security forensic psychiatric facilities in Sweden, where a psychosocial care approach is embedded. From this perspective and on the assumption that physical structures affect the therapeutic environment, a prospective longitudinal study was designed to investigate the impact of the facility relocation of three forensic psychiatric hospitals on patients' perceptions of ward atmosphere and quality of received forensic psychiatric care. Participants were patients over 18 years of age sentenced to compulsory forensic psychiatric treatment. Data were obtained by validated questionnaires. Overall, 58 patients (78%) answered the questionnaires at baseline with a total of 25 patients (34%) completing follow-up 1 at six months and 11 patients (15%) completing follow-up 2, one year after relocation. Approximately two-thirds of the participants at all time-points were men and their age range varied from 18 to 69. The results of this study showed that poor physical environment features can have a severe impact on care quality and can reduce the possibilities for person-centered care. Furthermore, the study provides evidence that the patients' perceptions of person-centered care in forensic psychiatric clinics are highly susceptible to factors in the physical and psychosocial environment. Future work will explore the staff's perception of ward atmosphere and the possibilities to adapt a person-centered approach in forensic psychiatric care after facility relocation. Copyright © 2016 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.

Twelve-month mental disorders in South Africa: prevalence, service use and demographic correlates in the population-based South African Stress and Health Study

PubMed Central

Williams, D. R.; Herman, A.; Stein, D. J.; Heeringa, S. G.; Jackson, P. B.; Moomal, H.; Kessler, R. C.

2009-01-01

Background South Africa’s history and current social conditions suggest that mental disorders are likely to be a major contributor to disease burden, but there has been no national study using standardized assessment tools. Method The South African Stress and Health Study was a nationally representative in-person psychiatric epidemiological survey of 4351 adults (aged ≥18 years) that was conducted as part of the WHO World Mental Health (WMH) Survey Initiative between January 2002 and June 2004. Twelve-month prevalence and severity of DSM-IV disorders, treatment, and sociodemographic correlates were assessed with Version 3.0 of the WHO Composite International Diagnostic Interview (CIDI 3.0). Results The 12-month prevalence of any DSM-IV/CIDI disorder was 16.5%, with 26.2% of respondents with disorder classified as severe cases and an additional 31.1% as moderately severe cases. The most common disorders were agoraphobia (4.8 %), major depressive disorder (4.9%) and alcohol abuse or dependence (4.5 %). Twenty-eight percent of adults with a severe or moderately severe disorder received treatment compared to 24.4% of mild cases. Some 13.8% of persons with no disorder received treatment. Treatment was mostly provided by the general medical sector with few people receiving treatment from mental health providers. Conclusions Psychiatric disorders are much higher in South Africa than in Nigeria and there is a high level of unmet need among persons with severe and moderately severe disorders. PMID:17903333

"Why Are You Here? Can't You Cope at Home?" The Psychiatric Crisis of People with Intellectual Disabilities and the Community's Response

ERIC Educational Resources Information Center

Spassiani, Natasha; Abou Chacra, Megan Sarah; Lunsky, Yona

2017-01-01

Introduction: Individuals with intellectual disability (ID) are high users of emergency mental health services and can experience stigmatization in these circumstances. The purpose of the study was to examine the experiences of people with ID living in the community who interact with emergency services as a result of a psychiatric crisis, from the…

Integration of a Psychiatric Service in a Long-Term Charitable Facility for People with Intellectual Disabilities: A 5-Year Medication Survey

ERIC Educational Resources Information Center

Ruggerini, Ciro; Guaraldi, Gian Paolo; Russo, Angela; Neviani, Vittoria; Castagnini, Augusto

2004-01-01

Since the implementation of a psychiatric service in a long-term facility for people with intellectual disability, the usage of psychotropic and anti-convulsant drugs has been surveyed over the 5-year period 1994-1999. At that time, although the overall prevalence rate of residents on medication was not declining significantly, a decrease in…

A national study of transitional hospital services in mental health.

PubMed Central

Dorwart, R A; Hoover, C W

1994-01-01

OBJECTIVES. Shifts in care for the seriously mentally ill from inpatient to community-based treatment have highlighted the importance of transitional care. Our objectives were to document the kinds and quantity of transitional services provided by psychiatric hospitals nationally and to assess the impact of hospital type (psychiatric vs general), ownership (public vs private), case mix, and revenue source on provision of these services. METHODS. A national sample of nonfederal inpatient mental health facilities (n = 915) was surveyed in 1988, and data were analyzed by using multiple regression. RESULTS. Half (46%) of the facilities surveyed provided patient follow-up of 1 week or less, and almost all (93%) conducted team review of discharge plans, but 74% provided no case management services. Hospital type was the most consistent predictor of transitional care, with psychiatric hospitals providing more of these services than general hospitals. Severity of illness, level of nonfederal funding, urbanicity, and teaching hospital affiliation were positively associated with provision of case management. CONCLUSIONS. Transitional care services for mentally ill patients leaving the hospital were found to be uneven and often inadequate. Reasons for broad variation in services are discussed. PMID:8059877

Correlates of past-year mental health service use among Latinos: results from the National Latino and Asian American Study.

PubMed

Alegría, Margarita; Mulvaney-Day, Norah; Woo, Meghan; Torres, Maria; Gao, Shan; Oddo, Vanessa

2007-01-01

We examined correlates and rates of past-year mental health service use in a national sample of Latinos residing in the United States. We used data from the National Latino and Asian American Study, a national epidemiological household survey of Latinos. Cultural factors such as nativity, language, age at migration, years of residence in the United States, and generational status were associated with whether or not Latinos had used mental health services. However, when the analysis was stratified according to past-year psychiatric diagnoses, these associations held only among those who did not fulfill criteria for any of the psychiatric disorders assessed. Rates of mental health service use among those who did not fulfill diagnostic criteria were higher among Puerto Ricans and US-born Latinos than among non-Puerto Ricans and foreign-born Latinos. Rates of mental health service use among Latinos appear to have increased substantially over the past decade relative to rates reported in the 1990s. Cultural and immigration characteristics should be considered in matching mental health services to Latinos who need preventive services or who are symptomatic but do not fulfill psychiatric disorder criteria.

Hormonal Contraception and Risk of Psychiatric and Other Noncommunicable Diseases in HIV-Infected Women

PubMed Central

Jenkins, Cathy A.; Shepherd, Bryan E.; Bebawy, Sally S.; Turner, Megan; Sterling, Timothy R.; Melekhin, Vlada V.

2015-01-01

Abstract Background: Hormonal contraception use is common among human immunodeficiency virus (HIV)-infected women. Risk of psychiatric and other noninfectious complications of hormonal contraception use has not been described in this population. Methods: We performed a retrospective cohort study of HIV-infected women receiving care in Tennessee from 1998 to 2008 to examine the risks of incident psychiatric and other noncommunicable diseases (NCDs), including cardiovascular, hepatic, renal, and malignant diseases, and hormonal contraception use, including depot medroxyprogesterone acetate (DMPA) and combined estrogen- and progestin-containing hormonal contraceptives. We used marginal structural models with inverse probability weights to account for time-varying confounders associated with hormonal contraception use. Results: Of the 392 women included, 94 (24%) used hormonal contraception during the study period. Baseline psychiatric disease was similar between women who received and did not receive hormonal contraception. There were 69 incident psychiatric diagnoses and 72 NCDs. Only time-varying DMPA use was associated with increased risk of psychiatric disease (adjusted odds ratio [aOR] 3.70; 95% confidence interval [95% CI] 1.32–10.4) and mood disorders, specifically (aOR 4.70 [1.87–11.8]). Time-varying and cumulative combined hormonal contraception use were not statistically associated with other NCDs (aOR 1.64, 95% CI 0.64–4.12 and aOR 1.16, 95% CI 0.86–1.56, respectively). However, risk of incident NCDs was increased with cumulative DMPA exposure (per year exposure aOR 1.45, 95% CI 1.01–2.08). Conclusions: Among HIV-infected women, DMPA was associated with risk of incident psychiatric diseases, particularly mood disorders, during periods of use. Cumulative DMPA exposure was also associated with risk of other NCDs. However, combined estrogen and progestin-containing hormonal contraception use was not statistically associated with risk of any NCDs. PMID:25751720

Clinical findings of the second 1000 UK Gulf War veterans who attended the Ministry of Defence's Medical Assessment Programme.

PubMed

Lee, H A; Gabriel, R; Bale, A J; Bolton, P; Blatchley, N F

2001-06-01

To review the diagnoses made in the second 1000 veterans of the Gulf conflict 1990-91 seen in the Ministry of Defence's Gulf Veterans' Medical Assessment Programme and to determine the main conditions related to Gulf service. Case series of 1000 consecutive Gulf veterans who presented to the programme between 25 February 1997 and 19 February 1998. Gulf War veterans. Assessment of the patient's health status. Diagnosis of medical and psychiatric conditions using ICD-10. 204 patients were unwell. 309 patients had organic disease, of whom 248 were well, 252 had psychiatric conditions which remained active in 173. The remaining 79, now well, had had psychiatric disorders following Gulf service. The principal psychiatric diagnosis was post traumatic stress disorder and the majority arose as a result of Gulf service. 796 (80%) veterans were well. There were 309 (31%) patients with organic disease. 252 (25%) veterans had psychiatric conditions of which 173 (69%) had an active diagnosed disorder and post traumatic stress disorder was the predominant condition. The pattern of disease is similar to that seen in NHS practice. We found, like others, no evidence to support a unique Gulf War syndrome. Post conflict illnesses have many common features.

How patient participation is constructed in mental health care: a grounded theory study.

PubMed

Jørgensen, Kim; Rendtorff, Jacob Dahl; Holen, Mari

2018-05-06

The aim of the study was to explore how patient participation is constructed in social interaction processes between nurses, other health professionals and service users, and which structures provide a framework for the participation of service users in a psychiatric context? Ten tape-recorded interviews of nurses and observations of interactions between nurses, other health professionals and service users reflected differing constructed views of patient participation. Charmaz's interpretation of the grounded theory method was used, and the data were analysed using constant comparative analysis. The study was designed in accordance with the ethical principles of the Helsinki Declaration (1) and Danish law (2). Each study participant in the two psychiatric departments gave informed consent after verbal and written information. The articulation of patient participation emphasises the challenge between, on the one side, orientations of ethical care, and, on the other, paternalism and biomedicine. The core category was generated from four inter-related categories: (i) taking care of the individual needs; (ii) the service user as expert; and (iii) biomedicine, and (iv) paternalism, and their 13 subcategories. This study illuminates the meaning of patient participation in a psychiatric context based on social interaction between nurses, other health professionals and service users. This can contribute to dealing with the challenges of incorporating patient participation as an ideology in all service users in a psychiatric context and is therefore important knowledge for health professionals. © 2018 Nordic College of Caring Science.

Course of Psychiatric Symptoms and Abstinence among Methamphetamine-Dependent Persons in Sober Living Recovery Homes.

PubMed

Polcin, Douglas L; Witbrodt, Jane; Korcha, Rachael; Gupta, Shalika; Mericle, Amy A

2016-01-01

Although studies of co-occurring psychiatric disorders among methamphetamine (MA)-dependent persons have been conducted in treatment programs, none have examined them in service settings used to sustain long-term recovery, such as sober living houses (SLHs). Residents entering SLHs (N = 243) were interviewed within two weeks and at 6-, 12-, and 18-month follow-up. Measures assessed psychiatric symptoms using the Brief Symptom Inventory (BSI), past-year drug and alcohol dependence, and abstinence over six-month time periods. Overall, severity of psychiatric symptoms on the BSI was similar among MA-dependent and other dependent residents. Global psychiatric severity, depression, and somatization scales on the BSI predicted abstinence for both groups. However, phobic anxiety and hostility scales were associated with abstinence for MA-dependent residents but not for those dependent on other substances. The similarity of psychiatric symptoms among persons with and without MA dependence in SLHs is different from what studies have found in treatment programs. The association between psychiatric symptoms and abstinence for both groups suggests SLHs should consider provision of on- or off-site mental health services. Additional research is needed to understand why phobic anxiety and hostility are associated with abstinence among MA-dependent residents but not those dependent on other substances.

Psychosocial correlates of using faith healing services in Riyadh, Saudi Arabia: a comparative cross-sectional study.

PubMed

Alosaimi, Fahad D; Alshehri, Youssef; Alfraih, Ibrahim; Alghamdi, Ayedh; Aldahash, Saleh; Alkhuzayem, Haifa; Al-Beeshi, Haneen

2015-01-01

In this study, we compared the prevalence of psychiatric disorders and the characteristics of those who either use or do not use faith healers (FHs) services. We also assessed the independent factors of study subjects associated with using FHs. This cross-sectional study compared those who use FHs (n = 383) with a control group of those who do not use them (i.e., shopping mall visitors, n = 424) using a survey of sociodemographic characteristics and a validated Arabic version of the Mini International Neuropsychiatric Interview (MINI 6.0). Participants who ranked higher among FH users included males, people who were either married, divorced, or widowed, those with less education, and those with lower income. They were more likely to report past medical and psychiatric history. Those with diagnosable psychiatric disorders were more likely to visit FHs, especially if the diagnosis was of psychotic and bipolar disorders. The prevalence of psychiatric disorders was higher among FH users, and depressive and anxiety disorders were the most prevalent. The study showed that having past psychiatric history and a current psychiatric disorder are risk factors for using FHs. Also, a high percentage of FH users had a diagnosable psychiatric disorder. Further research should assess how to facilitate their access to the mental health system.

Treatment needs of prisoners with psychiatric disorders.

PubMed Central

Gunn, J; Maden, A; Swinton, M

1991-01-01

OBJECTIVE--To describe the prevalence of psychiatric disorder and the treatment needs of sentenced prisoners in England and Wales. DESIGN--Population survey based on a 5% sample of men serving prison sentences. SETTING--Sixteen prisons for adult males and nine institutions for male young offenders representative of all prisons in prison type, security levels, and length of sentences. SUBJECTS--406 young offenders and 1478 adult men, 404 and 1365 of whom agreed to be interviewed. MAIN OUTCOME MEASURES--History of psychiatric disorder, clinical diagnosis of psychiatrist, and required treatment. RESULTS--652 (37%) men had psychiatric disorders diagnosed, of whom 15 (0.8%) had organic disorders, 34 (2%) psychosis, 105 (6%) neurosis, 177 (10%) personality disorder, and 407 (23%) substance misuse. 52 (3%) were judged to require transfer to hospital for psychiatric treatment, 96 (5%) required treatment in a therapeutic community setting, and a further 176 (10%) required further psychiatric assessment or treatment within prison. CONCLUSIONS--By extrapolation the sentenced prison population includes over 700 men with psychosis, and around 1100 who would warrant transfer to hospital for psychiatric treatment. Provision of secure treatment facilities, particularly long term medium secure units, needs to be improved. Services for people with personality, sexual, and substance misuse disorders should be developed in both prisons and the health service. PMID:1912775

Course of Psychiatric Symptoms and Abstinence among Methamphetamine Dependent Persons in Sober Living Recovery Homes

PubMed Central

Polcin, Douglas; Witbrodt, Jane; Korcha, Rachael; Gupta, Shalika; Mericle, Amy A.

2016-01-01

Background Although studies of co-occurring psychiatric disorders among methamphetamine (MA) dependent persons have been conducted in treatment programs, none have examined them in service settings used to sustain long-term recovery, such as sober living houses (SLHs). Methods Residents entering SLHs (N=243) were interviewed within two weeks and at 6-, 12-, and 18-month follow-up. Measures assessed psychiatric symptoms using the Brief Symptom Inventory (BSI), past year drug and alcohol dependence, and abstinence over 6-month time periods. Results Overall, severity of psychiatric symptoms on the BSI were similar among MA dependent and other dependent residents. Global psychiatric severity, depression and somatization scales on the BSI predicted abstinence for both groups. However, phobic anxiety and hostility scales were associated with abstinence for MA dependent residents but not for those dependent on other substances. Conclusion The similarity of psychiatric symptoms among persons with and without MA dependence in SLHs is different from what studies have found in treatment programs. The association between psychiatric symptoms and abstinence for both groups suggests SLHs should consider provision of on- or off-site mental health services. Additional research is needed to understand why phobic anxiety and hostility are associated with abstinence among MA dependent residents but not those dependent on other substances. PMID:27184803

42 CFR 482.60 - Special provisions applying to psychiatric hospitals.

Code of Federal Regulations, 2010 CFR

2010-10-01

... medicine or osteopathy, psychiatric services for the diagnosis and treatment of mentally ill persons; (b... determine the degree and intensity of treatment furnished to Medicare beneficiaries, as specified in § 482...

Patterns of admission to acute psychiatric in-patient facilities: a national survey in Italy.

PubMed

Preti, A; Rucci, P; Santone, G; Picardi, A; Miglio, R; Bracco, R; Norcio, B; de Girolamo, G

2009-03-01

A proper understanding of patterns of care represents a crucial step in improving clinical decision making and enhancing service provision. Only a few studies, however, have explored global patterns of psychiatric admissions nationwide, and none have been undertaken in Italy. Sociodemographic, clinical and treatment-related information was collected for 1577 patients admitted to 130 public and 36 private in-patient facilities in Italy during an index period in the year 2004. All patients were also rated using the 24-item Brief Psychiatric Rating Scale (BPRS) and the Personal and Social Performance (PSP) rating scales. Non-affective psychoses (36%) were the most common diagnoses and accounted to a large extent for compulsory admissions. Private facilities were more likely to admit patients with organic mental disorders and substance abuse/dependence and less likely to admit patients with non-affective psychoses. Overall, 77.8% of patients had been receiving treatment by a mental health professional in the month prior to admission. In 54% of cases, the admission was solicited by patients' family members. The main factors preceding admission were impairment in work or social functioning, social withdrawal, and conflict with family members. Agitation, delusions and/or hallucinations, and the presence of multiple problems were associated with compulsory admissions, whereas depressive and anxiety symptoms were associated with voluntary admissions. In a mixed, public-private psychiatric care system, like the Italian one, public and private facilities admit patients with widely different clinical characteristics and needs. Family support represents an important resource for most patients, and interventions specifically addressed to relieving family burden are warranted.

Impact of the New Mental Health Services on Rates of Suicide and Hospitalisations by Attempted Suicide, Psychiatric Problems, and Alcohol Problems in Brazil.

PubMed

Machado, Daiane B; Alves, Flávia Jôse; Rasella, Davide; Rodrigues, Laura; Araya, Ricardo

2018-05-01

A sizeable proportion of all suicides have mental health issues in the background. The association between access to mental health care in the community and decreased suicide rates is inconsistent in the literature. Brazil undertook a major psychiatric reform strengthening psychiatric community-based care. To evaluate the impact of the new Brazilian community mental health care units (CAPS-Psychosocial-Community-Centres) on municipal rates of suicide, and hospitalisations by attempted suicide, psychiatric and alcohol problems. We performed robust multivariable negative binomial regression models with fixed effect for panel data from all 5507 Brazilian municipalities. Suicide and hospitalization rates were calculated by sex and standardised by age for each municipality and year from 2008 to 2012. The main variable of interest was municipal CAPS coverage. CAPS municipal coverage was associated with lower suicide rates but this was not statistically significant (RR: 0.981; 95% CI 0.952-1.011). However, increased CAPS coverage was associated with lower hospitalizations for attempted suicide (RR: 0.887; 95% CI 0.841-0.935), psychiatric (RR: 0.841; 95% CI 0.821-0.862), and alcohol problems (RR: 0.882; 95% CI 0.860-0.904). Our results suggest that access to community mental health services seems to reduce hospitalisations due to attempted suicide, psychiatric and alcohol problems but not suicidal rates. Therefore, increased investments in community mental health services in low-middle-income countries might decrease costs associated with potentially avoidable hospitalizations.

[Many faces of deinstitutionalization--sociological interpretation].

PubMed

Forster, R

2000-09-01

The article summarizes in an international perspective what kind of results psychiatric deinstitutionalization has brought so far: a profound change of size and functions of the psychiatric hospital; better services for people with less severe problems; and the failing of community services to compensate for some of the functions of the former asylums, resulting in trans-institutionalization and/or neglect for many chronic patients. Three different sociological versions to explain the background and typical outcomes of psychiatric deinstitutionalization have been brought forward so far: political economy, professional dominance and post-structuralism. They are confronted with an approach using the concept of medicalisation which offers a more comprehensive understanding of the process.

Associations among Major Psychiatric Diagnoses.

ERIC Educational Resources Information Center

Wolf, Abraham W.; And Others

1988-01-01

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

Quality of life of caregivers with relatives suffering from mental illness in Hong Kong: roles of caregiver characteristics, caregiving burdens, and satisfaction with psychiatric services

PubMed Central

2012-01-01

Background The study attempted to explore the quality of life (QoL) of Chinese caregivers with mentally ill relatives. It also aimed to examine the differential roles of caregiving burdens, caregiver characteristics, and satisfaction with psychiatric services in caregivers' QoL. Methods 276 caregivers with relatives attending community psychiatric facilities in Hong Kong were invited to fill out a questionnaire. One sample t-tests were conducted to compare the results of this study with that of other Chinese populations in Hong Kong, Taiwan, and mainland China. A hierarchical regression analysis was performed to examine the relative influence of different factors on caregivers' QoL. Results Our sample of caregivers had significantly lower QoL scores than other Chinese populations. Results also suggest that Chinese caregivers who had chronic illness, younger in age, a lower education level, experienced more difficulties in handling negative symptoms, and were more dissatisfied with mental health services had poorer quality of life. Indeed, caregiver characteristics displayed a much stronger association with caregivers' QoL than did caregiving burdens and satisfaction with psychiatric services. Conclusions This study supports the strong association of caregiver characteristics and the QoL of caregivers and establishes the nature of the relationship between satisfaction with mental health services and caregiver QoL. Implications for future research and practice are discussed. PMID:22289443

Characteristics of third-party money management for persons with psychiatric disabilities.

PubMed

Elbogen, Eric B; Swanson, Jeffrey W; Swartz, Marvin S; Wagner, H Ryan

2003-08-01

The study examined different types of third-party money management arrangements for persons with psychiatric disabilities and consumers' perceptions of their finances in the context of these arrangements. Clinical and demographic data were collected through structured interviews and record reviews for 240 persons with a diagnosis of a psychotic or major affective disorder who had been involuntarily hospitalized and were awaiting discharge on outpatient commitment in North Carolina. All consumers were receiving Supplemental Security Income or Social Security Disability Insurance. Third-party money management arrangements were reported by 102 (41 percent) of the study participants. A majority (77 percent) of these consumers had their finances managed by a family member. Consumers with third-party money managers were more likely to have a median annual income below 5,000 US dollars, to have a diagnosis of a primary psychotic disorder, and to have substance use problems. Most participants with third-party money managers reported that they received sufficient money to cover basic expenses, although about half also perceived having insufficient money to participate in enjoyable activities. Given that treatment for severe mental illness emphasizes social skills training and development of social support networks, financial limitations could undermine therapeutic efforts. It is important that clinicians consider the role of financial concerns when assessing consumers. Additional research should be conducted to better understand the role of financial variables in providing effective mental health services.

A theoretical framework for psychiatric nursing practice.

PubMed

Onega, L L

1991-01-01

Traditionally, specific theoretical frameworks which are congruent with psychiatric nursing practice have been poorly articulated. The purpose of this paper is to identify and discuss a philosophical base, a theoretical framework, application to psychiatric nursing, and issues related to psychiatric nursing knowledge development and practice. A philosophical framework that is likely to be congruent with psychiatric nursing, which is based on the nature of human beings, health, psychiatric nursing and reality, is identified. Aaron Antonovsky's Salutogenic Model is discussed and applied to psychiatric nursing. This model provides a helpful way for psychiatric nurses to organize their thinking processes and ultimately improve the health care services that they offer to their clients. Goal setting and nursing interventions using this model are discussed. Additionally, application of the use of Antonovsky's model is made to nursing research areas such as hardiness, uncertainty, suffering, empathy and literary works. Finally, specific issues related to psychiatric nursing are addressed.

Mental health treatment patterns in perinatally HIV-infected youth and controls.

PubMed

Chernoff, Miriam; Nachman, Sharon; Williams, Paige; Brouwers, Pim; Heston, Jerry; Hodge, Janice; Di Poalo, Vinnie; Deygoo, Nagamah Sandra; Gadow, Kenneth D

2009-08-01

Youths perinatally infected with HIV often receive psychotropic medication and behavioral treatment for emotional and behavioral symptoms. We describe patterns of intervention for HIV-positive youth and youth in a control group in the United States. Three hundred nineteen HIV-positive youth and 256 controls, aged 6 to 17 years, enrolled in the International Maternal Adolescent AIDS Clinical Trials 1055, a prospective, 2-year observational study of psychiatric symptoms. One hundred seventy-four youth in the control group were perinatally exposed to HIV, and 82 youth were uninfected children living in households with HIV-positive members. Youth and their primary caregivers completed Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition-referenced symptom-rating scales. Children's medication and behavioral psychiatric intervention histories were collected at entry. We evaluated the association of past or current psychiatric treatment with HIV status, baseline symptoms, and impairment by using multiple logistic regression, controlling for potential confounders. HIV-positive youth and youth in the control group had a similar prevalence of psychiatric symptoms (61%) and impairment (14% to 15%). One hundred four (18%) participants received psychotropic medications (stimulants [14%], antidepressants [6%], and neuroleptic agents [4%]), and 127 (22%) received behavioral treatment. More HIV-positive youth than youth in the control group received psychotropic medication (23% vs 12%) and behavioral treatment (27% vs 17%). After adjusting for symptom class and confounders, HIV-positive children had twice the odds of children in the control group of having received stimulants and >4 times the odds of having received antidepressants. Caregiver-reported symptoms or impairment were associated with higher odds of intervention than reports by children alone. HIV-positive children are more likely to receive mental health interventions than control-group children. Pediatricians and caregivers should consider available mental health treatment options for all children living in families affected by HIV.

Psychiatric treatment received by primary care patients with panic disorder with and without agoraphobia.

PubMed

Marcks, Brook A; Weisberg, Risa B; Keller, Martin B

2009-06-01

Although the majority of individuals with panic disorder first present to the primary care setting, little is known about the psychiatric treatment that primary care patients with the disorder typically receive. The purpose of this study was to explore characteristics of treatment received by patients with panic disorder with agoraphobia and by those with panic disorder without agoraphobia, examine demographic and clinical predictors of receiving treatment, and explore treatment barriers. This study used data from the Primary Care Anxiety Project (PCAP), which is a naturalistic, longitudinal study of anxiety disorders among primary care patients. This study presents data for 235 PCAP participants diagnosed at the study intake assessment as having panic disorder with agoraphobia (N=150) or without agoraphobia (N=85). Many patients with panic disorder were not receiving psychiatric treatment at study intake (38%), with those without agoraphobia being less likely to receive treatment. Psychotropic medications were the treatment of choice, with selective serotonin reuptake inhibitors or serotonin and norepinephrine reuptake inhibitors being the most commonly received class of medications (34%). Only 38% of those with panic disorder with agoraphobia and 24% of those with panic disorder without agoraphobia were receiving psychotherapy, and the use of empirically supported interventions was rare. The most common treatment barriers were not believing in using medication or therapy for emotional problems and not receiving a treatment recommendation from one's provider. The findings suggest a need for better treatment dissemination, in addition to making interventions more accessible or adapting them to the particular needs of primary care patients.

Coping strategies and self-stigma among adolescents discharged from psychiatric hospitalization: a 6-month follow-up study.

PubMed

Moses, Tally

2015-03-01

The effects of mental illness stigma on adolescents receiving psychiatric treatment may largely be determined by their coping strategies. Yet, little is known about adolescents' use of stigma-coping strategies, or how helpful these are for addressing stigma-related stress. This study explores how adolescents discharged from psychiatric hospitalization anticipate coping with a hypothetical social stigma event related to hospitalization. We examine how well anticipated coping strategies predict adolescents' self-stigma ratings following 6 months. To evaluate the direction of causality, the reverse order of effects, the influence of self-stigma on coping strategies, is also assessed. A voluntary sample of 80 adolescents participated in two face-to-face interviews that assessed coping and self-stigma. Anticipated (baseline) and actual (follow-up) coping strategies were measured with a modified Response to Stress Questionnaire (primary and secondary control engagement coping, disengagement) and two stigma-specific strategies developed for this study (disconfirming stereotypes and aggression/confrontation). Relationships between anticipated coping strategies and self-stigma were assessed with ordinary least squares (OLS) regression; multivariate general linear modeling (GLM) and structural equation modeling (SEM) explored the reverse associations. Youth reporting higher self-stigma ratings at follow-up anticipated using more disengagement and effort to disconfirm stereotypes and less secondary control engagement coping at baseline. Anticipated use of secondary control engagement coping was uniquely significant in predicting participants' self-stigma when controlling for baseline self-stigma. At the same time, higher baseline self-stigma ratings predicted less adaptive coping (disengagement and effort to disconfirm stereotypes) at follow-up. The results point to the particular importance of secondary control engagement coping for helping to mitigate the impact of peer prejudice or discrimination on self-stigma among youth receiving psychiatric services. At the same time, higher initial levels of self-stigma likely drive less adaptive coping with peer stigma. These bidirectional influences point to a vicious cycle between internalizing negative stereotypes and coping in ways that perpetuate negative outcomes. © The Author(s) 2014.

Case-based reimbursement for psychiatric hospital care.

PubMed

Sederer, L I; Eisen, S V; Dill, D; Grob, M C; Gougeon, M L; Mirin, S M

1992-11-01

A fixed-prepayment system (case-based reimbursement) for patients initially requiring hospital-level care was evaluated for one year through an arrangement between a private nonprofit psychiatric hospital and a self-insured company desiring to provide psychiatric services to its employees. This clinical and financial experiment offered a means of containing costs while monitoring quality of care. A two-group, case-control study was undertaken of treatment outcomes at discharge, patient satisfaction with hospital care, and service use and costs during the program's first year. Compared with costs for patients in the control group, costs for those in the program were lower per patient and per admission; cumulative costs for patients requiring rehospitalization were also lower. However, costs for outpatient services for patients in the program were not calculated. Treatment outcomes and patients' satisfaction with hospital care were comparable for the two groups.

[Psychiatric outpatient consultation-liaison services--how do they work and what are their effects: results of a pilot study?].

PubMed

Kirchen-Peters, Sabine; Fehrenbach, Rosa-Adelinde; Diefenbacher, Albert

2012-11-01

Many patients benefit from interventions performed by the psychiatric liaison service. Prospective longitudinal study of community dwelling elderly patients supplemented by a questionnaire answered by family members, as well as expert interviews with the members of the consultation-liaison team and semi-structured interviews with family members. The majority of patients had some benefit from the liaison psychiatric interventions, access to care was improved and lack of specialist support was reduced. In addition there was some cost offset due to prevention of admissions to nursing homes and inpatient hospital treatment. With regard to demographic developments gerontopsychiatric liaison services should be integrated into the present system of health care. This should be supported by adjusting judicial obstacles that hamper such strategies. © Georg Thieme Verlag KG Stuttgart · New York.

Text Messaging for Psychiatric Outpatients: Effect on Help-Seeking and Self-Harming Behaviors.

PubMed

Kodama, Toyohiko; Syouji, Hiroko; Takaki, Sachiko; Fujimoto, Hirokazu; Ishikawa, Shinichi; Fukutake, Masaaki; Taira, Masaru; Hashimoto, Takeshi

2016-04-01

A mobile phone intervention was developed and tested with 30 psychiatric outpatients with mental illness, who had high ideation for suicide. The intervention involved promoting help-seeking behaviors by sending text messages, including information about social welfare services and reminders about medical appointments, for 6 months. After the intervention period, the number of participants who used social services significantly increased, and more than 80% of participants reported that the text messaging service was helpful and useful. Compared to baseline, participants' self-harming behaviors decreased and the attending psychiatrists rated their suicide ideation as weaker. This is the first intervention study to promote psychiatric patients' help-seeking using text messaging, and although it was not a randomized controlled trial, this intervention has practical value and may lead to the prevention of suicide. Copyright 2016, SLACK Incorporated.

[Head of psychiatric service--a position or a vocation?].

PubMed

Iastrebov, V S

2006-01-01

An attempt to create a social and psychological image of contemporary psychiatric department leader has been made. Professional and social activity of a modern head physician, his personal, business and other qualities are described. Taking into account these characteristics, the author suggests a system of competitive selection for this position and a broad discussion of the problem in psychiatric society.

Suicide risk assessment practices: a national survey of generalist drug and alcohol residential rehabilitation services.

PubMed

Ross, Joanne; Darke, Shane; Kelly, Erin; Hetherington, Kate

2012-09-01

Clients of drug and alcohol treatment services represent a high-risk group for attempted and completed suicide. The current study sought to examine suicide risk assessment practices in Australian generalist residential rehabilitation services. Semistructured interviews were conducted with managers of residential rehabilitation services and with volunteers from staff responsible for the case management/treatment of clients. Ninety per cent of services participated. In total, 64 managers and 142 staff were interviewed. One-third of services had no documented policy for the assessment and management of suicide risk, and one-quarter of staff had never received formal training in risk assessment. In more than one-third of agencies staff were not expected to use a structured suicide risk assessment tool when assessing a client's acute risk. To varying degrees agencies were gathering information about psychiatric comorbidity, but this information did not appear to be routinely integrated into the client's suicide risk assessment. The development of clearly documented polices, standardised assessment tools and the provision of annual training for all staff would help to address some of the gaps identified in current practice. © 2012 Australasian Professional Society on Alcohol and other Drugs.

Housing First, Consumer Choice, and Harm Reduction for Homeless Individuals With a Dual Diagnosis

PubMed Central

Tsemberis, Sam; Gulcur, Leyla; Nakae, Maria

2004-01-01

Objectives. We examined the longitudinal effects of a Housing First program for homeless, mentally ill individuals’ on those individuals’ consumer choice, housing stability, substance use, treatment utilization, and psychiatric symptoms. Methods. Two hundred twenty-five participants were randomly assigned to receive housing contingent on treatment and sobriety (control) or to receive immediate housing without treatment prerequisites (experimental). Interviews were conducted every 6 months for 24 months. Results. The experimental group obtained housing earlier, remained stably housed, and reported higher perceived choice. Utilization of substance abuse treatment was significantly higher for the control group, but no differences were found in substance use or psychiatric symptoms. Conclusions. Participants in the Housing First program were able to obtain and maintain independent housing without compromising psychiatric or substance abuse symptoms. PMID:15054020

Mental health care use in adolescents with and without mental disorders.

PubMed

Jörg, Frederike; Visser, Ellen; Ormel, Johan; Reijneveld, Sijmen A; Hartman, Catharina A; Oldehinkel, Albertine J

2016-05-01

The aim of the study was to estimate the proportion of adolescents with and without a psychiatric diagnosis receiving specialist mental health care and investigate their problem levels as well as utilization of other types of mental health care to detect possible over- and undertreatment. Care utilization data were linked to psychiatric diagnostic data of 2230 adolescents participating in the TRAILS cohort study, who were assessed biannually starting at age 11. Psychiatric diagnoses were established at the fourth wave by the Composite International Diagnostic Interview. Self-, parent- and teacher-reported emotional and behavioral problems and self-reported mental health care use were assessed at all four waves. Of all diagnosed adolescents, 35.3 % received specialist mental health care. This rate increased to 54.5 % when three or more disorders were diagnosed. Almost a third (28.5 %) of specialist care users had no psychiatric diagnosis; teachers gave them relatively high ratings on attention and impulsivity subscales. Diagnosed adolescents without specialist mental health care also reported low rates of other care use. We found no indication of overtreatment. Half of the adolescents with three or more disorders do not receive specialist mental health care nor any other type of care, which might indicate unmet needs.

Euthanasia and Assisted Suicide of Patients with Psychiatric Disorders in the Netherlands 2011–2014

PubMed Central

Kim, Scott Y H; De Vries, Raymond; Peteet, John R

2017-01-01

Importance Euthanasia and/or physician assisted suicide of psychiatric patients is increasing in some jurisdictions such as Belgium and the Netherlands. However, little is known about the practice and it remains very controversial. Objective To describe the characteristics of patients receiving euthanasia/assisted suicide for psychiatric conditions and how the practice is regulated in the Netherlands. Design and Setting A review of psychiatric euthanasia/assisted suicide case summaries made available online by the Dutch Regional Euthanasia Review Committees, as of 1 June 2015. Two senior psychiatrists used directed content analysis to review and code the reports. 66 cases from 2011–14 were reviewed. Main Outcomes Clinical and social characteristics of patients, physician review process of the patients’ requests, and the Review Committees’ assessments of the physicians’ actions. Results 70% (46 of 66) of patients were women, 32% were over 70 years-old, 44% were between 50–70, and 24% were 30–50. Most had chronic, severe conditions, with histories of attempted suicides and psychiatric hospitalizations. A majority had personality disorders and were described as socially isolated or lonely. Depressive disorders were the primary issue in 55% of cases. Other conditions represented were psychotic, PTSD/anxiety, somatoform, neurocognitive, and eating disorders, as well as prolonged grief and autism. Co-morbidities with functional impairments were common. A minority (41%) of physicians performing euthanasia/assisted suicide were psychiatrists. 18 (27%) patients received the procedure from physicians new to them, 15 (23%) of whom were physicians from the End-of-Life Clinic, a mobile euthanasia clinic. Consultation with other physicians was extensive, but 11% of cases had no independent psychiatric input and 24% of cases involved disagreement among consultants. The Review Committee found one case to have failed to meet legal due care criteria. Conclusions and Relevance Persons receiving EAS for psychiatric disorders in the Netherlands are mostly women, of diverse ages, with complex and chronic psychiatric, medical, and psychosocial histories. The granting of their EAS requests appears to involve considerable physician judgment, usually involving multiple physicians who do not always agree (and sometimes without independent psychiatric input) but the Review Committees generally defer to the physicians performing the EAS. PMID:26864709

[Definition of the core area of medical services in the psychiatric-psychotherapeutic field--the prerequisite for any delegation].

PubMed

Jordan, Wolfgang; Bleich, Stefan; Cohrs, Stefan; von Einsiedel, Regina; Falkai, Peter; Grosskopf, Volker; Hauth, Iris; Steiner, Johann; Adler, Lothar

2011-11-01

Based on legal jurisdiction, knowledge of the psychiatric-psychotherapeutic field and insight into the necessity of a new allocation of responsibilities in the overall therapeutic service of a clinic, the core areas of medical activities are defined for the first time, innovative organisational approaches to the reorganisation of therapeutic service are presented and discussed against the background of qualified staff deficit, introduction of an OPS coding for inpatient psychiatry and economic constraints. © Georg Thieme Verlag KG Stuttgart · New York.

[Feasibility of consultation - liaison psychiatry in a large general hospital: quantitative description of services and personnel expenditure].

PubMed

Windhager, Elmar; Thaler, Katharina; Selberis-Vahl, Wilia Vasiliki; Friedl-Wörgetter, Petra; Windhager, Isabella; Zauner, Katharina

2015-01-01

The integration of psychiatric departments in general hospitals lead to an increasing demand of psychiatric consultation, which often overstrains personnel resources of short staffed psychiatric services. To provide consulting service, as it is demanded by guidelines, a multidisciplinary consulting team could be a possible solution. A retrospective descriptive analysis of all consultations made by the psychosocial consultation and liaison service at the general hospital Wels-Grieskirchen in the years 2012 and 2013. There was an increase in referrals overall of 22 % from 2012 to 2013. The largest increase was observed in the group of psychiatrists, who carried out 33.1 % of all consultations. Most consultations, 39.5 %, were done by the group of clinical psychologists, partly substituting medical attendance. Taking together both occupational groups, the expected number of consultations of at least 3 % of all admissions could be achieved. A multidisciplinary consulting team consisting of psychiatrists, psychologists, psychosomatic physicians and social workers staffed with 5.11-6.79 full-time personnel is able to provide psychosocial consultation service at a quantitative level required by international guidelines.

Resolving the psychiatric bed crisis: a critical analysis of policy.

PubMed

Loader, Katie

The National Service Framework (NSF) for Mental Health in 1999 was central to the modernisation of mental health services under the New Labour government of 1997. It placed an emphasis on universal clinical standards and set out a vision for service developments over the next 10 years. One such proposal was the development of crisis resolution teams, aimed at reducing the psychiatric admissions rate by providing care at home. This article provides a critical analysis of policies relating to the provision of 24-hour access to mental health services, focusing on the specifications for creating crisis resolution teams, as laid out in the NSF for Mental Health and the NHS Plan. First, it looks at the historical context surrounding the policy, examining the content of the NSF and NHS plan and how policy was disseminated and implemented nationally and locally. Then it examines the effects and changes this policy brought about and, specifically, whether it has achieved its aims of reducing the nationwide acute psychiatric inpatient admission rate.

Mental health care in Italy: organisational structure, routine clinical activity and costs of a community psychiatric service in Lombardy region.

PubMed

Fattore, G; Percudani, M; Pugnoli, C; Contini, A; Beecham, J

2000-01-01

The Magenta Community Mental Health Centre (CMHC) is the public agency responsible for providing adult psychiatric care to about 85,000 adult residents. In 1995, it had 1,145 clients and incurred costs of Euro 1.9 millions. Average cost per patient and per adult resident were Euro 1,661 and Euro 22.2, respectively. These values mask large variation across diagnosis: while patients with schizophrenia and related disorders had an average cost of Euro 3,771, those with neurotic and related disorders had an average cost of Euro 439. Patients with schizophrenia and related disorders (28% of the patients) absorbed about 60% of total costs and made extensive use of several types of services (hospital, outpatient, domiciliary, social and rehabilitative care). Since integrating different types of services is the key element of Italian psychiatric care, the new fee-for-service system adopted by the NHS to fund providers does not appear appropriate, particularly for schizophrenic patients.

Effects of a brief education and treatment-planning group on evidence-based PTSD treatment utilization and completion among veterans.

PubMed

DeViva, Jason C; Bassett, Gwendolyn A; Santoro, Gia M; Fenton, Lisa

2017-08-01

Veterans with posttraumatic stress disorder (PTSD) presenting for care with Veterans Affairs Health Care System (VA) tend not to engage in evidence-based psychotherapies (EBPs) despite widespread availability of these treatments. Though there is little evidence that "readiness for treatment" affects treatment choice, many VA providers believe that interventions to increase readiness would be helpful. This naturalistic study examined the effects of a 4-session education/treatment-planning group on treatment choice among veterans in a VA outpatient PTSD treatment program. Treatment choices and completion rates of 114 veterans who received at least 1 session of the group (EG) were compared with those of 68 veterans who did not receive the group and received PTSD program treatment as usual (TAU). TAU and EG cases were matched on gender and service era. Of 114 EG cases, 52 (45.6%) chose to receive EBPs, compared with 10 of 68 TAU cases (14.7%). These rates were significantly different, χ2(1) = 18.1, p < .0001. Among cases choosing EBPs, 52.2% of EG cases completed the EBPs as planned, compared with 60% of TAU cases. These percentages were not significantly different. Among EG cases choosing EBPs, lower likelihood of treatment completion was related to psychiatric medication prescription, presence of PTSD service connection, and higher overall service-connection level. The education/treatment-planning group was associated with higher likelihood of selecting but not completing EBPs for PTSD. The decision to engage in trauma-focused treatment may be a different process from the decision to complete such treatment. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

Understanding readmission to psychiatric hospital in Australia from the service users' perspective: a qualitative study.

PubMed

Duhig, Michael; Gunasekara, Imani; Patterson, Sue

2017-01-01

Inpatient care is integral to balanced mental health systems, contributing to containment of risk associated with psychiatric crises and affording opportunities for treatment. However, psychiatric wards are not always safe and service users are often dissatisfied with the experience. Hence, and because inpatient care is the most costly component of mental health systems, minimising duration of admission and reducing risk of readmission are clinical and strategic priorities internationally. With (primarily quantitative) research to date focused on explaining readmission in terms of characteristics of individuals and services, understanding of the 'revolving door phenomenon' remains limited. Considering verstehen critical to addressing this messy problem, we examined readmission from the service users' perspective. Using grounded theory techniques, we inductively analysed data from interviews with 13 people readmitted to inpatient care within 28 days of discharge. Participants, including eight men, were recruited in 2013 from three psychiatric wards at a metropolitan hospital in Australia. Analysis supported description of readmission as a process, fundamentally related to insufficiency of internal, interpersonal and/or environmental resources to maintain community tenure. For the people in this study, admission to hospital was either the default coping mechanism or the culmination of counter-productive attempts to manage stressful circumstances. Readmission can appropriately be understood as one representation of a fundamental social malaise and the struggle of some people to survive in an apparently inhospitable world. The findings indicate that neither locating the 'problem of readmission' within an individual and promoting self-governance/self-control/self-regulation, nor identifying failures of specific services or sectors are likely to support the economic and ethical imperative of reducing psychiatric admissions. The findings of the study and limitations related to its conduct in a particular setting provide fertile ground for further research and design of interventions to break the readmission cycle. However, balanced, mental health services alone are insufficient; systems of care must become 'recovery oriented'. © 2015 John Wiley & Sons Ltd.

Data collection in consultation-liaison psychiatry: an evaluation of Casemix.

PubMed

Ellen, Steven; Lacey, Cameron; Kouzma, Nadya; Sauvey, Nick; Carroll, Rhonda

2006-03-01

To evaluate the usefulness of Casemix as a data collection system for consultation-liaison psychiatry services. Health information staff were requested to code psychiatric assessments and diagnosis prospectively for admissions to the Alfred Hospital, Melbourne, between July 2002 and June 2004 using Casemix. Psychiatric assessments were requested on 2.5% of all hospital admissions (n = 2575). Casemix provided extensive demographic and hospital unit data for referred patients, is easy to set up, and is cost-free for the psychiatry service. Casemix can provide extensive meaningful data for consultation-liaison psychiatry services that could assist in the argument for greater funding of these services.

Interaction of motivation and psychiatric symptoms on substance abuse outcomes in sober living houses.

PubMed

Polcin, Douglas L; Korcha, Rachael A; Bond, Jason C

2015-01-01

Studies show residents of sober living recovery houses (SLHs) make improvements in a variety of areas including alcohol and drug use, arrests, and employment. Longitudinal measures of motivation (assessed as costs and benefits of continuing sobriety) have been shown to be associated with alcohol and drug outcomes in SLHs. However, how motivation interacts with other potentially important factors, such as psychiatric severity, is unclear. The present study aimed to assess how perceived costs and benefits of sobriety among residents of SLHs differed by psychiatric severity. The study also aimed to assess how costs and benefits interacted with psychiatric severity to influence outcome. Two hundred forty-five residents of SLHs were assessed at baseline and 6, 12, and 18 months. High psychiatric severity was associated with higher severity of alcohol and drug problems and higher perceived costs of sobriety at all data collection time points. Perceived costs and benefits of sobriety were strong predictors of alcohol and drug problems for participants with low psychiatric severity. Perceived costs, but not perceived benefits, predicted outcomes for residents with high psychiatric severity. CONCLUSIONS/IMPORTANCE: High psychiatric severity is a serious impediment for some residents in SLHs. These individuals perceive sobriety as difficult and that perception is associated with worse outcome. Finding ways to decrease perceived costs and challenges to sustained sobriety among these individuals is essential as is collaboration with local mental health services. SLHs should consider whether additional onsite services or modifications of SLH operations might help this population.

Career Choice and Longevity in U.S. Psychiatric-Mental Health Nurses.

PubMed

Alexander, Robbi K; Diefenbeck, Cynthia A; Brown, Carlton G

2015-06-01

The demand for mental health services in the United States taxes the existing care continuum and is projected to increase as federal initiatives such as the Affordable Care Act and mental health parity improve access to, and coverage for, mental health services. Quality health care providers, such as psychiatric-mental health nurses, are needed to bolster the mental health system. Prior research has focused on the unpopularity of psychiatric nursing as a career choice for nursing students. The purpose of this study is to understand how seasoned psychiatric nurses came to choose and remain in the specialty; descriptive phenomenology is used. In a face-to-face interview, eight registered nurses described their experiences with psychiatric nursing as a student, their entry into psychiatric nursing, and factors related to their longevity in the specialty. Giorgi's Existential Phenomenological Research Method was employed to analyze the interview data. Three themes emerged related to career choice: Interest Developed Prior to or While in Nursing School, Personal Relevance, and Validation of Potential. Three themes emerged related to retention: Overcoming Stereotypes to Develop Career Pride, Positive Team Dynamics, and Remaining Hopeful. Nurse educators play an important role in identifying talent, validating capability, enhancing interest, and increasing students' confidence to pursue a psychiatric nursing career, while nursing administrators and clinical specialists play a key role in retention. Findings also stimulate pertinent questions surrounding the long-term viability of the psychiatric-mental health nursing specialty.

Therapeutic abortion: the psychiatric nurse as therapist, liaison, and consultant.

PubMed

Zahourek, R; Tower, M

1971-01-01

It is noted that as abortion becomes an accepted medical practice, more nurses will be involved in the treatment and counseling of the therapeutic abortion patient. The authors, psychiatric nurses in a Colorado comprehensive urban mental health center, became involved in the treatment of the therapeutic abortion patient with the passing of the State's liberalized 1967 abortion law. As they became involved with all aspects of therapeutic abortion patients' care, they identified 3 specific roles for the psychiatric nurse: 1) providing direct They treatment, 2) providing liaison service and promoting continuity of care for the patient, and 3) providing consultation service to the staff involved with the patient. As the psychiatric nurses shared their own mixed feelings about abortion with the obstetrical staff, the staff began to feel less guilty and less alone with their feelings. The became more involved with the patients and benefited them more.

Psychiatric disorders in individuals diagnosed with infantile autism as children: a case control study.

PubMed

Mouridsen, Svend Erik; Rich, Bente; Isager, Torben; Nedergaard, Niels Jørgen

2008-01-01

The objective of this study was to compare the prevalence and types of psychiatric disorders in a clinical sample of 118 individuals diagnosed as children with infantile autism (IA) with psychiatric disorders in 336 matched controls from the general population using data from the nationwide Danish Psychiatric Central Register. The average observation time was 32.5 years, and mean age at follow-up was 40.6 years (range 25-55 years). Of the 118 individuals with IA, 57 (48.3%) had been in contact with psychiatric hospitals (inpatient hospitalization or outpatient visits) during the follow-up period, compared with 20/336 (6.0%) in the control group (p < 0.0001). This observation should alert general psychiatrists to the possibility of additional treatable psychiatric disorders occurring in individuals with IA. Of the 118 individuals in the IA group, 20 individuals (17%) had been given a comorbid psychiatric diagnosis during the observation period, compared with 9 individuals (2.7%) in the control group. Of the subjects with IA, 3.4% had received a diagnosis of schizophrenia (F20) at least once since the index admission in childhood, 0.8% had been diagnosed with delusional disorder (F22), 0.8% with acute psychotic disorder (F23), and 1.6% with unspecified non-organic psychosis (F29). In the control group, 0.9% had been diagnosed with schizophrenia (p = 0.08). In the group with IA, 3.4% had received a diagnosis in the broad category of affective disorders compared with 1.2% in the control group (p = 0.21). Issues associated with using registers in the ascertainment of co-occurring psychiatric disorders in IA are discussed.

Mental health symptoms as prognostic risk markers of all-cause and psychiatric sickness absence in office workers.

PubMed

Roelen, Corné A M; Hoedeman, Rob; van Rhenen, Willem; Groothoff, Johan W; van der Klink, Jac J L; Bültmann, Ute

2014-02-01

To investigate mental health symptoms as prognostic risk markers of all-cause and psychiatric sickness absence (SA). Mental health symptoms were measured in 1137 office workers with the Four-Dimensional Symptom Questionnaire (4DSQ), including scales for distress, depression, anxiety and somatization. The total number of SA days was accumulated prospectively on the individual level and high SA was defined as ≥30 SA days during 1-year follow-up. Psychiatric SA was also tallied on the individual level during 1-year follow-up. Baseline 4DSQ scores were associated with high all-cause SA and psychiatric SA by logistic regression analysis. The Hosmer-Lemeshow test and calibration slope were used to assess the accuracy of predictions by 4DSQ scores. The ability of 4DSQ scores to discriminate high-risk from low-risk employees was estimated by the area under the receiver operating characteristic curve. Six hundred thirty-three office workers (56%) participated in the study. All 4DSQ scales were prospectively associated with high all-cause SA and with psychiatric SA. Distress and somatization scores showed acceptable calibration, but failed to discriminate between office workers with and without high all-cause SA. The distress scale did show adequate calibration (calibration slope = 0.95) and discrimination (area under the receiver operating characteristic curve = 0.71) for psychiatric SA. Distress was a valid prognostic risk marker for identifying office workers at work, but at risk of future psychiatric SA. Further research is necessary to investigate the prognostic performance of distress as risk marker of psychiatric SA in other working populations and to determine cut-off points for distress.

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…

Preparing Flight Attendants for In-Flight Psychiatric Emergencies: A Training Manual

ERIC Educational Resources Information Center

Gras, Rebecca E.

2011-01-01

While in-flight psychiatric emergencies occur at a lower rate than other medical emergencies (Matsumoto & Goebert, 2001), they tend to cause a higher degree of disruption for passengers (Gordan, Kingham, & Goodwin, 2004). However, flight attendants often receive training that is too basic, minimal, and insufficient to effectively manage…

Psychiatric Disorders and Sexual Risk among Adolescents in Mental Health Treatment

ERIC Educational Resources Information Center

Brown, Larry K.; Hadley, Wendy; Stewart, Angela; Lescano, Celia; Whiteley, Laura; Donenberg, Geri; DiClemente, Ralph

2010-01-01

Objective: To examine the relationship between psychiatric disorders and sexual behaviors among adolescents receiving mental health treatment. Adolescents in mental health treatment have been found to have higher rates of HIV risk behavior than their peers, but data concerning the relationship between psychopathology and risk are inconsistent and…

[The new law on strengthening the rights of victims of sexual abuse and its implications for the forensic-psychiatric assessment of sexual offenders].

PubMed

Bumb, Jan Malte; Foerster, Klaus; Dressing, Harald

2014-07-01

Highlighting practical implications and research aspects of forensic-psychiatric assessments in the context of the new law on strengthening the rights of victims of sexual abuse. Based on a clinical case we report implications for the forensic-psychiatric assessment. The new law now requires an expert to evaluate the necessity and the subject's motivation to receive a given treatment. Up to now, the majority of sexual offenders were assumed to be responsible for their actions and in most cases a forensic-psychiatric assessment was not required. For this reason, guidelines for forensic-psychiatric assessments are urgently needed. The number of forensic-psychiatric assessments is likely to increase substantially and a relevant-case law is still lacking. © Georg Thieme Verlag KG Stuttgart · New York.

The Role of Primary Care Clinicians in Diagnosing and Treating Bipolar Disorder

PubMed Central

2010-01-01

Because many patients with bipolar disorder seek treatment in primary care practices, physicians in these settings need to be able to diagnose bipolar disorder and common psychiatric and medical comorbidities and to initiate and manage treatment. Unfortunately, bipolar disorder is often underrecognized. The most common symptoms in patients with bipolar disorder are depressive, but these patients may also have anxiety, mood swings, sleep problems, irritability, difficulty concentrating, relationship issues, alcohol- or drug-related problems, and infections. Social and family history and screening tools can help clarify diagnosis. The goal of treatment should be recovery, but periodic relapse and medication nonadherence should be expected. Primary care physicians should decide what level of intervention their practices can support. To manage these patients effectively, practices may need to train office staff, set up monitoring and follow-up systems, establish links with referral and community support services, develop therapeutic alliances with patients, and provide psychoeducation for patients and significant others. Receiving comprehensive psychiatric and medical care and support can be life-changing for patients with bipolar disorder and their families. PMID:20628500