Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 21.302
Filtrar
1.
MMWR Morb Mortal Wkly Rep ; 69(26): 825-829, 2020 Jul 03.
Artigo em Inglês | MEDLINE | ID: mdl-32614815

RESUMO

In the United States, approximately 180,000 patients receive mental health services each day at approximately 4,000 inpatient and residential psychiatric facilities (1). SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19), can spread rapidly within congregate residential settings (2-4), including psychiatric facilities. On April 13, 2020, two patients were transferred to Wyoming's state psychiatric hospital from a private psychiatric hospital that had confirmed COVID-19 cases among its residents and staff members (5). Although both patients were asymptomatic at the time of transfer and one had a negative test result for SARS-CoV-2 at the originating facility, they were both isolated and received testing upon arrival at the state facility. On April 16, 2020, the test results indicated that both patients had SARS-CoV-2 infection. In response, the state hospital implemented expanded COVID-19 infection prevention and control (IPC) procedures (e.g., enhanced screening, testing, and management of new patient admissions) and adapted some standard IPC measures to facilitate implementation within the psychiatric patient population (e.g., use of modified face coverings). To assess the likely effectiveness of these procedures and determine SARS-CoV-2 infection prevalence among patients and health care personnel (HCP) (6) at the state hospital, a point prevalence survey was conducted. On May 1, 2020, 18 days after the patients' arrival, 46 (61%) of 76 patients and 171 (61%) of 282 HCP had nasopharyngeal swabs collected and tested for SARS-CoV-2 RNA by reverse transcription-polymerase chain reaction. All patients and HCP who received testing had negative test results, suggesting that the hospital's expanded IPC strategies might have been effective in preventing the introduction and spread of SARS-CoV-2 infection within the facility. In congregate residential settings, prompt identification of COVID-19 cases and application of strong IPC procedures are critical to ensuring the protection of other patients and staff members. Although standard guidance exists for other congregate facilities (7) and for HCP in general (8), modifications and nonstandard solutions might be needed to account for the specific needs of psychiatric facilities, their patients, and staff members.


Assuntos
Infecções por Coronavirus/prevenção & controle , Infecção Hospitalar/prevenção & controle , Hospitais Psiquiátricos , Programas de Rastreamento , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Instituições Residenciais , Adulto , Idoso , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/transmissão , Infecção Hospitalar/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pneumonia Viral/epidemiologia , Pneumonia Viral/transmissão , Wyoming/epidemiologia
2.
Bull World Health Organ ; 98(6): 426-430, 2020 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-32514217

RESUMO

Problem: In Latvia, the move towards community-based mental health-care services has been slow. Approach: The hospital managers of the only psychiatric hospital in Riga decided to establish two community-based clinics that were financially and administratively integrated with the hospital. The clinics were established using a step-wise approach by redistributing resources, including psychiatrists, nurses and beds, from the hospital to the new clinics. In 2005, the Veldre clinic started outpatient consultations and day care admissions. In 2009, Pardaugava clinic opened as an outpatient clinic. In 2012, an open-door inpatient ward with 30 beds was transferred from the psychiatric hospital to Veldre. In 2013, Pardaugava clinic opened a day care clinic and an open-door inpatient ward, transferring 26 beds from the psychiatric hospital. Local setting: Latvians have worse mental health indicators than those of the average population in Europe. Mental care has traditionally focused on inpatient care. Relevant changes: The clinics are now providing most of the outpatient services and the number of inpatients treated at the hospital has declined from 5696 patients in 2004 to 4957 patients in 2018. Patients are treated in a more open and patient-centred environment. Lessons learnt: The administrative and financial integration of the new community-based clinics within the existing structures of the hospital is a successful approach. Transferring resources to the clinics seems to have improved the quality of care without requiring additional funding apart from the initial investment costs. Involving the staff members during the planning phase reduced resistance to the project.


Assuntos
Serviços Comunitários de Saúde Mental/organização & administração , Hospitais Psiquiátricos/organização & administração , Instituições de Assistência Ambulatorial/organização & administração , Humanos , Letônia , Transtornos Mentais/epidemiologia , Transtornos Mentais/terapia
3.
Global Health ; 16(1): 53, 2020 06 24.
Artigo em Inglês | MEDLINE | ID: mdl-32580774

RESUMO

During the COVID-19 pandemic, as a large city located in Southwest China, Chengdu was mainly affected by imported cases. For a psychiatric hospital, the enclosed management model, the crowded wards and the uncooperative patients are the risk factors of nosocomial infection. Admitting new patients while preventing the COVID-19 outbreak within the institutions was a crucial challenge. The Mental Health Centre of Chengdu proposed a series of effective management strategies to deal with the rapidly evolving situation during the COVID-19 pandemic which included regulation for the inpatients, their families and staff, and achieved Zero infection in our hospital.


Assuntos
Infecções por Coronavirus/prevenção & controle , Surtos de Doenças/prevenção & controle , Hospitais Psiquiátricos/organização & administração , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , China/epidemiologia , Infecções por Coronavirus/epidemiologia , Humanos , Pneumonia Viral/epidemiologia
4.
Rev Lat Am Enfermagem ; 28: e3296, 2020.
Artigo em Inglês, Português, Espanhol | MEDLINE | ID: mdl-32578752

RESUMO

OBJECTIVE: to assess risk related to drug use in men admitted to a psychiatric hospital and to identify associations with sociodemographic, socioeconomic variables, and risk conditions. METHOD: a cross-sectional study with the application of a screening test in 209 participants hospitalized for mental and behavioral disorders due to the use of psychoactive substances. Statistical analysis was performed using descriptive statistics and adjustment of a binary logistic regression model for moderate or high risk of drug use. The odds ratio measured the strength of association. RESULTS: high use in life was observed, with alcohol and tobacco experimentation in adolescence. A high prevalence of related risk was observed for alcohol, tobacco, smoked and inhaled cocaine, and marijuana. Moderate and elevated risks were found for tobacco (22.5% and 62.5%, respectively), alcohol (13.5% and 73%), marijuana (16% and 32.5%), smoked cocaine (3% and 41%) and inhaled cocaine (9% and 19.5%). CONCLUSION: the results showed high use in life, with an age of early experimentation. Tobacco and alcohol are the main drugs used by hospitalized men.


Assuntos
Consumo de Bebidas Alcoólicas/psicologia , Hospitais Psiquiátricos/estatística & dados numéricos , Fumar/psicologia , Transtornos Relacionados ao Uso de Substâncias/psicologia , Adolescente , Adulto , Consumo de Bebidas Alcoólicas/epidemiologia , Brasil/epidemiologia , Estudos Transversais , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Fumar/epidemiologia , Fatores Socioeconômicos , Transtornos Relacionados ao Uso de Substâncias/complicações , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Adulto Jovem
5.
Psychol Trauma ; 12(S1): S151-S152, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32525384

RESUMO

The COVID-19 pandemic has placed competing demands on many graduate students working at practica. Though graduate programs seek to minimize potential sources of exposure to the virus, some practicum sites rely on students as essential staff. At the same time, although some students may wish to eliminate this source of potential exposure to the virus, other students may consider the opportunity to fulfill their practicum duties at a time of crisis an important part of their educational experience. Guidance published by the Association of Psychology Postdoctoral and Internship Centers regarding internship students provides at least a starting point for programs to develop policies that allow students to make informed decisions about their practicum training. (PsycInfo Database Record (c) 2020 APA, all rights reserved).


Assuntos
Infecções por Coronavirus , Currículo , Educação de Pós-Graduação , Hospitais Psiquiátricos , Pandemias , Pneumonia Viral , Psicoterapia , Adulto , Educação de Pós-Graduação/ética , Educação de Pós-Graduação/organização & administração , Humanos
7.
Epidemiol Psychiatr Sci ; 29: e129, 2020 May 22.
Artigo em Inglês | MEDLINE | ID: mdl-32438939

RESUMO

AIMS: Studies on the frequency of caregiver involvement in representative inpatient samples are scarce. The aim of our study was to conduct a representative survey on caregiver involvement in routine inpatient care involving all three parties (patients, caregivers, psychiatrists). Therefore, we performed face-to-face interviews consisting of open-ended questions to gain a deeper understanding of when and how caregivers are involved in care treatment and to identify which topics are mainly discussed. METHODS: This cross-sectional survey included inpatients from 55 acute psychiatric wards across ten psychiatric hospitals, their treating psychiatrists and, when possible, their caregivers. In total, we performed semi-structured face-to-face interviews with 247 patients, their treating psychiatrists and 94 informal caregivers. Each psychiatrist named the next two to three patients to be discharged. After a patient had given informed consent, the interview was performed by a researcher. In addition, the psychiatrist and, when possible, the primary caregiver identified by the patient, were also interviewed. RESULTS: It was perceived by both patients and psychiatrists that contact between caregiver and psychiatrist had taken place in one-third of the patient cases. Predictors for psychiatrist-caregiver-contact were revealed in the patient's diagnosis (schizophrenia), a lower history of inpatient stays, and the respective hospital. According to psychiatrists the most frequent subjects of discussion with caregivers involved therapeutic issues and organisational and social-psychiatric topics (e.g. work, living and social support). Patients and caregivers stated that psychiatric treatment and the diagnostic classification of the mental illness were the most frequent topics of conversation. For all three groups, the most often cited reason for missed caregiver involvement was the subjective perception that a caregiver was not in fact needed. CONCLUSIONS: Whether or not caregivers were contacted and involved during an inpatient stay strongly depended on the individual hospital. The frequency of involvement of caregivers can certainly be increased by changing processes and structures in hospitals. All three parties (patients, caregivers and psychiatrists) most often stated that the caregiver was not involved in the treatment because they thought it was unnecessary. Evidence demonstrates the positive effect of caregivers' involvement on the therapeutic process but also on the well-being of the caregiver, therefore it is necessary to increase awareness of this evidence among all three interest groups.


Assuntos
Cuidadores/psicologia , Tomada de Decisões , Pacientes Internados/estatística & dados numéricos , Relações Profissional-Família , Psiquiatria , Esquizofrenia/terapia , Adulto , Estudos Transversais , Feminino , Hospitalização , Hospitais Psiquiátricos , Humanos , Pessoa de Meia-Idade , Apoio Social , Inquéritos e Questionários
8.
Hist Psychiatry ; 31(3): 325-340, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32349552

RESUMO

This article addresses the implementation of malaria fever therapy in Spain. Neuropsychiatrist Rodríguez-Lafora first used it in 1924, but Vallejo-Nágera was the main advocate for the technique. He had learned the method from Wagner von Jauregg himself, and he worked in the Military Psychiatric Clinic and the San José Mental Hospital, both in Ciempozuelos (Madrid). Vallejo-Nágera worked with the parasitologist Zozaya, who had travelled to England with a Rockefeller Foundation grant in order to learn from British malariologist, Sydney Price James. This article details the results of the uneven implementation of this treatment in Spanish psychiatric institutions. Although syphilologists and internists used fever therapy for the treatment of general paralysis of the insane, they were much less enthusiastic than psychiatrists.


Assuntos
Hipertermia Induzida/história , Malária/história , Neurossífilis/história , Psiquiatria/história , História do Século XIX , História do Século XX , Hospitais Psiquiátricos/história , Humanos , Hipertermia Induzida/efeitos adversos , Hipertermia Induzida/ética , Neurossífilis/terapia , Espanha
9.
Encephale ; 46(3S): S81-S84, 2020 Jun.
Artigo em Francês | MEDLINE | ID: mdl-32471705

RESUMO

OBJECTIVES: The sudden changes of healthcare system due to COVID-19 particularly affect the organization of psychiatry. The objective of this review is to examine the adaptations of psychiatric care in France during this pandemic. METHOD: This narrative review is based on the observation of changes made in French psychiatric hospitals and on an analysis of the literature. RESULTS: Regarding psychiatric hospitalization, the COVID-19 epidemic required rapid measures that profoundly modified the conditions of patients' reception, forcing the medical staffs to adapt their methods of care. The authors noted the creation of at least 89 wards specifically dedicated to patients with COVID-19 needing psychiatric hospitalization, allowing dual care of general medicine and psychiatry. Regarding ambulatory care, maintaining patients with long-term follow-up was a priority. Patients recalling and teleconsultation have been precious resources but cannot entirely replace face-to-face consultations. DISCUSSION: COVID-19 epidemic created unprecedented situation of large-scale upheavals in the healthcare system and in society. Despite the absence of previous recommendations on the subject, French psychiatry has shown great adaptability. Some changes could inspire post-COVID-19 care.


Assuntos
Betacoronavirus , Infecções por Coronavirus , Reestruturação Hospitalar , Hospitais Psiquiátricos/organização & administração , Serviços de Saúde Mental/organização & administração , Pandemias , Pneumonia Viral , Psicoterapia/organização & administração , Assistência Ambulatorial/organização & administração , Conversão de Leitos , França/epidemiologia , Pessoal de Saúde/psicologia , Acesso aos Serviços de Saúde , Humanos , Transtornos Mentais/epidemiologia , Transtornos Mentais/terapia , Serviços de Saúde Mental/estatística & dados numéricos , Serviços de Saúde Mental/provisão & distribução , Saúde do Trabalhador , Quartos de Pacientes , Psicoterapia/estatística & dados numéricos , Mudança Social , Estresse Psicológico/etiologia , Estresse Psicológico/terapia , Telemedicina
10.
Encephale ; 46(3): 193-201, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32370982

RESUMO

OBJECTIVE: The lack of resources and coordination to face the coronavirus epidemic raises concerns for the health of patients with mental disorders in a country where we still have memories of the dramatic experience of famine in psychiatric hospitals during the Second World War. This article aims to propose guidance to ensure mental health care during the SARS-CoV epidemic in France. METHODS: The authors performed a narrative review identifying relevant results in the scientific and medical literature and in local initiatives in France. RESULTS: We identified four types of major vulnerabilities among patients with mental disorders during this pandemic: (1) medical comorbidities that are more frequently found among patients with mental disorders (cardiovascular and pulmonary pathologies, diabetes, obesity, etc.) which are risk factors for severe covid-19 infection; (2) age (the elderly form the population most vulnerable to the coronavirus); (3) cognitive and behavioural disorders, which can hamper compliance with confinement and hygiene measures and finally and (4) psychosocial vulnerability as a result of stigmatization and/or socio-economic difficulties. Furthermore, the mental health healthcare system is more vulnerable than other healthcare systems. Current government plans are poorly suited to psychiatric establishments in a context of major shortages of organizational, material and human resources. In addition, a certain number of structural aspects make the psychiatric institution particularly vulnerable: many beds have been closed, wards have high densities of patients, mental health community facilities are closed, and medical teams are understaffed and poorly trained to face infectious diseases. There are also major issues when referring patients with acute mental disorders to intensive care units. To maintain the continuity of psychiatric care in this pandemic situation, several directions can be considered, in particular with the creation of "COVID+ units". These units are under the dual supervision of a psychiatrist and an internist/infectious disease specialist; all new entrants are placed in quarantine for 14 days; the nursing staff receives specific training, daily medical check-ups and close psychological support. Family visits are prohibited and replaced by videoconference. At the end of hospitalization, in particular for the population of patients in compulsory ambulatory care situations, specific case-management are organized with the possibility of home visits, in order to support patients when they get back home and to help them cope with the experience of confinement, which is liable to induce recurrences of mental disorders. The total or partial closure of community mental health facilities is particularly disturbing for patients, but a regular follow-up is possible with telemedicine and should include the monitoring of suicide risk and psycho-education strategies; developing support platforms could also be very helpful in this context. Private practice psychiatrists also have a crucial role of information towards their patients on confinement and barrier measures, and also on measures to prevent the psychological risks inherent in confinement: maintenance of regular sleep r, physical exercise, social interactions, stress management and coping strategies, prevention of addictions, etc. They should also be trained to prevent, detect and treat early warning symptoms of post-traumatic stress disorder, because their prevalence was high in the regions of China most affected by the pandemic. DISCUSSION: French mental healthcare is now facing a great and urgent need for reorganization and must also prepare in the coming days and weeks to face an epidemic of emotional disorders due to the confinement of the general population.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/psicologia , Transtornos Mentais/terapia , Saúde Mental , Pneumonia Viral/epidemiologia , Pneumonia Viral/psicologia , Idoso , Idoso de 80 Anos ou mais , Epidemias , França/epidemiologia , Hospitais Psiquiátricos/organização & administração , Hospitais Psiquiátricos/normas , Hospitais Psiquiátricos/estatística & dados numéricos , Humanos , Transtornos Mentais/epidemiologia , Transtornos Mentais/prevenção & controle , Pandemias , Transtornos Psicóticos/epidemiologia , Transtornos Psicóticos/terapia , Quarentena/psicologia , Quarentena/estatística & dados numéricos , Fatores de Risco , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Transtornos de Estresse Pós-Traumáticos/etiologia , Transtornos de Estresse Pós-Traumáticos/terapia , Suicídio/prevenção & controle , Suicídio/estatística & dados numéricos
11.
Encephale ; 46(3S): S40-S42, 2020 Jun.
Artigo em Francês | MEDLINE | ID: mdl-32370981

RESUMO

The recent COVID-19 pandemic has led to major organisational changes in health care settings, especially in psychiatric hospitals. We conducted a national online survey to assess the evolution of electroconvulsive therapy (ECT) in the different centres practicing this treatment. 65 responses from all over France were analysed. More than 90 % of the centres practising ECT experienced a decrease in their activity. Half of the centres experienced a total cessation of activity and 25 % of the centres experienced a decrease of more than half of their usual activity. Post-pandemic COVID-19 psychiatric care is expected to be difficult. It is essential not to add to this difficulty the complications, often serious, that will be associated with delaying or stopping the practice of ECT. It will also be necessary to remain vigilant with regard to the specific neuropsychiatric consequences that will follow the pandemic.


Assuntos
Betacoronavirus , Infecções por Coronavirus , Eletroconvulsoterapia/tendências , Hospitais Psiquiátricos/organização & administração , Pandemias , Pneumonia Viral , Transtorno Bipolar/terapia , Controle de Doenças Transmissíveis , Continuidade da Assistência ao Paciente , Assistência à Saúde , Transtorno Depressivo/terapia , Eletroconvulsoterapia/estatística & dados numéricos , França , Humanos , Utilização de Procedimentos e Técnicas
12.
Int J Biol Sci ; 16(10): 1741-1744, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32226293

RESUMO

Recently, more than 300 Chinese patients with psychiatric disorders were diagnosed with the 2019 novel coronavirus disease (COVID-19). Possible reasons quoted in the report were the lack of caution regarding the COVID-19 outbreak in January and insufficient supplies of protective gear. We outlined major challenges for patients with psychiatric disorders and mental health professionals during the COVID-19 outbreak, and also discussed how to manage these challenges through further mental health service reform in China.


Assuntos
Betacoronavirus , Infecções por Coronavirus/psicologia , Transtornos Mentais/complicações , Serviços de Saúde Mental/organização & administração , Serviços de Saúde Mental/provisão & distribução , Pneumonia Viral/psicologia , China/epidemiologia , Infecções por Coronavirus/complicações , Surtos de Doenças , Reforma dos Serviços de Saúde , Hospitais Psiquiátricos , Humanos , Pandemias , Pneumonia Viral/complicações , Psiquiatria , Quarentena/psicologia
13.
PLoS One ; 15(4): e0230074, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32271784

RESUMO

Individuals with severe mental illness have long been segregated from living in communities and participating in socio- cultural life. In recent years, owing to progressive legislations and declarations (in India and globally), there has been a growing movement towards promoting social inclusion and community participation, with emphasis on the need to develop alternative and inclusive care paradigms for persons with severe mental illness. However, transitions from inpatient care to community settings is a complex process involving implications at multiple levels involving diverse stakeholders such as mental health service users, care providers, local communities and policy makers. This article studies how the transition from a hospital setting to a community-based recovery model for personals with severe mental illness can be facilitated. It reflects on the innovative process of creating a Supported Housing model in South India, where 11 MH Service users transitioned from a psychiatric ECRC to independent living facilities. Experiences in various phases of the project development, including care provider- and community level responses and feedback were scrutinised to understand the strategies that were employed in enabling the transition. Qualitative methods (including in-depth interviews and naturalistic observations) were used with residents and staff members to explore the challenges they encountered in stabilizing the model, as well as the psychosocial benefits experienced by residents in the last phase. These were complemented with a Brief Psychiatric Rating Scale (BPRS) and WHO Quality of Life scale to compare baseline and post-assessment results and an increase of quality of life. Results display a significant reduction of psychiatric symptoms in patients (p< 0.5). It also describes the challenges encountered in the current context, and strategies that were used to respond and adapt the model to address these concerns effectively. Positive behavioural and psycho-emotional changes were observed amongst the residents, significant amongst those being enhanced in their mobility and participation. The article concludes by discussing the implications of this study for the development of innovative community-based models in wider contexts.


Assuntos
Hospitais Psiquiátricos , Habitação , Tempo de Internação , Transtornos Mentais/epidemiologia , Inovação Organizacional , Adulto , Feminino , Pessoal de Saúde , Humanos , Índia , Pessoa de Meia-Idade , Modelos Teóricos , Qualidade de Vida , Comportamento Social
14.
Medwave ; 20(2): e7853, 2020 Mar 24.
Artigo em Espanhol, Inglês | MEDLINE | ID: mdl-32225132

RESUMO

Introduction: Patients of the Short-stay Child and Adolescent Unit of the Del Salvador Psychiatric Hospital (Valparaíso, Chile) exhibit different clinical and social characteristics compared to literature reports of other national centers, although published data are scarce. Objectives: To describe the operation of the Unit, the socio-familial and clinical characteristics of its patients and analyze factors associated with their clinical evolution. Methods: We performed a cross-sectional study to describe the patients hospitalized over a three-year period. Variables were registered in an anonymized database. Clinical evolution was evaluated over the year following hospital discharge. Results: The Unit's model of care can be described as involving biomedical, psychodynamic, and ecological components. We included 98 patients, of which 70.4% were male, and the average age was 11.5 ± 2.3 years. 82.6% were of low socioeconomic status, and 35.7% did not attend school; 98.9% presented family dysfunction, and 91.8% of parents had a history of psychopathology. The most frequent reason for admission was the risk of harm to self or others. The most frequent discharge diagnoses were behavioral, depressive, and personality development disorders. The average length of stay was 41.8 ± 31.1 days. The most commonly used pharmacological agents were antipsychotics and mood stabilizers. Regarding clinical evolution in the first year post-discharge, 47% were evaluated as positive, 27% regular, and 26% unsatisfactory. The factor associated with an unsatisfactory clinical course was having had in-patient antidepressants. Re-admission during the first year post-discharge was associated with comorbid substance use disorder. Treatment noncompliance was associated with a history of behavioral disorder at hospital discharge and having parents with a history of suicide or consummated suicide. Conclusions: The patient profile is one of low socioeconomic status, severe psychopathology, maladaptive behavior, family dysfunction, and parental psychopathology. Substance use disorder is also associated with readmission.


Assuntos
Hospitalização , Transtornos Mentais , Transtornos Relacionados ao Uso de Substâncias , Adolescente , Antipsicóticos , Criança , Chile , Estudos Transversais , Família , Feminino , Hospitais Psiquiátricos , Humanos , Masculino , Transtornos Mentais/complicações , Transtornos Mentais/psicologia , Transtornos Mentais/terapia , Readmissão do Paciente , Transtornos Relacionados ao Uso de Substâncias/complicações , Suicídio
16.
Encephale ; 46(3S): S3-S13, 2020 Jun.
Artigo em Francês | MEDLINE | ID: mdl-32312567

RESUMO

OBJECTIVE: The lack of ressources and coordination to face the epidemic of coronavirus raises concerns for the health of patients with mental disorders in a country where we keep in memory the dramatic experience of famine in psychiatric hospitals during the Second World War. This article aims at proposing guidance to ensure mental health care during the SARS-CoV epidemy in France. METHODS: Authors performed a narrative review identifying relevant results in the scientific and medical literature and local initiatives in France. RESULTS: We identified four types of major vulnerabilities in patients suffering from mental disorders during this pandemic: (1) medical comorbidities that are more frequently found in patients suffering from mental disorders (cardiovascular and pulmonary pathologies, diabetes, obesity, etc.) which represent risk factors for severe infections with Covid-19; (2) age (the elderly constituting the population most vulnerable to coronavirus); (3) cognitive and behavioral troubles which can hamper compliance with confinement and hygiene measures and finally and (4) psychosocial vulnerability due to stigmatization and/or socio-economic difficulties. Furthermore, the mental health healthcare system is more vulnerable than other healthcare systems. Current government plans are poorly adapted to psychiatric establishments in a context of major shortage of organizational, material and human resources. In addition, a certain number of structural aspects make the psychiatric institution particularly vulnerable: many beds are closed, wards have a high density of patients, mental health community facilities are closed, medical teams are understaffed and poorly trained to face infectious diseases. We could also face major issues in referring patients with acute mental disorders to intensive care units. To maintain continuity of psychiatric care in this pandemic situation, several directions can be considered, in particular with the creation of Covid+ units. These units are under the dual supervision of a psychiatrist and of an internist/infectious disease specialist; all new entrants should be placed in quarantine for 14 days; the nurse staff should benefit from specific training, from daily medical check-ups and from close psychological support. Family visits would be prohibited and replaced by videoconference. At the end of hospitalization, in particular for the population of patients in compulsory ambulatory care situations, specific case-management should be organized with the possibility of home visits, in order to support them when they get back home and to help them to cope with the experience of confinement, which is at risk to induce recurrences of mental disorders. The total or partial closure of mental health community facilities is particularly disturbing for patients but a regular follow-up is possible with telemedicine and should include the monitoring of the suicide risk and psychoeducation strategies; developing support platforms could also be very helpful in this context. Private psychiatrists have also a crucial role of information with their patients on confinement and barrier measures, but also on measures to prevent the psychological risks inherent to confinement: maintenance of sleep regularity, physical exercise, social interactions, stress management and coping strategies, prevention of addictions, etc. They should also be trained to prevent, detect and treat early warning symptoms of post-traumatic stress disorder, because their prevalence was high in the regions of China most affected by the pandemic. DISCUSSION: French mental healthcare is now in a great and urgent need for reorganization and must also prepare in the coming days and weeks to face an epidemic of emotional disorders due to the containment of the general population.


Assuntos
Betacoronavirus , Continuidade da Assistência ao Paciente/organização & administração , Infecções por Coronavirus/epidemiologia , Transtornos Mentais/terapia , Serviços de Saúde Mental/organização & administração , Pandemias , Pneumonia Viral/epidemiologia , Assistência ao Convalescente , Fatores Etários , Idoso de 80 Anos ou mais , Antivirais/farmacocinética , Antivirais/uso terapêutico , Criança , Transtornos Cognitivos/epidemiologia , Transtornos Cognitivos/terapia , Comorbidade , Infecções por Coronavirus/psicologia , Interações Medicamentosas , França/epidemiologia , Unidades Hospitalares/organização & administração , Hospitais Psiquiátricos/organização & administração , Humanos , Controle de Infecções/métodos , Transtornos Mentais/epidemiologia , Transtornos Mentais/etiologia , Serviços de Saúde Mental/provisão & distribução , Equipe de Assistência ao Paciente , Cooperação do Paciente , Pneumonia Viral/psicologia , Prisioneiros/psicologia , Transtornos de Estresse Pós-Traumáticos/etiologia , Transtornos de Estresse Pós-Traumáticos/terapia , Estresse Psicológico/etiologia , Estresse Psicológico/terapia , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/terapia , Suicídio/prevenção & controle , Populações Vulneráveis
17.
Artigo em Russo | MEDLINE | ID: mdl-32119217

RESUMO

The article presents results of study of issues of psychiatric care organization in mental hospital in 2015-2017. The structure, age distribution and social status of patients are analyzed on the basis of data from Psychiatric Hospital № 13 of the Moscow Health Care Department.


Assuntos
Hospitais Psiquiátricos , Transtornos Mentais , Humanos , Transtornos Mentais/terapia , Moscou , Psicoterapia/organização & administração
19.
Crim Behav Ment Health ; 30(1): 38-49, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32173951

RESUMO

BACKGROUND: In England, forensic psychiatric hospital services are provided at three security levels: high, medium and low. All are publicly funded and similarly regulated, but medium and low secure services are provided in the private and charitable (PCS) sector as well as the National Health Service (NHS). Originally, medium secure hospital services were conceived as for up to 2 years' inpatient stay, but numbers of longer stay patients have been rising. Little is known about their characteristics or whether they differ between NHS and PCS settings. AIMS: To describe and compare characteristics of long-stay patients in NHS and in PCS medium security hospital units. METHODS: Data were extracted from clinical records in 14 NHS and 9 PCS hospital units for all patients fulfilling criteria for long stay: having been in high security for more than 10 years or medium security for more than 5 years or in a mix of both for more than 15 years in total. RESULTS: 178 NHS and 107 PCS patients were eligible for inclusion, respectively, 16 and 22% of the total patient populations in these settings. The mean length of stay in a medium or high secure setting was similar: 163 and 164 months. Characteristics of the patients, however, differed between unit type. NHS services admitted more patients from prison and PCS services more from other hospitals. NHS services included a lower proportion of patients with personality disorder or intellectual disability. 'Challenging behaviour' was more prevalent in PCS; a history of absconding was found more often among NHS patients. CONCLUSIONS: The two systems of service appear to be used differently. More research is needed to explain why patients apparently without behavioural disturbances remain in specialist secure facilities for such a long time and whether their needs are truly being met in the least restrictive environment possible.


Assuntos
Hospitais Privados/estatística & dados numéricos , Hospitais Psiquiátricos/estatística & dados numéricos , Hospitais Públicos/estatística & dados numéricos , Serviços de Saúde Mental/estatística & dados numéricos , Admissão do Paciente/estatística & dados numéricos , Adulto , Inglaterra , Feminino , Humanos , Tempo de Internação , Masculino , Transtornos Mentais/terapia , Serviços de Saúde Mental/organização & administração , Pessoa de Meia-Idade , Prisões , Instalações Privadas , Setor Privado , Logradouros Públicos , Setor Público , Medidas de Segurança , Fatores Socioeconômicos , Medicina Estatal/organização & administração
20.
Clin Ter ; 171(2): e97-e100, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32141478

RESUMO

The Italian Law n. 9/2012 provided the Italian Regions with a new decisional role by demanding the management/rehabilitation of prisoners judged as partially/fully mentally ill to care and protection delivered by the psychiatric services of the Regional Health Service. Healthcare has to be guaranteed by the so-called High-Security Forensic Psychiatry Residences (Italian: Residenze per l'Esecuzione delle Misure di Sicurezza: REMS) and by community mental health centres. Ensuring patients' and professionals' health and safety is a complex issue which requires effective strategies to cope with several structural, technological, and organisational problems. The present paper summarises the historical evolution of the Italian laws towards the development of the High-Security Forensic Psychiatry Residences in Italy, focusing specifically on the Tuscany Region situation. The paper also presents the key issues emerging after the implementation of the Law 81/2014 which complemented the Law 9/2012. Since these reforms included the need for assessing to what extent the patient may be considered as a danger to society and for ensuring the safety of National Health Service (NHS) professionals, they underscored the importance of a preventive use of specific clinical governance tools aimed to reduce risk of adverse events. The present work has the strength of proposing a new, evidence-based scientific approach to the implementation of assessment and care pathways in High-Security Forensic Psychiatry Residences.


Assuntos
Psiquiatria Legal/legislação & jurisprudência , Pessoal de Saúde , Prisioneiros , Medidas de Segurança , Psiquiatria Legal/história , História do Século XXI , Hospitais Psiquiátricos , Habitação , Humanos , Itália , Gestão de Riscos
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA