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1.
BMC Psychiatry ; 21(1): 190, 2021 04 13.
Artículo en Inglés | MEDLINE | ID: mdl-33849472

RESUMEN

BACKGROUND: Randomised controlled trials suggest that family therapy has a positive effect on the course of depression, schizophrenia and anorexia nervosa. However, it is largely unknown whether a positive link also exists between caregiver involvement and patient outcome in everyday psychiatric hospital care, using information reported directly from patients, i.e. patient-reported experience measures (PREM), and their caregivers. The objective of this study is to examine whether caregiver-reported involvement is associated with PREM regarding patient improvement and overall satisfaction with care. METHODS: Using data from the National Survey of Psychiatric Patient Experiences 2018, we conducted a nationwide cross-sectional study in Danish psychiatric hospitals including patients and their caregivers who had been in contact with the hospital (n = 940 patients, n = 1008 caregivers). A unique patient identifier on the two distinct questionnaires for the patient and their caregiver enabled unambiguous linkage of data. In relation to PREM, five aspects of caregiver involvement were analysed using logistic regression with adjustment for patient age, sex and diagnosis. RESULTS: We consistently find that high caregiver-reported involvement is statistically significantly associated with high patient-reported improvement and overall satisfaction with care with odds ratios (OR) ranging from 1.69 (95% confidence interval (CI) 0.95-2.99) to 4.09 (95% CI 2.48-6.76). This applies to the following aspects of caregiver-reported involvement: support for the patient-caregiver relationship, caregiver information, consideration for caregiver experiences and the involvement of caregivers in decision making. No statistically significant association is observed regarding whether caregivers talk to the staff about their expectations for the hospital contact. CONCLUSION: This nationwide study implies that caregiver involvement focusing on the patient-caregiver relationship is positively associated with patient improvement and overall satisfaction with care in everyday psychiatric hospital care.


Asunto(s)
Hospitales Psiquiátricos , Satisfacción Personal , Cuidadores , Estudios Transversales , Dinamarca , Humanos , Satisfacción del Paciente , Encuestas y Cuestionarios
2.
Rev Saude Publica ; 55: 14, 2021.
Artículo en Inglés, Portugués | MEDLINE | ID: mdl-33886952

RESUMEN

OBJECTIVE: To characterize the profile of patients hospitalized for mental and behavioral disorders by the Unified Health System (SUS) in Brazil between 2000 and 2014, and to verify how aspects of the new mental health policy influenced the rate of hospitalized patients in that period. METHODS: Non-concurrent prospective cohort study using secondary data from inpatients with a primary diagnosis of mental and behavioral disorders between 01/01/2000 and 12/31/2014. Sociodemographic, clinical, and hospital characteristics variables were selected. Overall rates of hospitalized patients were calculated according to reason for admission, type of hospital, legal nature, and number of admissions per year for each patient. The association between rates of hospitalized patients, number of psychiatric beds per year, and number of Psychosocial Care Centers per year were tested. RESULTS: We selected a total of 1,549,298 patients, whose most frequent diagnoses on first admission were psychoactive substance use disorders, followed by schizophrenia and mood disorders. The median of hospitalizations per patient was 1.9 and the length of stay per patient was 29 days. The overall rate of hospitalized patients was reduced by almost half in the period. The number of beds per year was positively associated with the rates of hospitalized patients; the number of CAPS per year was negatively associated with some rates of hospitalized patients. CONCLUSION: Even in the face of adversity, the National Mental Health Policy has advanced in its goal of progressively reducing hospital beds and increasing the supply of substitute services such that both strategies were associated with the reduced inpatient rates. But the changes were felt with greater intensity in the first years of the policy's implementation, becoming less pronounced in recent years.


Asunto(s)
Hospitalización , Trastornos Mentales , Brasil/epidemiología , Hospitales , Hospitales Psiquiátricos , Humanos , Pacientes Internos , Trastornos Mentales/epidemiología , Trastornos Mentales/terapia , Estudios Prospectivos
3.
Artículo en Inglés | MEDLINE | ID: mdl-33805037

RESUMEN

INTRODUCTION: This study aimed to explore how healthcare professionals and users could perceive user involvement in the handover between mental health hospitals and community mental healthcare, drawing on the discourse analysis framework from Fairclough. METHODS: A qualitative research design with purposive sampling was adopted. Five audio-recorded focus group interviews with nurses, users and other health professionals were explored using Fairclough's discourse analysis framework. Ethical approval: The study was designed following the ethical principles of the Helsinki Declaration and Danish Law. Each study participant in the two intersectoral sectors gave their informed consent after verbal and written information was provided. RESULTS: This study has shown how users can be subject to paternalistic control despite the official aims that user involvement should be an integral part of the care and treatment offered. As evidenced in discussions by both health professionals and the users themselves, the users were involved in plans with the handover on conditions determined by the health professionals who were predominantly focused on treating diseases and enabling the users to live a life independent of professional help. CONCLUSIONS: Our results can contribute to dealing with the challenges of incorporating user involvement as an ideology in the handover between mental health hospitals and community mental health. There is a need to start forming a common language across sectors and, jointly, for professionals and users to draw up plans for intersectoral care.


Asunto(s)
Servicios de Salud Mental , Salud Mental , Personal de Salud , Hospitales Psiquiátricos , Humanos , Investigación Cualitativa
4.
BMC Psychiatry ; 21(1): 165, 2021 03 24.
Artículo en Inglés | MEDLINE | ID: mdl-33761921

RESUMEN

BACKGROUND: Movement is a basic component of health. Little is known about the spatiotemporal movement of patients with mental disorders. The aim of this study was to determine how spatiotemporal movement of patients related to their symptoms and wellbeing. METHOD: A total of 106 patients (inpatients (n = 69) and outpatients (n = 37)) treated for a wide range of mental disorders (transdiagnostic sample) carried a GPS-enabled smartphone for one week at the beginning of treatment. Algorithms were applied to establish spatiotemporal clusters and subsequently related to known characteristics of these groups (i.e., at the hospital, at home). Symptomatology, Wellbeing, and Psychological flexibility were also assessed. RESULTS: Spatiotemporal patterns of inpatients and outpatients showed differences consistent with predictions (e.g., outpatients showed higher active areas). These patterns were largely unassociated with symptoms (except for agoraphobic symptoms). Greater movement and variety of movement were more predictive of wellbeing, however, in both inpatients and outpatients. CONCLUSION: Measuring spatiotemporal patterns is feasible, predictive of wellbeing, and may be a marker of patient functioning. Ethical issues of collecting GPS data are discussed.


Asunto(s)
Hospitales Psiquiátricos , Trastornos Mentales , Humanos , Pacientes Internos , Trastornos Mentales/terapia , Movimiento , Pacientes Ambulatorios
5.
J Pastoral Care Counsel ; 75(1_suppl): 49-52, 2021 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-33730920

RESUMEN

This Special Issue discusses the results of the international COVID-19 survey that took place during the first wave of the pandemic. This contribution discusses chaplaincy in a psychiatric hospital during the COVID-19 pandemic. Chaplaincy vignettes with patients and interventions with staff are described, showing how chaplaincy changed and remained the same during this time. The focus here is on acknowledging disturbed and broken connections, as well as intervening to sustain community.


Asunto(s)
/psicología , Servicio de Capellanía en Hospital , Hospitales Psiquiátricos , Cuidado Pastoral/métodos , Femenino , Humanos , Masculino , Religión
6.
Soins ; 66(853): 30-31, 2021 Mar.
Artículo en Francés | MEDLINE | ID: mdl-33775299

RESUMEN

The first advanced practice nurses in psychiatry and mental health are being deployed across the country. Such is the case at Paris XV psychiatric university hospital, which is working to gradually integrate an advanced practice nurse into medico-psychological centres to work with patients with schizophrenia. The role also comprises time devoted to research and teaching.


Asunto(s)
Enfermería de Práctica Avanzada , Esquizofrenia , Enfermería de Práctica Avanzada/organización & administración , Hospitales Psiquiátricos , Hospitales Universitarios , Humanos , Paris , Esquizofrenia/enfermería
7.
Psychiatry Res ; 298: 113833, 2021 04.
Artículo en Inglés | MEDLINE | ID: mdl-33657449

RESUMEN

Some psychiatric hospitals have instituted mandatory COVID-19 testing for all patients referred for admission. Others have permitted patients to decline testing. Little is known about the rate of COVID-19 infection in acute psychiatric inpatients. Characterizing the proportion of infected patients who have an asymptomatic presentation will help inform policy regarding universal mandatory versus symptom-based or opt-out testing protocols. We determined the COVID-19 infection rate and frequency of asymptomatic presentation in 683 consecutively admitted patients during the surge in the New York City region between April 3rd, 2020 and June 8th, 2020. Among these psychiatric inpatients, there was a 9.8 % overall rate of COVID-19 infection. Of the COVID-19 infected patients, approximately 76.1 % (51/67) either had no COVID-19 symptoms or could not offer reliable history of symptoms at the time of admission. Had they not been identified by testing and triaged to a COVID-19 positive unit, they could have infected others, leading to institutional outbreak. These findings provide justification for psychiatric facilities to maintain universal mandatory testing policies, at least until community infection rates fall and remain at very low levels.


Asunto(s)
/normas , /epidemiología , Hospitales Psiquiátricos/normas , Trastornos Mentales/terapia , Admisión del Paciente/normas , Adulto , Comorbilidad , Femenino , Humanos , Masculino , Trastornos Mentales/epidemiología , Persona de Mediana Edad , Ciudad de Nueva York/epidemiología , Derivación y Consulta , Triaje/normas
8.
Tijdschr Psychiatr ; 63(3): 166-171, 2021.
Artículo en Holandés | MEDLINE | ID: mdl-33779969

RESUMEN

BACKGROUND: Since the COVID-19 outbreak there are warnings for an increase of psychological complaints in the general population and in psychiatric patients. AIM: To gain insight in corona associated factors that can provoke psychiatric decompensation, wherefore admission in our psychiatric clinic was necessary. To investigate if the admission rate of our clinic increased since the start of the quarantine measures. METHOD: From the 16th of March until the 1st of June 2020 we collected data in our psychiatric acute admission clinic in Amsterdam of patients with a corona associated triggering factor for the current psychiatric decompensation. Additionally, the admission rates between the 16th of March and the 1st of June 2020 were compared with the admission rates in the same period in 2019. RESULTS: In 25 of 120 admitted patients there was a corona associated triggering factor. The disruption of daily routine and increased stress due to corona were mentioned most often. In the studied period there were significantly more admissions in 2020 compared to 2019. CONCLUSION: The corona crisis can contribute to psychiatric decompensation. In a fifth of the admitted patients a corona associated triggering factor was mentioned. Furthermore we observed a higher demand for psychiatric admissions since the start of the quarantine measures in comparison with 2019.


Asunto(s)
/psicología , Trastornos Mentales/epidemiología , Admisión del Paciente , Hospitales Psiquiátricos , Humanos , Países Bajos/epidemiología , Estrés Psicológico/epidemiología
9.
J Psychiatr Pract ; 27(2): 137-144, 2021 Mar 05.
Artículo en Inglés | MEDLINE | ID: mdl-33656821

RESUMEN

The widespread prevalence of coronavirus disease 2019 (COVID-19) means that inpatient psychiatric units will necessarily manage patients who have COVID-19 that is comorbid with acute psychiatric symptoms. We report a case of recurrence of respiratory symptoms and positive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) reverse transcription-polymerase chain reaction (RT-PCR) testing in a patient on an inpatient psychiatric unit occurring 42 days after the initial positive SARS-CoV-2 RT-PCR test, 38 days after initial symptom resolution, and 30 days after the first of 3 negative SARS-CoV-2 RT-PCR tests. Over the course of the admission, the patient was safely initiated on clozapine. Recent literature on COVID-19's potential recurrence and neuropsychiatric effects is reviewed and implications for the management of COVID-19 on inpatient psychiatric units are discussed. In the era of COVID-19 and our still-developing understanding of this illness, psychiatrists' role as advocates and collaborators in our patients' physical health care has become even more critical.


Asunto(s)
Antidepresivos/uso terapéutico , Antipsicóticos/uso terapéutico , Trastorno Depresivo Mayor/complicaciones , Trastorno Depresivo Mayor/tratamiento farmacológico , Trastornos Psicóticos/complicaciones , Trastornos Psicóticos/tratamiento farmacológico , Adulto , Alcoholismo/complicaciones , Alcoholismo/diagnóstico , /psicología , Clozapina , Trastorno Depresivo Mayor/diagnóstico , Hospitales Psiquiátricos , Humanos , Pacientes Internos/psicología , Masculino , Mirtazapina/uso terapéutico , Trastornos Psicóticos/diagnóstico , Recurrencia , Sertralina/uso terapéutico , Intento de Suicidio
10.
BMC Psychiatry ; 21(1): 120, 2021 03 02.
Artículo en Inglés | MEDLINE | ID: mdl-33653305

RESUMEN

BACKGROUND: Violence risk assessment is a routine part of clinical services in mental health, and in particular secure psychiatric hospitals. The use of prediction models and risk tools can assist clinical decision-making on risk management, including decisions about further assessments, referral, hospitalization and treatment. In recent years, scalable evidence-based tools, such as Forensic Psychiatry and Violent Oxford (FoVOx), have been developed and validated for patients with mental illness. However, their acceptability and utility in clinical settings is not known. Therefore, we conducted a clinical impact study in multiple institutions that provided specialist mental health service. METHODS: We followed a two-step mixed-methods design. In phase one, we examined baseline risk factors on 330 psychiatric patients from seven forensic psychiatric institutes in China. In phase two, we conducted semi-structured interviews with 11 clinicians regarding violence risk assessment from ten mental health centres. We compared the FoVOx score on each admission (n = 110) to unstructured clinical risk assessment and used a thematic analysis to assess clinician views on the accuracy and utility of this tool. RESULTS: The median estimated probability of violent reoffending (FoVOx score) within 1 year was 7% (range 1-40%). There was fair agreement (72/99, 73% agreement) on the risk categories between FoVOx and clinicians' assessment on risk categories, and moderate agreement (10/12, 83% agreement) when examining low and high risk categories. In a majority of cases (56/101, 55%), clinicians thought the FoVOx score was an accurate representation of the violent risk of an individual patient. Clinicians suggested some additional clinical, social and criminal risk factors should be considered during any comprehensive assessment. In addition, FoVOx was considered to be helpful in assisting clinical decision-making and individual risk assessment. Ten out of 11 clinicians reported that FoVOx was easy to use, eight out of 11 was practical, and all clinicians would consider using it in the future. CONCLUSIONS: Clinicians found that violence risk assessment could be improved by using a simple, scalable tool, and that FoVOx was feasible and practical to use.


Asunto(s)
Psiquiatría Forense , Trastornos Mentales , China , Estudios de Factibilidad , Hospitales Psiquiátricos , Humanos , Trastornos Mentales/diagnóstico , Medición de Riesgo , Violencia
11.
Artículo en Inglés | MEDLINE | ID: mdl-33673580

RESUMEN

Acute mental health care facilities have become the modern equivalent to the old asylum, designed to provide emergency and temporary care for the acutely mentally unwell. These facilities require a model of mental health care, whether very basic or highly advanced, and an appropriately designed building facility within which to operate. Drawing on interview data from our four-year research project to examine the architectural design and social milieu of adult acute mental health wards in Aotearoa New Zealand, official documents, philosophies and models of mental health care, this paper asks what is the purpose of the adult inpatient mental health ward in a bicultural country and how can we determine the degree to which they are fit for purpose. Although we found an important lack of clarity and agreement around the purpose of the acute mental health facility, the general underpinning philosophy of mental health care in Aotearoa New Zealand was that of recovery, and the CHIME principles of recovery, with some modifications, could be translated into design principles for an architectural brief. However, further work is required to align staff, service users and official health understandings of the purpose of the acute mental health facility and the means for achieving recovery goals in a bicultural context.


Asunto(s)
Hospitales Psiquiátricos , Trastornos Mentales , Adulto , Humanos , Pacientes Internos , Trastornos Mentales/terapia , Nueva Zelanda
13.
BMC Psychiatry ; 21(1): 82, 2021 02 08.
Artículo en Inglés | MEDLINE | ID: mdl-33557780

RESUMEN

BACKGROUND AND OBJECTIVES: Coercion in psychiatry is legally tolerated as a last resort. The reduction of the use of coercion is a shared goal of hospital administrators, medical and nursing staff and representatives of patients and families but requires the identification of risk factors for coercion. These risk factors in geriatric psychiatric inpatient settings are not well known, especially regarding seclusion. Through examining the prevalence of coercion and patients' characteristics, this study aims to identify risk factors for coercion in elderly people. METHODS: The use of coercion in the geriatric psychiatry division of Geneva University Hospital in 2017 was retrospectively analyzed. The incidence rate ratios were estimated with multivariable Poisson regressions to assess risk factors for coercion. RESULTS: Eighty-one of 494 patients (16.4%) experienced at least one coercive measure during their stay (mainly seclusion). The risk factors for coercion were younger age, male gender, being divorced or married, cognitive disorders, high item 1 of the Health of the Nation Outcome Scales (HoNOS) score (overactive, aggressive, disruptive or agitated behavior) at admission, previous psychiatric hospitalizations and involuntary referrals from the emergency department. Other disorders and global HoNOS scores were not associated with the use of coercion. CONCLUSION: Higher risks of coercion were outlined in men with cognitive disorders, agitated behaviors, and previous psychiatric hospitalizations. They differed from those observed in younger adults in terms of age, civil status, disorders, global HoNOS scores and referrals. Therefore, geriatric psychiatric populations should be specifically investigated for the development of interventions aiming coercion reduction.


Asunto(s)
Trastornos Mentales , Psiquiatría , Adulto , Anciano , Coerción , Psiquiatría Geriátrica , Hospitales Psiquiátricos , Humanos , Pacientes Internos , Masculino , Trastornos Mentales/epidemiología , Trastornos Mentales/terapia , Aislamiento de Pacientes , Prevalencia , Restricción Física , Estudios Retrospectivos , Factores de Riesgo
15.
Artículo en Ruso | MEDLINE | ID: mdl-33591672

RESUMEN

The article considers problematic issues in hospital-replacing out-patient mental care management on the basis of the Psychiatric Hospital № 13 in 2015-2017. The analysis covered structure of mental patients, their age and social status. Also, patients under active dispensary monitoring and compulsory continuous out-patient treatment were analyzed. The new management component - «the out-patient psychiatric module¼ - is proposed to be introduced into the structure of mental dispensary.


Asunto(s)
Trastornos Mentales , Enfermos Mentales , Hospitales Psiquiátricos , Humanos , Trastornos Mentales/epidemiología , Trastornos Mentales/terapia , Moscú , Organizaciones , Pacientes Ambulatorios
16.
Fortschr Neurol Psychiatr ; 89(4): 154-161, 2021 Apr.
Artículo en Alemán | MEDLINE | ID: mdl-33440454

RESUMEN

AIM OF THE STUDY: Alcohol and substance-related disorders (ICD 10 F1x.x) are among the most frequent diagnoses made in hospitalized patients requiring somatic and psychiatric care. In order to assess the success of treatment, it is important to establish and implement outcome indicators in practice. METHOD: In 2016, global treatment indicators for admission and at discharge were collected at 10 Vitos clinics in Hesse (CGI and GAF). More than 10,000 patients with ICD10 F1x diagnoses were included in the evaluation. RESULTS: The evaluations show significant improvements of the clinical status as well as differences in treatment duration, remissions and gender differences. CONCLUSION: The study suggests that global indicators of outcome quality are useful in the assessment of treatment success of alcohol and substance-related disorders. Limitations of the study design, instruments and sample are critically reviewed.


Asunto(s)
Trastornos Mentales , Trastornos Relacionados con Sustancias , Hospitalización , Hospitales Psiquiátricos , Humanos , Pacientes Internos , Trastornos Mentales/epidemiología , Trastornos Mentales/terapia , Trastornos Relacionados con Sustancias/epidemiología , Trastornos Relacionados con Sustancias/terapia , Resultado del Tratamiento
17.
J Psychosom Res ; 142: 110352, 2021 03.
Artículo en Inglés | MEDLINE | ID: mdl-33450429

RESUMEN

OBJECTIVES: Gendered inequalities in workplace stress are linked to sex-specific health trajectories that are poorly understood. Measuring gendered inequalities is challenging but necessary to better explain individual differences in occupational health. The aim of this exploratory, retrospective study was to create a measure of occupational gender-roles and use structural equation models to investigate pathways linking layers of gendered factors to workplace stress, allostatic load, and mental health in a sample of psychiatric hospital workers (N = 192). METHODS: Individual-level gender-roles were measured with the Bem Sex-Role Inventory Short-Form. Occupational gender-roles were measured using a novel web-based survey approach. Sex-specific allostatic load indices were constructed using 23 biomarkers (e.g., neuroendocrine, immune, cardiovascular, and metabolic). Workplace stress was assessed using the Job Content Questionnaire and the Effort-Reward at Work Questionnaire. Depressive symptoms were assessed with the Beck Depression Inventory-II, burnout symptoms with the Maslach Burnout Inventory - General Survey, and trauma symptoms with the PTSD Civilian Checklist. RESULTS: Individual-level masculine gender-roles were positively associated with psychological demands (R2 = 0.103) and social support (R2 = 0.078). Masculine and feminine occupational gender-roles were positively associated with decisional latitude (R2 = 0.157) and effort-reward ratio (R2 = 0.058). Both individual masculine and feminine gender-roles had protective effects on depressive symptoms (R2 = 0.289) and burnout symptoms (R2 = 0.306) but only individual masculine gender-roles had protective effects on trauma symptoms (R2 = 0.198). We found no association between occupational gender-roles and mental health and allostatic load. CONCLUSION: Beyond individual gender-roles, our study shows the utility of measuring occupational gender-roles to delineate associations between workplace stressors and mental health that should be applied in future studies of sex differences in occupational health.


Asunto(s)
Alostasis/fisiología , Hospitales Psiquiátricos/normas , Salud Mental/normas , Estrés Laboral/psicología , Estrés Psicológico/psicología , Adolescente , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Adulto Joven
19.
Soins Psychiatr ; 41(330): 12-16, 2020.
Artículo en Francés | MEDLINE | ID: mdl-33353601

RESUMEN

The "total institutions" described by Erving Goffman have always functioned, particularly in psychiatry, in accordance with internal rules organising directly or indirectly the sex life of the patients. Sexual relations were limited, banned and even sanctioned. The evolution of psychiatric hospitals changed views and sexual practices. The circular of 15 March 1960 introduced mixed-gender wards in hospitals. Homosexuality, hitherto tolerated, particularly in women's units, made way for heterosexual relationships which became a concern for caregivers. In 2013, a judgement issued by the Bordeaux administrative court of appeal against a psychiatric unit brought the debate back into focus. It raised the question of fundamental liberties and human rights.


Asunto(s)
Hospitales Psiquiátricos , Derechos Humanos , Sexualidad , Femenino , Humanos , Masculino
20.
Soins Psychiatr ; 41(330): 17-22, 2020.
Artículo en Francés | MEDLINE | ID: mdl-33353602

RESUMEN

Diego, a young adolescent, is hospitalised in a psychiatric unit for anorexia. The diagnosis of anorexia, as well as medical practices, result in resistance from the young man, for whom being "anorexic" seems incompatible with a masculine and heterosexual vision of oneself. His passage through the psychiatric unit is then not without effect on his sexual development.


Asunto(s)
Hospitales Psiquiátricos , Desarrollo Sexual , Adolescente , Anorexia/terapia , Hospitalización , Humanos , Masculino
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