A Systematic Review on the Impact of Seasonality on Severe Mental Illness Admissions: Does Seasonal Variation Affect Coercion?

Coercion in psychiatry is associated mainly with involuntary admissions. The purpose of this study was to investigate the associations between hospital admissions of patients suffering from affective and schizophrenic disorders and seasonality. A systematic literature search using PubMed, Scopus and Google Scholar was conducted, including studies with affective and schizophrenia disorder admissions, published from October 1992 to August 2020. A total of 31 studies were included in the review. Four broad severe mental illness admission categories were identified regarding seasonality: affective disorders, schizophrenia disorders, involuntary admission affective disorders and involuntary admission schizophrenia disorders. There was clear and strong evidence for spring and summer peaks for severe mental illness admissions; data provided for age, gender and involuntary admissions was limited. Seasonality may have a significant effect on the onset and exacerbation of psychopathology of severe mental illness and should be considered as a risk factor in psychiatric admissions, violence and the risk of mental health coercion. A better understanding of the impact of seasonality on severe mental illness will help professionals to provide the best practices in mental health services in order to reduce and prevent psychiatric hospitalizations (especially involuntary admissions) resulting in further coercive measures.

The impact of meteorological factors on involuntary admission in Attica, Greece.

Few studies in the literature have examined the effect of meteorological factors, especially temperature, on psychiatric hospitalization and even less on their association with involuntary admission. This study aimed to investigate the potential association of meteorological factors with the involuntary psychiatric hospitalization in the region of Attica, Greece. The research was conducted at the Psychiatric Hospital of Attica "Dafni". This was a retrospective time series study of 8 consecutive years of data (2010 to 2017) and included 6887 involuntarily hospitalized patients. Data on daily meteorological parameters were provided from the National Observatory of Athens. Statistical analysis was based on Poisson or negative binomial regression models with adjusted standard errors. Analyses were initially based on univariable models for each meteorological factor separately. All meteorological factors were taken into account through factor analysis and then, through cluster analysis, an objective grouping of days with similar weather type was performed. The resulting types of days were examined for their effect on the daily number of involuntary hospitalizations. Increases in maximum temperature, in average wind speed and in minimum atmospheric pressure values were associated with an increase in the average number of involuntary hospitalizations per day. Increase of the maximum temperature above 23 °C at lag 6 days before admission did not affect significantly the frequency of involuntary hospitalizations. Low temperature and average relative humidity above 60% levels had a protective effect. The predominant day type at lag 1 to 5 days before admission showed the strongest correlation with the daily number of involuntary hospitalizations. The cold season day type, with lower temperatures and a small diurnal temperature range, northerly winds of moderate speed, high atmospheric pressure and almost no precipitation, was associated with the lowest frequency of involuntary hospitalizations, whereas the warm season day type, with low daily temperature and small daily temperature range during the warm season, high values of relative humidity and daily precipitation, moderate wind speed/gust and atmospheric pressure, was associated with the highest. As climate change increases the frequency of extreme weather events, it is necessary to develop a different organizational and administrative culture of mental health services.

Cognitive- behavioral psychotherapy of patients with tinnitus.

In this work 112 studies were reviewed and 21 of them were considered as more reliable and more credible. It is well known that Cognitive-Behavioural Therapy (CBT) is the most valid approach regarding its effectiveness. There are many variations of CBT used in patients with tinnitus, but the most effective appears to be the Cognitive-Behavioural Acceptance and Commitment Therapy. Also, treatment-variations consist in the use of hearing aids, and psycho-education. The Acceptance and Commitment Therapy is a third-generation psychological intervention invented by Steven Hayes in 1986. This therapy also applies to the treatment of many psychological problems, such as depression, anxiety, psychoses and substance use problems, and chronic diseases. The purpose of this therapy is not to reduce symptoms, but to improve health and behaviour changes in order for the patient to accept the inevitable pain involved in his/her condition. There are other forms of therapy that come from the broader spectrum of CBT, such as book-therapy (self-help method), rehabilitation treatment of tinnitus, and the Axiological Model based solely on cognitive psychotherapy inspired by the CBT founder, Aaron Beck. Because the latter treatment is at its first steps, there is no literature yet, and it must be considered as an experimental model. It is also well known that intervention with CBT could significantly reduce the anxiety and stress caused by tinnitus. The CBT technique incorporates many elements used to treat tinnitus, such as self-assessment, applied relaxation, cognitive restructuring, behavioral activation, and positive mental imagery. Finally, it becomes apparent that the tinnitus problem, which is serious for these patients, is increasingly affecting the psychiatric and psychotherapeutic communities.