Percepción del uso del humor por parte de enfermeras y pacientes en los servicios de salud mental / Perception of the use of humour by nurses and patients at Mental Health Units

Objetivo: conocer, en función de la literatura disponible, el significado del sentido del humor entre enfermeras y pacientes en el contexto de servicios de salud mental, así como determinar los factores que facilitan o dificultan el uso del sentido del humor en las unidades de salud mental. Métodos: se llevó a cabo una revisión narrativa en el periodo 2022-2023. Las búsquedas se realizaron en Pubmed, PsycINFO, LILACS y CINAHL, usando los descriptores: “Nurse-patient relations”, “mental health”, “wit and humor as topic”, "psychiatric nursing”. Se incluyeron todo tipo de documentos que abordaran el tema según los objetivos, publicados desde 2012 hasta noviembre de 2022 en inglés, español o portugués. Se añadió un artículo traducido del coreano por su relevancia. Resultados: se incluyeron 10 manuscritos en la revisión. Los hallazgos sugieren que el sentido del humor se percibe como una herramienta esencial para fortalecer la relación entre enfermeras y pacientes en entornos psiquiátricos. No obstante, se destaca la existencia de factores que podrían conducir a un uso inapropiado del humor, llevando a la deshumanización de la atención y la posible ruptura del vínculo terapéutico. Conclusiones: es importante considerar cuidadosamente el empleo del humor en el contexto de la salud mental, para garantizar su efectividad sin comprometer la calidad asistencial. (AU)

Objective: based on the literature available, to understand the meaning of sense of humour between nurses and patients in the setting of Mental Health Units, as well as to determine the factors that facilitate its use, o make it difficult. Methods: a narrative review was conducted during the 2022-2023 period. Searches were conducted in Pubmed, PsycINFO, LILACS and CINAHL, using the descriptors: “Nurse-patient relations”, “mental health”, “wit and humor as topic”, “psychiatric nursing”. All type of documents addressing this matter according to the objectives were included, published from 2012 until November 2022 in English, Spanish or Portuguese. An article translated from Korean was added due to its relevance. Results: ten (10) manuscripts were included in the review. Findings suggested that sense of humour was perceived as an essential tool in order to strengthen the relations between nurses and patients in psychiatric settings. However, it was highlighted that there are factors which could induce an inadequate use of humour, leading to dehumanization in care and a potential breach in the therapeutic link. Conclusions: it is important to carefully consider the use of humour in the mental health setting, in order to guarantee its effectiveness without compromising the quality of care. (AU)

Verbal de-escalation to reduce the use of mechanical restraint during nonvoluntary ambulance transfers. / Utilización de la desescalada verbal para reducir la contención mecánica durante los traslados no voluntarios en ambulancia.

OBJECTIVES: To evaluate the usefulness of annual training in verbal de-escalation techniques for reducing the use of mechanical restraints during nonvoluntary ambulance transfers of patients with mental health problems who need emergency care. MATERIAL AND METHODS: Quasi-experimental before-after study. Patients with mental diseases treated by a psychiatric team and transferred from home without their consent were included from January through December 2008 in Barcelona. Since 2013, the team had been attending annual training sessions in verbal de-escalation based on the recommendations of the BETA project (Best Practices in the Evaluation and Treatment of Agitation). We compared the prevalence of the use of mechanical restraint before and after the team started verbal de-escalation training. We also analyzed variables associated with the need to use restraints. RESULTS: Patients in 633 nonvoluntary transfers were included. Mechanical restraints were used in 42.0% of transfers before de-escalation training and in 20.6% of transfers afterwards, reflecting a 50.1% reduction. Logistic regression identified younger age and the presence of psychotic symptoms as factors associated with the use of restraints; the use of verbal de-escalation was a protective factor (P 0.005). CONCLUSION: Annual training in verbal de-escalation techniques following the BETA project's recommendations led to a 50% reduction in the need to use mechanical restraint during nonvoluntary ambulance transfers of patients with mental health problems.

OBJETIVO: Evaluar la efectividad de la formación anual en desescalada verbal (DV) en la reducción de las contenciones mecánicas (CM) durante los traslados no voluntarios en ambulancia a urgencias de pacientes con enfermedad mental. METODO: Estudio cuasiexperimental antes-después. Se incluyeron todos los pacientes con enfermedad mental trasladados de manera no voluntaria en Barcelona por un equipo de atención psiquiátrica en domicilio, desde enero de 2008 hasta diciembre de 2020. En el año 2013 el equipo al completo inició una formación anual en DV en base a las recomendaciones del proyecto BETA (Best Practices in the Evaluation and Treatment of Agitation). Se ha comparado la prevalencia de CM durante dichos traslados, antes y después de iniciar la formación en DV. Asimismo se han analizado los factores asociados a la necesidad de CM. RESULTADOS: Se incluyeron 633 traslados no voluntarios. Antes de la formación en DV hubo un 42,0% de CM y después fue del 20,6%, lo que supone una reducción del 50,1%. La regresión logística mostró que los factores asociados a la necesidad de CM son una menor edad y la existencia de síntomas psicóticos como factores de riesgo y uso de la DV como factor protector (p 0,005). CONCLUSIONES: La formación anual en DV siguiendo las recomendaciones del proyecto BETA ha permitido una reducción del 50% de la necesidad de CM durante el traslado no voluntario en ambulancia de pacientes con enfermedad mental.

Utilización de la desescalada verbal para reducir la contención mecánica durante los traslados no voluntarios en ambulancia / Verbal de-escalation to reduce the use of mechanical restraint during nonvoluntary ambulance transfers

Objetivo: Evaluar la efectividad de la formación anual en desescalada verbal (DV) en la reducción de las contenciones mecánicas (CM) durante los traslados no voluntarios en ambulancia a urgencias de pacientes con enfermedad mental. Método: Estudio cuasiexperimental antes-después. Se incluyeron todos los pacientes con enfermedad mental trasladados de manera no voluntaria en Barcelona por un equipo de atención psiquiátrica en domicilio, desde enero de 2008 hasta diciembre de 2020. En el año 2013 el equipo al completo inició una formación anual en DV en base a las recomendaciones del proyecto BETA (Best Practices in the Evaluation and Treatment of Agitation). Se ha comparado la prevalencia de CM durante dichos traslados, antes y después de iniciar la formación en DV. Asimismo se han analizado los factores asociados a la necesidad de CM. Resultados: Se incluyeron 633 traslados no voluntarios. Antes de la formación en DV hubo un 42,0% de CM y después fue del 20,6%, lo que supone una reducción del 50,1%. La regresión logística mostró que los factores asociados a la necesidad de CM son una menor edad y la existencia de síntomas psicóticos como factores de riesgo y uso de la DV como factor protector (p < 0,005). Conclusiones: La formación anual en DV siguiendo las recomendaciones del proyecto BETA ha permitido una reducción del 50% de la necesidad de CM durante el traslado no voluntario en ambulancia de pacientes con enfermedad mental. (AU)

Objective: To evaluate the usefulness of annual training in verbal de-escalation techniques for reducing the use of mechanical restraints during nonvoluntary ambulance transfers of patients with mental health problems who need emergency care. Methods: Quasi-experimental before-after study. Patients with mental diseases treated by a psychiatric team andtransferred from home without their consent were included from January through December 2008 in Barcelona. Since 2013, the team had been attending annual training sessions in verbal de-escalation based on the recommendations of the BETA project (Best Practices in the Evaluation and Treatment of Agitation). We compared the prevalence of the use of mechanical restraint before and after the team started verbal de-escalation training. We also analyzed variables associated with the need to use restraints. Results: Patients in 633 nonvoluntary transfers were included. Mechanical restraints were used in 42.0% of transfers before de-escalation training and in 20.6% of transfers afterwards, reflecting a 50.1% reduction. Logistic regression identified younger age and the presence of psychotic symptoms as factors associated with the use of restraints; the use of verbal de-escalation was a protective factor (P < 0.005). Conclusions: Annual training in verbal de-escalation techniques following the BETA project’s recommendations led to a 50% reduction in the need to use mechanical restraint during nonvoluntary ambulance transfers of patients with mental health problems. (AU)

Determinants of mechanical restraint in an acute psychiatric care unit.

BACKGROUND: Despite numerous attempts to reduce the use of mechanical restraint (MR), this technique continues to be widely applied in many acute psychiatric care settings. In order to reduce MR, a better understanding of the variables associated with its use and duration in different clinical environments is essential. AIM: To determine the proportion of patients subjected to MR and the duration thereof in two acute care psychiatric units; and to identify the variables associated with the use and duration of MR. METHODS: Descriptive study of all patients admitted to the acute psychiatric units at the Parc de Salut Mar (Barcelona, Spain) in the year 2018. The number and percentage of patients subjected to MR, as well as the duration of each episode were assessed. The following data were also registered: sociodemographic characteristics, psychiatric diagnosis, and presence of cultural and/or language barriers. Multivariate analyses were performed to assess determinants of MR and its duration. RESULTS: Of the 464 patients, 119 (25.6%) required MR, with a median of 16.4 h per MR. Two factors - a diagnosis of psychotic disorder [Odds ratios (OR) = 0.22; 95%CI: 0.06-0.62; P = 0.005] and the presence of a language barrier (OR = 2.13; 95%CI: 1.2-3.7; P = 0.007) - were associated with a significantly higher risk of MR. Male sex was associated with a longer duration of MR (B = -19.03; 95%CI: -38.06-0.008; P = 0.05). CONCLUSION: The presence of a language barrier and a psychotic disorder diagnosis are associated with a significantly higher risk of MR. Furthermore, male sex is associated with a longer duration of MR. Individualized restraint protocols that include the required tools are necessary to ultimately limit the use of mechanical restraint.

Unidad de Hospitalización Domiciliaria del Hospital del Mar. Equipo de atención psiquiátrica domiciliaria en el área de Barcelona / Psychiatric Home Hospitalization Unit of the Hospital del Mar. A crisis resolution and home treatment team in Barcelona

Introducción: A pesar del desarrollo de la hospitalización domiciliaria en España durante los últimos años, es llamativa la escasez de literatura. El siguiente estudio pretende exponer los datos obtenidos por la Unidad de Hospitalización a Domicilio de Psiquiatría del Hospital del Mar (HADMar). HADMar es un programa de hospitalización domiciliaria creado hace 2años, que recibe pacientes procedentes de servicios comunitarios y hospitalarios con un seguimiento limitado en el tiempo. Al alta, el paciente es derivado a la unidad de referencia ambulatoria apropiada para cada caso. Material y métodos: Se seleccionó a todos los pacientes visitados desde 2015 hasta la actualidad. Se llevó a cabo un estudio descriptivo que define las características sociodemográficas de la muestra. Las variables clínicas estudiadas fueron la gravedad de los síntomas, el riesgo de suicidio y los cambios en la funcionalidad. Resultados: Un total de 135 pacientes fueron incluidos en la muestra. La edad media de los pacientes fue de 44,6 años y no hubo diferencias entre ambos sexos. De ellos, 26 pacientes tenían un historial de intentos autolíticos y el 11,1% vivían solos. El 51,1% fueron diagnosticados de un trastorno psicótico. La puntuación media en la escala GEP en la variable gravedad de los síntomas psiquiátricos fue 2,39 y el riesgo medio de suicidio 0,49. La puntuación de EEAG al alta era mayor que al ingreso. Conclusiones: Los resultados obtenidos en nuestro estudio son consistentes con resultados reportados en estudios previos. Los equipos de hospitalización domiciliaria han demostrado ser una alternativa a la hospitalización tradicional. Sin embargo, se necesitan más estudios que apoyen estos resultados

Introduction: Although home hospitalization has begun to develop widely in recent years there is a notable lack of studies. The following study includes data from the Psychiatric Home Hospitalization Unit of the Hospital del Mar (HADMar). This program has been running for 2years and takes place in a socio-demographically depressed area in Barcelona. It receives patients from community and hospital services. Monitoring is limited in time and at discharge patient are referred to the ambulatory unit. Material and methods: All patients visited from 2015 to the present time were selected. A total of 135 patients were included in the sample. A qualitative descriptive study was carried out in order to define the socio-demographic characteristics. The severity of symptoms, suicidal risk and changes in the functionality were considered as clinical outcomes. Results: The mean age of patients was 44.6 years and there were no gender differences. A total of 26 patients had a history of suicidal attempts and 11.1% lived alone; 51.1% were diagnosed with a psychotic disorder. The mean GEP score for the severity of the psychiatric symptoms was 2.39 and the mean risk of suicide was 0.49. There is an increase in the EEAG score from admission to discharge, which means an improvement in the functionality of patients. Conclusions: The results obtained in our study are consistent with previous results. Home crisis intervention teams have proved to be an alternative to traditional hospitalization. However, more studies are needed to support these results

Psychiatric Home Hospitalization Unit of the Hospital del Mar. A crisis resolution and home treatment team in Barcelona. / Unidad de Hospitalización Domiciliaria del Hospital del Mar. Equipo de atención psiquiátrica domiciliaria en el área de Barcelona.

INTRODUCTION: Although home hospitalization has begun to develop widely in recent years there is a notable lack of studies. The following study includes data from the Psychiatric Home Hospitalization Unit of the Hospital del Mar (HADMar). This program has been running for 2years and takes place in a socio-demographically depressed area in Barcelona. It receives patients from community and hospital services. Monitoring is limited in time and at discharge patient are referred to the ambulatory unit. MATERIAL AND METHODS: All patients visited from 2015 to the present time were selected. A total of 135 patients were included in the sample. A qualitative descriptive study was carried out in order to define the socio-demographic characteristics. The severity of symptoms, suicidal risk and changes in the functionality were considered as clinical outcomes. RESULTS: The mean age of patients was 44.6 years and there were no gender differences. A total of 26 patients had a history of suicidal attempts and 11.1% lived alone; 51.1% were diagnosed with a psychotic disorder. The mean GEP score for the severity of the psychiatric symptoms was 2.39 and the mean risk of suicide was 0.49. There is an increase in the EEAG score from admission to discharge, which means an improvement in the functionality of patients. CONCLUSIONS: The results obtained in our study are consistent with previous results. Home crisis intervention teams have proved to be an alternative to traditional hospitalization. However, more studies are needed to support these results.

Hikikomori in Spain: A descriptive study.

BACKGROUND: Social withdrawal behaviour is a major health problem that is becoming increasingly important, being necessary studies that investigate its psychopathology and existence in different cultures. AIMS: To describe the clinical and socio-demographic characteristics of hikikomori individuals in Spain. METHOD: Participants were 200 subjects referred to the Crisis Resolution Home Treatment (CRHT) because of social isolation. The definition of hikikomori was the state of avoiding social engagement with generally persistent withdrawal into one's residence for at least 6 months. Socio-demographic and clinical data were analysed, including Severity of Psychiatric Illness (SPI), Global Assessment of Functioning (GAF), Clinical Global Impression (CGI) and World Health Organization Disability Assessment (WHODAS) scales. RESULTS: A total of 164 cases were evaluated. Hikikomori were predominantly young male, with the mean age at onset of hikikomori of 40 years old and a mean socially withdrawn period of 3 years. Only three people had no symptoms suggestive of mental disorder. Psychotic and anxiety were the most common comorbid disorders. The scales administered describe the presence of serious symptoms and impairment in social functioning, with a high prevalence of poor collaboration with treatment. CONCLUSION: This study shows the existence of hikikomori in Spain. Its difficult detection and treatment highlights the need for specialized domiciliary teams. The high comorbidity leads us to conclude that it may not be a new diagnosis, but rather a severe syndrome associated with multiple mental illnesses. Primary hikikomori also exist, but less commonly. Future cross-national studies are needed in order to describe its definition and psychopathology.

Las urgencias psiquiátricas: oportunidades para la adherencia terapéutica. El programa E.M.S.E. Barcelona / Multidisciplinary Team of Specialized support (EMSE): A mobile outreach Project for psychiatric emergency home visits in the city of Barcelona

Introducción: se presenta la implantación de un nuevo dispositivo asistencias, el Equipo Multidisciplinar de Soporte Especializado (EMSE). Este es resultado de un programa de soporte y atención a las urgencias psiquiátricas extrahospitalarias en la ciudad de Barcelona (061). Se describen las características del programa, las fases de desarrollo y se realiza una evaluación. Métodos: se analiza la fase 2, se estudian los pacientes valorados en el domicilio en el periodo del 1 de enero del 2004 al 31 de diciembre de 2004. Las alertas son 196, de las cuales se generan 109 casos que serán tributarios de intervención domiciliaria. Resultados: el 55,5% son trastornos mentales graves desvinculados de la red, y el 22,6% son trastornos mentales vinculados pero que han sido atendidos hace más de cuatro semanas. La historia de trastorno psiquiátrico se caracteriza por tener un tiempo medio sin recibir tratamiento de 40 meses (DS ± 59,2 meses). El delirio, conductas de aislamiento y la agitación-agresividad son las razones de consulta principales. Los diagnósticos se agrupan en el espectro del trastorno esquizofrénico. Las recomendaciones-disposiciones de la consulta, el 48,4% se resuelven en ingresos involuntarios y el 22,6% finalizan en el Centro de Salud Mental. En la evaluación a los cuatro meses, se obtiene un 80% de vinculación en los casos gestionados por EMSE. Conclusiones: la utilidad del programa se constata al comprobar la adherencia al tratamiento. Además este dispositivo puede ser predictor y observatorio de detección de necesidades(AU)

Introduction: our group has set up a program for psychiatric emergency home interventions. It is composed of a multidisciplinary mobile outreach team (EMSE) that attends to spychicatic emergency units called for on the local emergency number (061). Objective: to describe the program, the phses of development and a preliminary evaluation. Methods: a descriptive analysis of home interventions from January 2004 to December 2004. During 2004 teher were 196 calls, of which 109 required home intervention. Results: 55,5% were severe mental disorders that were not being treated at the time. The most frequent motives for consultation were delusions, behavior associated with isolation and agitation-aggression. The diagnoses were classified in the spectrum of schizophrenic disorders. The results from intervention indicate that 48,4% are admitted involuntarily and 22,6% are referred to mental health community centres. The evaluation is positive and results in a 80% follow-up and adherence to treatment by patients. Conclusions: This program is proving both satisfactory and necessary. The adherence to treatment reflects the success of the interventions. The program will also be useful in predicting and detecting further needs(AU)