Development of the Therapeutic Alliance in Alternative Settings to Psychiatric Hospitalization: An Open Comparative Study.

Patient-therapist alliance in two alternative treatment settings developed similarly to that in traditional psychiatric hospitalization.

A Hybrid Type 1 trial of a multi-component mHealth intervention to improve post-hospital transitions of care for patients with serious mental illness: Study protocol.

BACKGROUND: The transition from acute (e.g., psychiatric hospitalization) to outpatient care is associated with increased risk for rehospitalization, treatment disengagement, and suicide among people with serious mental illness (SMI). Mobile interventions (i.e., mHealth) have the potential to increase monitoring and improve coping post-acute care for this population. This protocol paper describes a Hybrid Type 1 effectiveness-implementation study, in which a randomized controlled trial will be conducted to determine the effectiveness of a multi-component mHealth intervention (tFOCUS) for improving outcomes for adults with SMI transitioning from acute to outpatient care. METHODS: Adults meeting criteria for schizophrenia-spectrum or major mood disorders (n = 180) will be recruited from a psychiatric hospital and randomized to treatment-as-usual (TAU) plus standard discharge planning and aftercare (CHECK-IN) or TAU plus tFOCUS. tFOCUS is a 12-week intervention, consisting of: (a) a patient-facing mHealth smartphone app with daily self-assessment prompts and targeted coping strategies; (b) a clinician-facing web dashboard; and, (c) mHealth aftercare advisors, who will conduct brief post-hospital clinical calls with patients (e.g., safety concerns, treatment engagement) and encourage app use. Follow-ups will be conducted at 6-, 12-, and 24-weeks post-discharge to assess primary and secondary outcomes, as well as target mechanisms. We also will assess barriers and facilitators to future implementation of tFOCUS via qualitative interviews of stakeholders and input from a Community Advisory Board throughout the project. CONCLUSIONS: Information gathered during this project, in combination with successful study outcomes, will inform a potential tFOCUS intervention scale-up across a range of psychiatric hospitals and healthcare systems. CLINICALTRIALS: govregistration: NCT05703412.

Returning to college after inpatient psychiatric treatment: a case study of bipolar I disorder management.

Bipolar disorder is typically diagnosed in the teenage to early adulthood years. During this age, many individuals are students pursuing a college degree. Students developing the symptoms of bipolar disorder have a harder time navigating college and have significant difficulties transitioning back to school after psychiatric hospitalization, potentially influencing quality of life. Despite this, little attention has been given to the academic needs of hospitalized college students. This paper discusses the case of a 21-year-old female with a history of bipolar I disorder who was hospitalized for treatment of a manic episode. We discuss interventions to accommodate her educational needs during hospitalization to help minimize her academic load and ease her transition back to college. With this case study, we address the lack of well-established systems to reacclimate hospitalized college students and propose solutions to mitigate the hardships of transitioning from hospitalization back to the rigors of being a student.

Digital Media-related Problems Contributing to Psychiatric Hospitalizations Among Children and Adolescents Before and After the Onset of the COVID-19 Pandemic.

The role of digital media in crises leading to youth psychiatric admissions is understudied and digital media use increased during the COVID-19 pandemic. In this cross-sectional study, demographics, clinical characteristics, and digital media-related problems (DMRPs; sub-coded as cyberbullying, online communication problems, triggering content, and limit-setting problems) were extracted from hospital records of youth (n = 1,101) admitted to a pediatric psychiatric unit from May 2018 to November 2021. DMRPs were identified in 127 admissions (11.5%), led by the online communication problems and limit-setting subtypes (both 4-5%). Significantly more overall problems were identified following the pandemic onset (13.9% of admissions vs. 9.1% before, p < 0.05). The limit-setting subtype specifically increased post-COVID-19 (6.0% vs. 2.7%, p < 0.01), and was associated with prior admissions, suicide attempts, and impulse control/behavioral disorders. Online communication problems were significantly more common among girls and youth with a history of trauma. Interventions in acute settings to mitigate consequences of DMRPs are needed.

The relationship between school mental health service use in high school and educational outcomes of adolescents with psychiatric disorders.

This study aimed to examine the relationship between school mental health service use in high school and educational outcomes of adolescents with psychiatric disorders. The sample included 2617 adolescents who were enrolled in eighth grade in a large urban school district in the United States, were enrolled in Medicaid during eighth grade, and had a mental health diagnosis. Psychiatric hospitalization, school enrollment, school absences, out-of-school suspensions, school dropouts, and school exits for negative reasons were examined as mental health and educational outcomes. Compared with adolescents who used school mental health services for 2 years following eighth grade, adolescents who did not use school mental health service during the high school years had a significantly lower annual number of days enrolled in school and higher rates of exiting school for negative reasons such as school dropout and long-term hospitalization. Our findings support the positive role of school mental health care delivery in high schools in preventing negative educational outcomes for adolescents with psychiatric disorder.

Psychiatric Hospitalization for Psychopathological Disorders and Self-Injurious Behaviors in Italian Children and Adolescents during COVID-19.

The evidence shows that the COVID-19 pandemic dramatically increased the number of urgent psychiatric consultations for children and adolescents in hospital emergency departments (EDs). However, what needs to be further investigated are the characteristics of psychiatric hospitalization in children and adolescents admitted to the Child and Adolescent Neuropsychiatry Unit wards in EDs. Specifically, this retrospective study aimed to examine changes in (i) the number of inpatients and (ii) the distribution of psychopathological disorders and self-injurious behaviors in our Child and Adolescent Neuropsychiatry Unit ward during the COVID-19 lockdown in Italy (March-June 2020; October 2020-January 2021) compared with the same months of previous years. We found a significantly lower number of inpatients during the first four quarantine months than the first four reference months and a higher number of inpatients during the second four quarantine months than the second four reference months. Additionally, we found an increased frequency of mood disorders, non-suicidal self-injurious behavior, and suicidal ideation during the COVID-19 lockdown compared to the reference periods. Our findings underline the need to develop psychological healthcare services for future emergency periods in order to identify and treat psychological distress in children and adolescents early, reducing the risk of psychiatric hospitalization.

O papel do CAPS I na vida de seus usuários: um estudo a partir dos itinerários terapêuticos / The role of CAPS I in the lives of its users: a study based on therapeutic itineraries / El papel del CAPS I en la vida de sus usuarios: un estudio basado en itinerarios terapéuticos

Este artigo buscou compreender, a partir do itinerário terapêutico de pessoas em sofrimento psíquico e egressas de internação psiquiátrica, a inserção do centro de atenção psicossocial como equipamento de cuidado em suas trajetórias. Trata-se de estudo inspirado na Epistemologia Qualitativa de Gonzalez Rey no qual foram realizadas entrevistas com seis pessoas, de 27 a 52 anos, em tratamento em um Centro de Atenção Psicossocial tipo 1, e para análise do material transcrito foram adotados procedimentos inspirados no conceito de indicadores de González Rey e na análise temática de conteúdo. Neste artigo, foram discutidas duas categorias: (1) "O manicômio está presente" e (2) "CAPS: espaço de convivência e substituto da vida social?". Os indicadores apontaram que a internação psiquiátrica foi um recurso utilizado após inserção em CAPS, o qual é destacado mais como local de convívio do que de produção de autonomia e de desinstitucionalização. No percurso dos usuários, as internações ocorreram em hospitais gerais, hospitais especializados e comunidades terapêuticas. Os serviços de atenção primária não aparecem como ponto de cuidado à saúde mental, os serviços de urgência estão presentes na atenção às crises, dando ao CAPS contornos de um serviço para a convivência e não para o cuidado na crise. (AU)

Based on the therapeutic itinerary of individuals experiencing psychic distress and who have undergone psychiatric hospitalization, this study aimed to comprehend the integration of the Center of Psychosocial Attention as a care facility along their path. The study is inspired by Gonzalez Rey's Qualitative Epistemology, in which interviews were conducted with six individuals aged between 27 and 52, receiving treatment at a type 1 Center of Psychosocial Attention. Procedures inspired by González Rey's concept of indicators and thematic content analysis were employed to analyze the transcribed material. This paper will discuss two categories: (1) "The presence of the psychiatric hospital," and (2) "CAPS: A space for interaction and a substitute for social life?" The indicators reveal that psychiatric hospitalization was resorted to after involvement with CAPS, which is perceived more as a space for coexis-tence than for fostering autonomy and deinstitutionalization. As per the users' itineraries, hospitalizations occurred in general hospitals, specialized hospitals, and therapeutic communities. Primary care services do not emerge as a focal point for mental health care, whereas emergency services are present for crisis intervention, portraying CAPS as a service more geared towards coexistence rather than crisis management.

Este artículo buscó comprender, a partir del itinerario terapéutico de las personas en distrés psicológico y las dadas de alta de hospitalización psiqui-átrica, la inserción del centro de atención psicosocial como equipamiento de atención en sus trayectorias. Se trata de un estudio inspirado en la Epistemo-logía Cualitativa de González Rey, en el que se realizaron entrevistas a seis personas, de 27 a 52 años, en tratamiento en un Centro de Atención Psicosocial tipo 1 y para el análisis del material transcrito, procedimientos inspirados por el concepto de indicadores de González Rey y el análisis de contenido temático. En este artículo se discutirán dos categorías: (1) "Está presente el asilo" y (2) ¿"CAPS: espacio de convivencia y sustituto de la vida social?". Los indicadores señalaron que la hospitalización psiquiátrica fue un recurso utilizado después de la inserción en CAPS, que se destaca más como un lugar de socialización que para producir autonomía y desinstitucionalización. En el curso de los usuarios, los ingresos se realizaron en hospitales generales, hospitales especializados y comunidades terapéuticas. Los servicios de atención primaria no aparecen como un punto de atención en salud mental, los servicios de emergencia están presentes en la atención de crisis, dando al CAPS los contornos de un servicio de convivencia y no de atención en crisis. (AU)

Racial and ethnic inequities in psychiatric inpatient building and unit assignment.

Racism is a social determinant of mental health which has a disproportionally negative impact on the experiences of psychiatric inpatients of color. Distinct differences in the physical space and clinical settings of two inpatient buildings at a hospital system in the tristate (New York, New Jersey, Connecticut) area of the United States led to the present investigation of racial inequities in the assignment of patients to specific buildings and units. Archival electronic medical record data were analyzed from over 18,000 unique patients over a period of six years. Hierarchical logistic regression analyses were conducted with assigned building (old vs. new building) as the binary outcome variable. Non-Hispanic White patients were set as the reference group. Black, Hispanic/Latinx, and Asian patients were significantly less likely to be assigned to better resourced units in the new building. When limiting the analysis to only general adult units, Black and Hispanic/Latinx patients were significantly less likely to be assigned to units in the new building. These results suggest ethnoracial inequities in patient assignment to buildings which differed in clinical and physical conditions. The findings serve as a call to action for hospital systems to examine the ways in which structural racism impact clinical care.

Outcome of Involuntary Mental Health Assessment in a Psychiatric Department in Greece.

Despite their controversiality, involuntary admissions in psychiatric departments remain a central issue in mental health care. The present study aims to identify demographic and clinical factors possibly associated with emergency involuntary psychiatric assessment and its outcome in Greece. This study was carried out in the psychiatric department of the University General Hospital of Alexandroupolis (UGHA) from 1 March 2018 to 28 February 2019. The sample included 191 individuals who had been psychiatrically assessed without their consent following a prosecutorial order. The majority of the involuntary assessments resulted in hospitalization (71%), with 51% of them resulting in involuntary hospitalization. Almost all patients diagnosed with "F20-29 schizophrenia, schizotypal and delusional disorders" were subsequently admitted to the psychiatric department of the UGHA (77 of 81, 66 of them involuntarily). Higher admission rates were recorded among those who had been referred from the Prosecutor's Office of regions that are located far from the psychiatric department of UGHA (Fisher's exact test, p-value = 0.045). In multivariate logistic regression, prior contact with psychiatric services and having an "F20-29 schizophrenia, schizotypal and delusional disorders" diagnosis was statistically significant with admission to the hospital as an outcome variable. Our study suggests an increased risk of involuntary admission among patients with psychosis, patients who had visited a psychiatric service prior to their assessment as well as those living further away from the main psychiatric services of the hospital. Better organization of community psychiatric services in remote places from hospital central services may lead to fewer prosecutorial referrals and coercive measures.

Patterns of psychiatric hospitalizations of Arab and Jewish adults with chronic psychotic disorders, before and after national mental health reforms, Israel, 1991-2016.

BACKGROUND: Members of the Arab minority in Israel are at increased risk of developing mental illness, although less likely to seek care and have accessible treatment. This study compares trends in psychiatric hospitalizations between Arabs and Jews with chronic psychotic disorders, before and after introduction of the Community Rehabilitation of Persons with Mental Disability Law in 2000, and governmental recognition of the need to allocate resources for patients with co-occurring substance use disorder and mental illness in 2010. METHODS: The National Psychiatric Case Registry provided data on 18,684 adults with schizophrenia/schizoaffective disorder, hospitalized in 1991-2016 (at least once in 2010-2015). Repeated-measures ANOVA was used to measure the effect (and interactions) of population-group (Arabs and Jews), time-period (Period1: 1991-2000, Period2: 2001-2009, Period3: 2010-2016) and sex, on average length of stay (LOS), annual number of hospitalizations and hospitalization days. RESULTS: The proportion of Arab patients hospitalized with a diagnosis of chronic psychotic disorder (14.4%) was significantly lower than their proportion in the general population (21%), and their average age at first hospitalization (28.4 years) was older than that of Jewish inpatients (27.0 years). The average number of hospitalization days and LOS of Jewish patients were double that of Arab patients in Period1. Following implementation of the Rehabilitation Law, hospitalization days increased among Arab patients and decreased slightly among Jewish patients, such that by Period3 the average number of hospitalization days was similar among Jewish (41) and Arab (37) patients. The increase in hospitalization days among Arab patients was limited to men with no change noted among women. The number of hospitalization days among Arab women was about half that of Jewish women (p < 0.0001). CONCLUSIONS: The findings reveal a narrowing of disparities in psychiatric hospitalizations between Arab and Jewish patients in Israel over time. However, among Arab women the number of hospitalization days remains considerably lower than that of Jewish women, raising concerns that Arab women may be receiving insufficient care. Further study is needed to fully understand the underpinnings of these disparities, although increasing the number of Arabic-language mental health services and providing psycho-education, will help further close the gap.

Technologically assisted intensive home treatment: feasibility study.

Introduction: In recent year, many attempts have been made to provide patients with alternatives to psychiatric hospitalization during acute distress. Although several hospitalization alternatives have been offered, most of them still require patients to be distanced from their families, friends, and the social environment. Methods: In this report we describe the implementation of a novel approach to psychiatric care termed "Technologically assisted Intensive Home Treatment", where patients arriving to emergency settings are directed to home care with technological aids that enable close monitoring and ongoing contact with their therapists. Results: We describe the rationale and treatment principles of the treatment, and provide an elaborative description of the implementation process during the first year of implementation. Discussion: Additional attention is given to factors associated with early dropout from the program, in order to inform readers of predictors to optimal care. Limitations and directions for future research and practice are discussed.Clinical Trial Registration: The study was registered in the database of clinical trials (registration number SHEBA-19-6555-MW-CTIL) and in the Ministry of Health (registration number MOH_2022-08-22_011992).

Ethnic inequalities in community rehabilitation use and psychiatric hospitalizations among people with chronic psychotic disorder.

PURPOSE: Community rehabilitation is crucial for the long-term treatment of people with chronic psychotic disorder. Ethnic minorities are less likely to seek care and have accessible treatment. This study examines whether the use of rehabilitation services and the relationship between rehabilitation and number of hospitalization days differ between Arabs and Jews. METHODS: Data from the Israel National Psychiatric Case Register on 18,684 adults with schizophrenia/schizoaffective disorders hospitalized in 1963-2016 were merged with data from the national Mental Rehabilitation Register. Associations between the use of rehabilitation services and demographic and clinical characteristics were assessed through logistic regression modeling. Associations between ethnicity and duration of rehabilitation (housing or vocational) and annual hospitalization days during Period1: 2001-2009 and Period2: 2010-2016 were analyzed using ANOVA. RESULTS: Among Jewish patients (N = 2556), 37% and 57% used rehabilitation services during Period1 and Period2, respectively, compared with 18% and 40% among Arab patients (N = 15,145) (p < 0.0001). The use of rehabilitation services was significantly higher among Jews (adjusted OR = 2.26, 95% CI 2.07-2.47). Average duration of housing and vocational rehabilitation services did not differ between Arab and Jewish patients. In both groups, duration of rehabilitation was inversely associated with annual hospitalization days. CONCLUSIONS: The ethnic disparity in the use of rehabilitation services has narrowed over time, yet remains. Although fewer Arab patients use rehabilitation, Jewish and Arab benefit similarly from the services with regard to reduced hospitalization days. To further close the ethnic gap, greater efforts must be made to expand the availability of culturally appropriate rehabilitation services for the Arab minority.

Treatment Retention Rates of 3-monthly Paliperidone Palmitate and Risk Factors Associated with Discontinuation: A Population-based Cohort Study.

Objective: Limited evidence exists regarding real-world 3-monthly paliperidone palmitate (PP3M) treatment retention and associated factors. Methods: We conducted a retrospective, nationwide cohort study using the Taiwan National Health Insurance Research Database between October 2017 and December 2019. Adult patients with schizophrenia initiated on PP3M were enrolled. The primary outcomes were time to PP3M discontinuation, time to psychiatric hospitalization, and the proportions of patients receiving the next PP3M dose within 120 days among first-, second-, and third-dose completers. Key covariates included prior PP1M duration and adequate PP3M initiation. Results: The PP3M treatment retention rates were 79.7%, 66.3%, and 52.5% after 6, 12, and 24 months, respectively, with 86.4%, 90.6%, and 90.0% of respective first-, second-, and third-dose completers receiving the next PP3M dose. Adequate PP3M initiation and prior PP1M treatment duration > 180 days were associated with favorable PP3M treatment retention. In multivariate analyses, PP1M durations of 180-360 days (adjusted relative risk [aRR], 1.76) or < 180 days (aRR, 2.79) were associated with PP3M discontinuation at the second dose. Inadequate PP3M initiation was associated with discontinuation at the third dose (aRR, 2.18). Patients fully adherent to PP3M treatment in the first year had a higher probability of being free from psychiatric hospitalization (86.7% at 2 years), compared with those partially adherent or non-adherent to PP3M in the first year. Conclusion: Prior PP1M duration and adequate PP3M initiation are major factors affecting PP3M treatment retention. Higher PP3M treatment retention is associated with a lower risk of psychiatric hospitalization.

Impactos da Pandemia da Covid-19 na Atuação de Profissionais de uma Unidade de Internação Psiquiátrica / Impacts of the Covid-19 Pandemic on the Performance of Professionals in a Psychiatric Inpatient Unit / Impactos de la Pandemia Covid-19 en el Desempeño de los Profesionales en una Unidad de Hospitalización Psiquiátrica

No contexto de pandemia da covid-19, os profissionais de saúde têm sido expostos a situações que podem gerar sofrimento psicológico, como risco de contaminação, longas jornadas de trabalho, falta de equipamentos de proteção individual, estresse e ansiedade. Esta pesquisa investigou os impactos da pandemia da Covid-19 na atuação de profissionais de uma unidade de internação psiquiátrica em hospital geral. Trata-se de pesquisa qualitativa, desenvolvida a partir de entrevistas com profissionais de saúde cujo roteiro continha, dentre outras, a seguinte pergunta: "A pandemia da Covid-19 provocou alterações na sua atuação profissional?". Para análise dos achados, optou-se pela análise temática. Estes apontaram que os desafios para o cuidar na pandemia envolviam alterações nas ações de cuidado, redução da equipe, aumento da carga de trabalho, falta de equipamentos de segurança, medo e ansiedade na equipe, o que implicou na necessidade de suporte psicossocial aos profissionais, pois a pandemia intensificou a vivência de situações difíceis preexistentes. Face ao exposto, observou-se a necessidade de diferentes adaptações para o desenvolvimento do trabalho na unidade pesquisada, que, frente ao clima de tensão instalado no serviço, contava com uma equipe reduzida de profissionais de saúde.

In the context of the covid-19 pandemic, health professionals have been exposed to situations that can produce psychological suffering, such as risk of contamination, extended working time, absence of personal protective equipment, stress, and anxiety. This research studies the impacts of the Covid-19 pandemic on the performance of professionals who work in the psychiatric unit into a general hospital. It is a qualitative research built up from interviews with health professionals whose script contained, among others, the following question: "Has Covid-19 pandemic brought changes in your professional performance?". In order to analyze the findings, we have chosen the thematic analysis approach. Data findings pointed out that the challenges for care in the pandemic encompass changes in the practices of care, staff reduction, increased workload, lack of safety equipment, fear, and anxiety in the team, which implies the need for psychosocial support for the professionals, once the pandemic has deepened the experience of pre-existing difficult situations. Based on the above, there was a need for some new adaptations for doing the work in the researched unit, which faces both an atmosphere of tension hovering in the workplace and a reduced team of health professionals.

En el contexto de la pandemia del covid-19, los profesionales de la salud se han visto expuestos a situaciones que pueden generar sufrimiento psicológico, como el riesgo de contaminación, largas jornadas laborales, falta de equipo de protección personal, estrés y ansiedad. Esta investigación investigó los impactos de la pandemia Covid-19 en el desempeño de los profesionales en una unidad de internación psiquiátrica en un hospital general. Se trata de una investigación cualitativa, desarrollada a partir de entrevistas con profesionales de la salud cuyo guión contenía, entre otras, la siguiente pregunta: "¿La pandemia Covid-19 provocó cambios en su desempeño profesional?". Para analizar los hallazgos se eligió el análisis temático. Estos señalaron que los desafíos para la atención en la pandemia involucraron cambios en las acciones de atención, reducción de personal, aumento de la carga de trabajo, falta de equipos de seguridad, miedo y ansiedad en el equipo, lo que implica la necesidad de apoyo psicosocial a los profesionales, pues la pandemia intensificó la experiencia de situaciones difíciles preexistentes. Con base en lo anterior, fue necesario realizar diferentes adaptaciones para el desarrollo del trabajo en la unidad investigada, que contaba con un reducido equipo de profesionales de la salud y debido al ambiente de tensión instalado en el servicio.

Decreased inpatient psychiatric admissions with telepsychiatry use during the COVID-19 pandemic.

Objective: This study examines the quality of care provided through telepsychiatry by comparing psychiatric hospitalization rates among patients receiving in-person psychiatric care prior to the COVID-19 pandemic with rates among patients receiving virtual psychiatric care during the COVID-19 pandemic. Methods: Mental health-related hospitalization rates among patients enrolled in a large academic hospital's outpatient psychiatry programs between March 1, 2018 and February 28, 2022 were retrospectively analyzed. Four time periods were created, spanning March 1 to February 28 of the following year. Demographic and clinical data were collected from the electronic health record, and descriptive statistics were calculated. Change in hospitalization rate between time periods was evaluated using McNemar's test. Results: In the 2018 time period, 7.38% of all enrolled patients were hospitalized, compared to 7.70% hospitalized in the 2019 period, 5.74% in the 2020 period, and 5.38% in the 2021 period. Patients enrolled in both the 2018 and the 2019 periods saw no difference in hospitalization rate between the 2 years (2.93% in 2018, 2.83% in 2019; p = 0.830); patients enrolled in both 2019 and 2020 saw significantly lower hospitalization rates in 2020 (5.47% in 2019, 4.58% in 2020; p = 0.022); and patients enrolled in both 2020 and 2021 saw no difference (3.34% in 2020, 3.23% in 2021; p = 0.777). Conclusion: Psychiatric hospitalization rates significantly decreased between the 2019 and the 2020 periods, suggesting a decrease in admissions associated with adoption of telepsychiatry. Future research should differentiate the roles played by telepsychiatry and COVID-19-related factors in reducing hospitalization rates during the pandemic.

Compulsory admission: are there differences between migrants and natives? Data from a psychiatric emergency service of an Italian metropolitan area.

Background: As compared to natives, higher rates of involuntary admission were found among migrants in most European countries. A possible strategy to reduce this phenomenon is to develop preventive strategies targeting risk and protective factors of compulsory admission specific to the migrant population. Aims: The first aim of the present study was to evaluate compulsory admission rates in the migrant population as compared to natives admitted for an acute mental disorder. The second aim was investigate whether sociodemographic, clinical, and care-related variables associated with compulsory admission differed between migrants and natives. Moreover, in the whole sample we assessed whether migrant status affected the risk of compulsory admission. Methods: Retrospective single-center study on patients hospitalized in the period between January 1, 2018 and December 31, 2020 in a large metropolitan academic hospital. We compared sociodemographic, clinical, and care-related variables between migrants and natives, voluntary or compulsory admitted. We investigated the association between compulsory admission and the variables collected in the whole sample and in the migrants' and natives' groups with a correlation analysis followed by hierarchical logistic regression models. Results: The sample included 185 migrant patients and 933 native patients. The prevalence of compulsory admission was significantly higher in the migrants' group. Male gender, lower education, non-comprehension of the local language, a diagnosis of a schizophrenia spectrum disorder, and aggressive behavior were associated with compulsory admission in the migrants' sample, partially differing from the natives. Conclusion: Our study highlighted how migrant status is associated with a higher risk for compulsory admission. Inclusion policies or the presence of cultural mediators in emergency settings might be preventive strategies in this context.

A Machine-Learning Approach to Assess Factors Associated With Hospitalization of Children and Youths in Psychiatric Crisis.

OBJECTIVE: The authors used a machine-learning approach to model clinician decision making regarding psychiatric hospitalization of children and youths in crisis and to identify factors associated with the decision to hospitalize. METHODS: Data consisted of 4,786 mobile crisis response team assessments of children and youths, ages 4.0-19.5 years (mean±SD=14.0±2.7 years, 56% female), in Nevada. The sample assessments were split into training and testing data sets. A random-forest machine-learning algorithm was used to identify variables related to the decision to hospitalize a child or youth after the crisis assessment. Results from the training sample were externally validated in the testing sample. RESULTS: The random-forest model had good performance (area under the curve training sample=0.91, testing sample=0.92). Variables found to be important in the decision to hospitalize a child or youth were acute suicidality, followed by poor judgment or decision making, danger to others, impulsivity, runaway behavior, other risky behaviors, nonsuicidal self-injury, psychotic or depressive symptoms, sleep problems, oppositional behavior, poor functioning at home or with peers, depressive or schizophrenia spectrum disorders, and age. CONCLUSIONS: In crisis settings, clinicians were found to mostly focus on acute factors that increased risk for danger to self or others (e.g., suicidality, poor judgment), current psychiatric symptoms (e.g., psychotic symptoms), and functioning (e.g., poor home functioning, problems with peer relationships) when deciding whether to hospitalize or stabilize a child or youth. To reduce psychiatric hospitalization, community-based services should target interventions to address these important factors associated with the need for a higher level of care among youths in psychiatric crisis.

The use of physical restraints and PRN medications in adolescent psychiatric inpatient units.

PROBLEM: Although physical restraint practices and psychotropic/sedative pro re neta (PRN, as needed) medications have been commonly used for managing inpatient aggression, little is known about the characteristics of adolescents who receive them in psychiatric adolescent inpatient units. We aimed to determine the relationship between the use of physical restraints and psychotropic/sedative PRN medications, and to characterize individual attributes, substance use, clinical factors, and time of the first restraint episodes of the use of physical restraints and psychotropic/sedative PRN medications. METHODS: A retrospective case-control study approach was used with the data from electronic health records at a pediatric psychiatric hospital in the United States. Descriptive statistics, χ2 , multivariate logistic regression, and Cox proportional hazard model were used. FINDINGS: Participants of younger age and participants with a longer length of stay were significantly associated with the use of physical restraints and psychotropic/sedative PRN medications, although the substance-related risks were not significantly associated with the use of restraints. Physical restraints were more likely to have occurred soon after the admission and tapered off as the length of stay increased. CONCLUSIONS: This study provides important information in understanding the risk factors of the use of restraints and psychotropic/sedative PRN medications in psychiatric adolescent inpatient units.

Socio-demographic and clinical characteristics of SARS-CoV-2-positive psychiatric in-patients: A case-control study in the psychiatric wards of a Great Metropolitan Hospital in Milan.

During the first Covid-19 outbreak, the Niguarda Hospital of Milan featured two Psychiatry wards, one for SARS-CoV-2 positive patient and one for patients requiring hospitalization and negative for SARS-CoV-2. The two groups of patients were compared and were similar in distribution of psychiatric diagnosis, duration of illness and previous hospitalizations. SARS-CoV-2 positive participants had a lower severity of symptoms both at admission and discharge, a lower frequency of psychotic symptoms and substance intoxication at admission. These findings suggest that patients admitted to the COVID ward were hospitalized not only for their mental health condition but also because of the infection.

Involuntary psychiatric hospitalizations in Greece: Contemporary research and policy implications.

Involuntary psychiatric hospitalization is a contested issue in mental health care provision. Despite indications of very high rates of involuntary hospitalizations in Greece, no valid national statistical data has been collected. After reviewing current research on involuntary hospitalizations in Greece, the paper introduces the Study of Involuntary Hospitalizations in Greece (MANE), a multi-centre national study of the rates, process, determinants and outcome of involuntary hospitalizations, conducted in the regions of Attica, Thessaloniki and Alexandroupolis, from 2017 to 2020, and presents some preliminary comparative findings regarding the rates and process of involuntary hospitalizations. There is a major difference in the rates of involuntary hospitalizations between Alexandroupolis (around 25%) and Athens and Thessaloniki (over 50%), that is possibly related to the sectorized organization of mental health services in Alexandroupolis and to the benefits of not covering a metropolitan urban area. There is a significantly larger percentage of involuntary admissions that end in involuntary hospitalization in Attica and Thessaloniki compared to Alexandroupolis. Reversely, of those accessing the emergency departments voluntarily, almost everyone is admitted in Athens, while large percentages are not admitted in Thessaloniki and in Alexandroupolis. A significantly higher percentage of patients were formally referred upon discharge in Alexandroupolis compared to Athens and Thessaloniki. This may be due to increased continuity of care in Alexandroupolis and that might explain the low rates of involuntary hospitalization there. Finally, re-hospitalization rates were very high in all the study centers, demonstrating the revolving-door phenomenon, especially for voluntary hospitalizations. The MANE project came to address the gap in national recording of involuntary hospitalizations, by implementing, for the first time, a coordinated monitoring of involuntary hospitalizations in three regions of the country with different characteristics, so that a picture of involuntary hospitalizations can be drawn at national level. The project contributes to raising awareness of this issue at the level of national health policy and to formulating strategic goals to address the problem of violation of human rights and to promote mental health democracy in Greece.