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2.
Psychiatr Danub ; 33(Suppl 4): 710-718, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34718308

RESUMO

OBJECTIVE: The functional remission or recovery of schizophrenia patients is a challenging task which relies on pharmacotherapy but also on the timing of psychotherapy and other therapeutic interventions. The study aimed to assess the difference in strength and structure of symptoms networks between early and late phase schizophrenia. Our secondary objective was to check whether the overall, positive, negative, and general symptoms severity change over the course of treatment and disorder. METHODS: This nested cross-sectional analysis combined the samples from two studies performed during 2014-2016 at University Psychiatric Hospital Vrapce, Zagreb, Croatia on the consecutive sample of men 30-60 years old diagnosed with schizophrenia, 85 of them in the early (≤5 years from diagnosis), and 143 in the late phase of the illness. The study was funded by the project: "Biomarkers in schizophrenia - integration of complementary methods in longitudinal follow up of FEP patients". RESULTS: Median (IQR) age of the participant in the early phase was 36 (32-45) years and in the late phase 44 (38-49) years. Patients in the early phase had significantly higher odds for being in the symptomatic remission compared to the patients in the late-phase schizophrenia (OR=2.11; 95% CI 1.09-4.09) and had 10% less pronounced negative symptoms. The global strength, density, and structure of the symptoms network were not significantly different between the two study groups. CONCLUSIONS: Negative symptoms severity change with the course of illness and differ from the early to the late phase of schizophrenia. However, the overall network of psychotic symptoms is relatively stable, and overall strengths or density and the partial relationship between particular symptoms do not change significantly. The observed worsening of negative symptoms is probably at least partially caused by the lack of clear guidelines and effective treatment options aimed specifically toward negative symptoms.


Assuntos
Transtornos Psicóticos , Esquizofrenia , Adulto , Estudos Transversais , Hospitais Psiquiátricos , Humanos , Masculino , Pessoa de Meia-Idade , Psicoterapia , Esquizofrenia/terapia
3.
J Am Psychiatr Nurses Assoc ; 27(5): 355-360, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34651520

RESUMO

INTRODUCTION: In inpatient behavioral health units, a long-standing behavioral management controversy has been whether to physically restrain or seclude patients. The rate of restraint use at the institution underperformed compared with the national average, which led to the project implementation. AIMS: This quality improvement project's objective was to decrease restraint and seclusion use, improve quality of care, and decrease cost through implementation of recovery model principles. METHOD: Implementation started in October 2019 on a 14-bed inpatient medical/geriatric psychiatric unit with 38 psychiatric RNs at a large academic medical center. The project was a pre-post implementation design with interventions consisting of staff education, RN language observation, and orientation toolkit development. Changes in staff knowledge were measured by Recovery Knowledge Inventory surveys at baseline, 1 week posteducation, and 4 months posteducation. Restraint and seclusion use data were analyzed 3 months preimplementation and 3 months postimplementation. RESULTS: Staff knowledge of the recovery model increased from baseline to 1 week postimplementation in all four survey domains (range = 6% to 9% improvement). While improvements were maintained in two survey domains, two domains of staff knowledge showed slight declines (1% to 2% decline in scores) 4 months postintervention. Restraint use decreased 73.1% and seclusion use decreased 16.3% from pre to postintervention. CONCLUSION: Implementation of recovery model principles can decrease restraint and seclusion episodes, which increases quality and decreases cost to the organization.


Assuntos
Transtornos Mentais , Melhoria de Qualidade , Idoso , Hospitais Psiquiátricos , Humanos , Pacientes Internados , Isolamento de Pacientes , Restrição Física
4.
J Health Organ Manag ; ahead-of-print(ahead-of-print)2021 Oct 22.
Artigo em Inglês | MEDLINE | ID: mdl-34672471

RESUMO

PURPOSE: The context in which an innovation is implemented is an important and often neglected mediator of change. A prospective payment system (PPS) for psychiatric and psychosomatic facilities with major implications for inpatient psychiatric care in Germany was implemented from 2013 to 2017. This study aims to examine the determinants of implementation of this government policy using the Diffusion of Innovations theory and consider the role of context. DESIGN/METHODOLOGY/APPROACH: An exploratory case study was conducted in two wards of a psychiatric hospital in Germany: geriatric psychiatry (GerP) and general psychiatry (GenP). Fifteen interviews were conducted with different occupational groups and analyzed in-depths. Routine hospital data were analyzed for delimiting the two contexts. FINDINGS: Routine hospital data show a higher day-mix index (1.08 vs. 0.94) in the GerP context and a very different structure regarding PPS groups, indicating a higher patient complexity. Two types of factors influencing implementation were identified: Context-independent factors included social separation between nurses and doctors, poor communication behavior between the groups and a lack of conveying information about the underlying principles of the PPS. Context-dependent factors included compatibility of the new requirements with existing routines and the relative advantage of the PPS, which were both perceived to be lower in the GerP context. PRACTICAL IMPLICATIONS: Depending on the patient characteristics in the specific context, compatibility with existing routines should be ensured when implementing. Clear communication of the underlying principles and reduction of organizational and communicative barriers between professional groups are crucial success factors for implementing such innovations. ORIGINALITY/VALUE: This study shows how a diffusion process takes place in an organization even after the organization adopts an innovation. The authors could show how contextual differences in terms of patient characteristics result in different determinants of implementation from the views of the employees affected by the innovation.


Assuntos
Sistema de Pagamento Prospectivo , Psiquiatria , Idoso , Governo , Hospitais Psiquiátricos , Humanos , Políticas
5.
Zhonghua Yi Shi Za Zhi ; 51(3): 151-157, 2021 May 28.
Artigo em Chinês | MEDLINE | ID: mdl-34645199

RESUMO

Church General Hospital in Wuchang, China planned to establish a psychiatric hospital in 1930. Chi-liang Kwei, received his PhD at Johns Hopkins Medical School of America and was appointed to be in charge of the preparation. After working out a draft plan for the hospital, Dr. Kwei applied for the Henderson Research Scholarship on Mental Diseases. She planned to study under the guidance of Dr. D.K. Henderson in the Glasgow Mental Royal Hospital for a full year in preparation for the establishment of the hospital. By drawing on the correspondence files of Chi-liang Kwei and psychiatrists Adolf Meyer and David Kennedy Henderson, the paper describes the background conditions and planning for the hospital establishment and interprets the significance and value of Chi-liang Kwei's efforts to establish a psychiatric hospital from the perspective of the historic development of modern psychiatry in China.


Assuntos
Psiquiatria , Transtornos Psicóticos , China , Feminino , História do Século XX , Hospitais Psiquiátricos , Humanos , Psiquiatria/educação , Faculdades de Medicina
6.
Sci Rep ; 11(1): 21002, 2021 10 25.
Artigo em Inglês | MEDLINE | ID: mdl-34697335

RESUMO

COVID19 infection was associated with possible psychiatric manifestations, including psychosis and mania. In addition, psychiatric disorders might be triggered by severe psychological reactions to the pandemic or the measures taken to contain it. This study aimed to assess the trends of new-onset psychosis/mania during the pandemic timeline. Psychiatric emergency department records during January-July 2019 and 2020 of two regional mental health centers were manually examined. Cases of new-onset psychosis or mania were found in 326 out of 5161 records examined. The ratio of these cases increased by 45.5% in 2020 compared to 2019 (189 out of 2367, 137 out of 2479, respectively, p = 0.001). The peak increase was in April 2020 (9.4% vs. 4.7%, p = 0.015). There was no association between the rise of new-onset psychotic or manic episodes and national incidence of COVID19 cases, as observed during Israel 2nd wave. PCR tests were negative, except a single case. In this study, an increase in new-onset psychosis/mania was identified during the initial phase of the pandemic. Though causality could not be directly inferred, lack of infection symptoms, negative PCR testing and temporal distribution incongruent with COVID19 caseload did not support a direct effect of SARS-CoV-2. Alternative explanations are discussed, such as psychological reaction to stress and preventive measures, as well as case-shifting between different mental health settings.


Assuntos
Transtorno Bipolar/epidemiologia , COVID-19/epidemiologia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Hospitais Psiquiátricos/estatística & dados numéricos , Transtornos Psicóticos/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Transtorno Bipolar/psicologia , Teste de Ácido Nucleico para COVID-19 , Registros Eletrônicos de Saúde , Serviço Hospitalar de Emergência/tendências , Feminino , Hospitais Psiquiátricos/tendências , Humanos , Israel/epidemiologia , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Pandemias , Transtornos Psicóticos/psicologia , Estresse Psicológico , Adulto Jovem
7.
PLoS One ; 16(10): e0258302, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34637463

RESUMO

BACKGROUND: Psychiatric disorders constitute a major public health concern that are associated with substantial health and socioeconomic burden. Psychiatric patients may be more vulnerable to high temperatures, which under current climate change projections will most likely increase the burden of this public health concern. OBJECTIVE: This study investigated the short-term association between ambient temperature and mental health hospitalizations in Bern, Switzerland. METHODS: Daily hospitalizations for mental disorders between 1973 and 2017 were collected from the University Hospital of Psychiatry and Psychotherapy in Bern. Population-weighted daily mean ambient temperatures were derived for the catchment area of the hospital from 2.3-km gridded weather maps. Conditional quasi-Poisson regression with distributed lag linear models were applied to assess the association up to three days after the exposure. Stratified analyses were conducted by age, sex, and subdiagnosis, and by subperiods (1973-1989 and 1990-2017). Additional subanalyses were performed to assess whether larger risks were found during the warm season or were due to heatwaves. RESULTS: The study included a total number of 88,996 hospitalizations. Overall, the hospitalization risk increased linearly by 4.0% (95% CI 2.0%, 7.0%) for every 10°C increase in mean daily temperature. No evidence of a nonlinear association or larger risks during the warm season or heatwaves was found. Similar estimates were found across for all sex and age categories, and larger risks were found for hospitalizations related to developmental disorders (29.0%; 95% CI 9.0%, 54.0%), schizophrenia (10.0%; 95% CI 4.0%, 15.0%), and for the later rather than the earlier period (5.0%; 95% CI 2.0%, 8.0% vs. 2.0%; 95% CI -3.0%, 8.0%). CONCLUSIONS: Our findings suggest that increasing temperatures could negatively affect mental status in psychiatric patients. Specific public health policies are urgently needed to protect this vulnerable population from the effects of climate change.


Assuntos
Hospitalização , Saúde Mental , Temperatura , Idoso , Poluição do Ar/análise , Intervalos de Confiança , Feminino , Geografia , Hospitais Psiquiátricos , Humanos , Masculino , Transtornos Mentais/epidemiologia , Pessoa de Meia-Idade , Risco , Suíça/epidemiologia , Fatores de Tempo , Universidades
8.
Am J Public Health ; 111(10): 1780-1783, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34529451

RESUMO

Individuals with serious mental illness are particularly vulnerable to COVID-19. The New York State (NYS) Office of Mental Health implemented patient and staff rapid testing, quarantining, and vaccination to limit COVID-19 spread in 23 state-operated psychiatric hospitals between November 2020 and February 2021. COVID-19 infection rates in inpatients and staff decreased by 96% and 71%, respectively, and the NYS population case rate decreased by 6%. Repeated COVID-19 testing and vaccination should be priority interventions for state-operated psychiatric hospitals. (Am J Public Health. 2021;111(10):1780-1783. https://doi.org/10.2105/AJPH.2021.306444).


Assuntos
COVID-19/epidemiologia , COVID-19/prevenção & controle , Hospitais Psiquiátricos/estatística & dados numéricos , Vacinação em Massa/organização & administração , COVID-19/diagnóstico , Teste para COVID-19 , Humanos , New York/epidemiologia , Quarentena , SARS-CoV-2 , Populações Vulneráveis
9.
BMC Psychiatry ; 21(1): 433, 2021 09 03.
Artigo em Inglês | MEDLINE | ID: mdl-34479529

RESUMO

BACKGROUND: The system of secure care for young people in England and Wales comprises youth justice, welfare and mental health facilities. Empirical studies have failed to investigate the system as a whole. The National Adolescent Study in 2016 was the first to provide comprehensive system wide information. This paper, derived from that data set, addresses equity of service provision for young men and women in secure care who have mental health problems. METHODS: The detained census population of English young people in 2016 was 1322 and detailed data were available on 93% of this population, including 983 young men and 290 young women. The descriptive census data were interrogated to identify associations between gender, other sociodemographic and clinical variables, using Chi-square and Fisher's exact tests. RESULTS: Numerically more young men in secure care than young women in secure care warrant a psychiatric diagnosis but young women had a 9 fold increase in the odds of having a diagnosis compared with the young men. The pattern of mental health diagnoses differed significantly by gender as did the legislative framework under which females and males were placed. This different pattern of secure care placement continued to differ by gender when the nature of the mental health diagnosis was taken into account. CONCLUSIONS: No definitive explanation is evident for the significantly different placement patterns of young men and young women with the same mental health diagnoses, but the anticipated consequences for some, young men and some young women are important. Proper explanation demands an examination of process variables outwith the remit of this study. The lack of routine scrutiny and transparent processes across secure settings could be responsible for the development of these differential placement practices; these practices seem at odds with the duty placed on public services by the Equality Act.


Assuntos
Transtornos Mentais , Serviços de Saúde Mental , Adolescente , Feminino , Hospitais Psiquiátricos , Humanos , Masculino , Transtornos Mentais/epidemiologia , Transtornos Mentais/terapia , Saúde Mental , Fatores Sexuais
10.
Arch Psychiatr Nurs ; 35(5): 541-548, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34561071

RESUMO

OBJECTIVE: To understand how patients in suicidal crises perceive their engagement with nurses in mental hospitals. METHODS: A qualitative study based on grounded theory was conducted. Semi-structured interviews were used with 11 hospitalised adults living through suicidal crises. The data were analysed by multiple researchers, using the constant comparison method, coding, and memo writing. FINDINGS: The core process was: 'Feeling nurtured through an interpersonal engagement'. This process underpinned two categories: 'Feeling safe and cared for while struggling to trust' and 'Working toward alleviation and change of my suicidal ideation'. The patients valued nurses who integrated caring approaches of building trust, demonstrating compassion, and promoting safety, with healing approaches of helping them to express and explore their suicidal ideations, and develop new insights and ways of coping. This interpersonal engagement could nurture patients' feelings of being accepted and understood, and being hopeful and capable of overcoming their suicidal ideations. CONCLUSION: The conceptual insights can inform strategies to reframe overly instrumental approaches to prevent suicide and treat suicidal ideation, and instead promote an interpersonal orientation in nursing practice that integrates caring-healing approaches.


Assuntos
Enfermeiras e Enfermeiros , Suicídio , Adulto , Hospitais Psiquiátricos , Humanos , Saúde Mental , Ideação Suicida , Suicídio/prevenção & controle
11.
J Psychiatr Res ; 143: 285-291, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34530339

RESUMO

Individuals with serious mental illness (SMI) are at increased risk for arrest and incarceration relative to the same-community population without SMI. Publicly-funded inpatient psychiatric hospitals usually feature short lengths of stay and limited opportunities for extended services that might impact criminal justice involvement after discharge. This study examined the influence of an early intervention program for SMI at a high-volume public psychiatric hospital on involvement in the criminal justice system post-discharge. The Early Onset Treatment Program (EOTP) is an extended service intervention program for uninsured patients who are within 5 years of SMI onset. Criminal justice records (number of arrests with conviction, days of incarceration) were obtained for EOTP participants (n = 164) and comparison patients (n = 164) matched on demographics, diagnosis, and discharge date via propensity score matching. Data were zero-inflated and analyzed using hurdle models, controlling for prior arrests. The EOTP group was less likely to be convicted of at least one crime post-discharge (0 arrests vs. > 0, p < .001), and spent fewer days incarcerated (if incarcerated ≥1 day, p < .03). Participation in the EOTP service was linked to reduced likelihood of post-discharge arrest and days incarcerated. Several alternative variables may contribute to this preliminary observation, including length of stay, medication adherence, longer environmental stability, and individual patient characteristics.


Assuntos
Criminosos , Transtornos Mentais , Assistência ao Convalescente , Hospitais Psiquiátricos , Humanos , Pacientes Internados , Transtornos Mentais/epidemiologia , Transtornos Mentais/terapia , Alta do Paciente
12.
BMJ Open ; 11(9): e049026, 2021 09 23.
Artigo em Inglês | MEDLINE | ID: mdl-34556512

RESUMO

BACKGROUND: The occurrence of depression in patients with schizophrenia (PWS) increases the risk of relapse, frequency and duration of hospitalisation, and decreases social and occupational functioning. OBJECTIVE: This study aimed to assess prevalence of unrecognised comorbid depression and its determinants in PWS. METHOD: A cross-sectional study was conducted from 1 to 30 March 2019 at Amanuel mental specialized hospital among 300 PWS. The 9-item Calgary Depression Scale for Schizophrenia was used to assess comorbid depression. Logistic regression was used to determine the association between outcome and explanatory variables. Statistical significance was declared at p value <0.05 with 95% CI. RESULTS: The prevalence of unrecognised comorbid depression was found to be 30.3%. Living alone (adjusted OR (AOR)=3.49, 95% CI=0.45 to 8.36), having poor (AOR=4.43, 95% CI=1.45 to 13.58) and moderate (AOR=4.45, 95% CI=1.30 to 15.22) social support, non-adherence to medication (AOR=3.82, 95% CI=1.70 to 8.55), presenting with current negative symptoms such as asocialia (AOR=4.33, 95% CI=1.98 to 9.45) and loss of personal motivation (AOR=3.46, 95% CI=1.53 to 7.84), and having suicidal behaviour (AOR=6.83, 95% CI=3.24 to 14.41) were the significant predictors of comorbid depression in PWS. CONCLUSION: This study revealed considerably a high prevalence of unrecognised comorbid depression among PWS. Therefore, clinicians consider timely screening and treating of comorbid depression in PWS.


Assuntos
Esquizofrenia , Estudos Transversais , Depressão/epidemiologia , Etiópia/epidemiologia , Hospitais Psiquiátricos , Humanos , Prevalência , Esquizofrenia/complicações , Esquizofrenia/epidemiologia
13.
J R Coll Physicians Edinb ; 51(3): 298-308, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34528624

RESUMO

This is the first of two papers which examine a series of portraits of patients at the Royal Edinburgh Asylum (REA) which were undertaken in the 1880s by John Miles, who, as well as being a professional painter, was also an inmate of the Morningside institution. The portraits by John Miles are of interest for several reasons. They are an example of patient art, only a small portion of which has survived from nineteenth century asylums. They are also in the tradition of patient portraiture. Miles's work is of interest because he was both a professional artist and a patient. His portraits also provide some insight into the patients' world: their appearance, demeanour, posture, clothing and their surroundings in the asylum. The patients in the portraits have been identified and their case notes examined. This information complements Miles's portraits and helps to build up a fuller picture of individual patients and their life in the Morningside Asylum. The case notes also reveal the symptomatology and behaviour of the patients. Alongside the portraits by Miles, we discuss a second series of portraits of the same patients and contained in a collection entitled 'Bruised Reeds'. We discuss if these portraits were also by Miles.


Assuntos
Hospitais Psiquiátricos , Humanos , Masculino
14.
J Psychiatr Pract ; 27(5): 346-360, 2021 09 16.
Artigo em Inglês | MEDLINE | ID: mdl-34529601

RESUMO

To improve quality of care and patient outcomes, and to reduce costs, hospitals in the United States are trying to mitigate readmissions that are potentially avoidable. By identifying high-risk patients, hospitals may be able to proactively adapt treatment and discharge planning to reduce the likelihood of readmission. Our objective in this study was to derive and validate a predictive model of 30-day readmissions for a small rural psychiatric hospital in the northeast. However, this model can be adapted by other rural psychiatric hospitals-a context that has been understudied in the literature. Our sample consisted of 1912 adult inpatients (1281 in the derivation cohort and 631 in the validation cohort), who were admitted between August 1, 2014, and July 31, 2016. We used deidentified data from the hospital's electronic medical record, including physician orders and discharge summaries. These data were merged with community-level variables that reflected the availability of care in the patients' zip codes. We first considered the correlates of 30-day readmission in a regression framework. We found that the probability of readmission increased with the number of previous admissions (vs. no readmissions). Moreover, the probability of readmission was much higher for patients with a depressive disorder (vs. no depressive disorder), with another mood disorder (vs. no other mood disorder), and/or with a psychotic disorder (vs. no psychotic disorder). We used these associations to derive a predictive model, in which we used the regression coefficients to construct a score for each patient. We then estimated the predicted probability of 30-day readmission on the basis of that score. After validating the model, we discuss the implications for clinical practice and the limitations of our approach.


Assuntos
Hospitais Psiquiátricos , Readmissão do Paciente , Adulto , Hospitalização , Humanos , Alta do Paciente , Estudos Retrospectivos , Estados Unidos
15.
Artigo em Inglês | MEDLINE | ID: mdl-34507388

RESUMO

Objective: The mental health community expected that seriously mentally ill (SMI) patients would be especially vulnerable to coronavirus disease 2019 (COVID-19) infection due to a higher medical comorbidity rate than the general population and disparities in access to medical care. Concern was voiced as to the impact on the psychiatric stability of this population due to anxiety about the pandemic, recommended isolation, and limited in-person interactions with treatment providers and support systems. The objective of this study was to evaluate the impact of COVID-19 on a cohort of involuntarily hospitalized SMI patients.Methods: The electronic medical records from March 28 through December 31, 2020 of all COVID-positive psychiatric inpatients were retrospectively reviewed. No outpatients or readmissions were included in the sample.Results: During the study period 238, COVID-positive inpatients were identified out of approximately 12,859 discreet admissions. The sample consisted of 158 men (66%) and 80 women (34%). The mean age of positive patients was 41 years. Eight patients (3%) required medical hospitalizations related to COVID-19, with 1 death. Ninety-seven patients (41%) had at least 1 or more of the known medical comorbidities related to increased risk for COVID-19 infection. Seclusion, restraints, and administration of as-needed medications (PRN) for anxiety or psychotic agitation occurred less frequently in the COVID-positive patients compared to those without infection.Conclusions: Medical hospitalizations were infrequent in the study sample. Medical comorbidities were much higher in this group relative to statewide data. Seclusion, restraint, and PRN administration were lower in the COVID-positive cohort compared to COVID-negative inpatients. Overall, the sample group did not experience significant negative outcomes as might have been expected for this population.


Assuntos
COVID-19 , Pacientes Internados , Adulto , Demografia , Feminino , Hospitais Psiquiátricos , Humanos , Masculino , Estudos Retrospectivos , SARS-CoV-2
16.
J Am Acad Child Adolesc Psychiatry ; 60(11): 1332-1334, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34481918

RESUMO

Increasing coronavirus disease 2019 (COVID-19) vaccination rates has been identified by the US Centers of Disease Control and Prevention as critical to ending the COVID-19 pandemic.1 On May 10, 2021, the Pfizer-BioNTech COVID-19 vaccine (BNT162b2; Pfizer, Inc, New York, New York, and BioNTech SE, Mainz, Germany) was approved for emergency use authorization by the US Food and Drug Administration for patients 12 years of age or older. Here we report a retrospective study describing the implementation of a COVID-19 vaccination program at our child and adolescent psychiatric hospital. To our knowledge, this is the first report detailing the administration of the COVID-19 vaccination in this setting.


Assuntos
Vacinas contra COVID-19 , COVID-19 , Adolescente , Criança , Hospitais Psiquiátricos , Humanos , Pandemias , Estudos Retrospectivos , SARS-CoV-2 , Vacinação
17.
Rev Bras Enferm ; 74(4): e20190519, 2021.
Artigo em Inglês, Português | MEDLINE | ID: mdl-34524365

RESUMO

OBJECTIVE: This study aims to discuss the care for people in psychic crises conducted by the team of the Mental Health Center of the Mobile Emergency Care Service of the Federal District - Brazil (NUSAM/SAMU/DF/BRAZIL), describing the dynamics of care, since the regulation from cases to follow-up. METHODS: Qualitative, exploratory, descriptive study, with data collected through data collection in the information system of the Health Department of the Federal District (SES/DF), participant observation activities and interviews, over a period of three months, with professionals from NUSAM/SAMU/DF. The qualitative analysis consisted of Bardin's content analysis. RESULTS: NUSAM/SAMU/DF showed its ability to offer care in a humanized and resolving way to urgencies and emergencies of a psychosocial nature, considering the resources it has. FINAL CONSIDERATIONS: The service's pioneering spirit regarding the prehospital approach to people in psychic crises is highlighted, characterized by the singularized, humanized and resolutive service.


Assuntos
Serviços Médicos de Emergência , Serviços de Emergência Psiquiátrica , Brasil , Coleta de Dados , Hospitais Psiquiátricos , Humanos
18.
BMC Psychiatry ; 21(1): 419, 2021 08 21.
Artigo em Inglês | MEDLINE | ID: mdl-34419009

RESUMO

BACKGROUND: Epidemiological studies have demonstrated considerable differences in the use of coercive measures among psychiatric hospitals; however, the underlying reasons for these differences are largely unclear. We investigated to what extent these differences could be explained by institutional factors. METHODS: Four psychiatric hospitals with identical responsibilities within the mental health care system, but with different inpatient care organizations, participated in this prospective observational study. We included all patients admitted over a period of 24 months who were affected by mechanical restraint, seclusion, or compulsory medication. In addition to the patterns of coercive measures, we investigated the effect of each hospital on the frequency of compulsory medication and the cumulative duration of mechanical restraint and seclusion, using multivariate binary logistic regression. To compare the two outcomes between hospitals, odds ratios (OR) with corresponding 95% confidence intervals (CI) were calculated. RESULTS: Altogether, coercive measures were applied in 1542 cases, corresponding to an overall prevalence of 8%. The frequency and patterns of the modalities of coercive measures were different between hospitals, and the differences could be at least partially related to institutional characteristics. For the two hospitals that had no permanently locked wards, certain findings were particularly noticeable. In one of these hospitals, the probability of receiving compulsory medication was significantly higher compared with the other institutions (OR 1.9, CI 1.1-3.0 for patients < 65 years; OR 8.0, CI 3.1-20.7 for patients ≥65 years); in the other hospital, in patients younger than 65 years, the cumulative duration of restraint and seclusion was significantly longer compared with the other institutions (OR 2.6, CI 1.7-3.9). CONCLUSIONS: The findings are compatible with the hypothesis that more open settings are associated with a more extensive use of coercion. However, due to numerous influencing factors, these results should be interpreted with caution. In view of the relevance of this issue, further research is needed for a deeper understanding of the reasons underlying the differences among hospitals.


Assuntos
Hospitais Psiquiátricos , Transtornos Mentais , Coerção , Humanos , Transtornos Mentais/epidemiologia , Transtornos Mentais/terapia , Isolamento de Pacientes , Restrição Física
19.
LGBT Health ; 8(6): 395-403, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34424726

RESUMO

Purpose: The study purpose was to compare suicide risk between lesbian, gay, bisexual, transgender, queer, and/or questioning (LGBTQ) and non-LGBTQ adolescents in a psychiatric hospital. Methods: Data were obtained from self-report measures completed by patients 12-17 years of age (n = 334) in a Midwestern psychiatric hospital from 2016 to 2017. Factors analyzed included sexual orientation, gender identity, suicidality, depression, nonsuicidal self-injury, abuse, substance use, bullying, perceived discrimination, and adult support. Results: Nearly one-third of patients identified as LGBTQ. A lifetime suicide attempt was reported by 69.6% of LGBTQ patients compared with 43.6% of non-LGBTQ patients. However, the prevalence of suicide attempts among LGBTQ patients with high adult support did not differ from that of non-LGBTQ patients. In the full logistic regression model adjusting for 13 factors, the adjusted odds ratio of a suicide attempt was 5.25 among transgender/questioning patients and 2.41 among nontransgender lesbian, gay, bisexual, queer, or questioning patients. All risk factors, apart from substance use, were more prevalent among LGBTQ than non-LGBTQ patients (p < 0.005). Among LGBTQ patients of color (Black/Latinx/Other), 91.3% had a lifetime suicide attempt versus 62.3% of White LGBTQ patients (p = 0.009). Conclusion: LGBTQ patients overall, and LGBTQ patients of color in particular, had higher rates of suicide attempts than non-LGBTQ patients. LGBTQ patients also had a higher prevalence of risk factors for suicide; however, the study variables did not fully explain the higher prevalence of suicide attempts. Future research should further examine possible risk factors for suicide among LGBTQ youth, such as stigma and discrimination.


Assuntos
Hospitalização/estatística & dados numéricos , Transtornos Mentais/terapia , Minorias Sexuais e de Gênero/psicologia , Suicídio/psicologia , Adolescente , Feminino , Hospitais Psiquiátricos , Humanos , Masculino , Meio-Oeste dos Estados Unidos , Fatores de Proteção , Fatores de Risco , Minorias Sexuais e de Gênero/estatística & dados numéricos , Tentativa de Suicídio/estatística & dados numéricos
20.
J Psychiatr Res ; 143: 16-20, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34438198

RESUMO

BACKGROUND: As patients with severe mental illness are at increased risk for COVID-19 mortality, the issue of willingness to be vaccinated is of extreme importance. METHODS: During February 2021 Shalvata Mental Health hospital provided Covid-19 vaccines to its patients. Fifty one patients suffering from severe mental illness, out of 196 patients hospitalized in closed, open or day wards during that period, signed the informed consent and were assessed for their clinical condition (OQ-45), fear of Covid-19 (FCV-19S) and approach to the vaccine (C19-VHS). All patients who were not vaccinated in February 2021 (baseline) were re-approached a month later to assess whether they had gotten vaccinated since. RESULTS: Patients who were not vaccinated at baseline had an oppositional approach to the vaccine, and did not significantly differ in their fear of Covid-19 levels or in levels of clinical severity (t(49) = 2.51, p = 0.02) from those who were vaccinated. From the 29 patients who were not vaccinated at baseline approach to the vaccine was a good predictor to getting vaccinated after one month (79% positive predictive value). CONCLUSIONS: The majority of patients suffering from a severe mental illness are willing to get vaccinated, and their decision of whether or not to get vaccinated is based on their viewpoint on the vaccine rather than being an outcome of their level of distress (OQ-45). It is important to allow vaccine accessibility to hospitalized patients, to consider their opinions and to provide useful information to lower vaccine hesitancy and improve vaccination rates.


Assuntos
COVID-19 , Transtornos Mentais , Atitude , Vacinas contra COVID-19 , Hospitais Psiquiátricos , Humanos , SARS-CoV-2 , Vacinação
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