Characterizing inpatient care for adults with schizophrenia using the Health Quality Ontario indices: A single-centre retrospective cohort study.

PURPOSE: This single-center retrospective cohort study is one of the first reports to evaluate the inpatient care provided to persons diagnosed with schizophrenia in Canada. METHODS: This study examined all admissions for adults diagnosed with schizophrenia over a 6-month period in 2017 to an inpatient psychiatric unit situated in a nonprofit general hospital in Kingston, Ontario, Canada. The Health Quality Ontario standards for the inpatient care of adults with schizophrenia were used to assess the quality of care provided in hospital. Standards were determined to have been met by doing a thorough chart review for each patient, reviewing all documentation in progress notes, admission notes, discharge notes and emergency room notes for quality standard completion. RESULTS: The average length of stay per patient was 18.64 days. The treatment at this facility largely focused on medication management of schizophrenia; however, it was found that several areas of care did not meet the standard of care as set by the Health Quality Ontario Quality Standards for Schizophrenia Care for Adults in Hospitals, which was set in 2016. Problematic areas were promoting physical activity and healthy eating (4.9% compliance), treatment with clozapine (13.1% compliance) and cognitive behavioural therapy (9.8% compliance). The study site is fully accredited and attending physicians were all psychiatrists. How pervasive these deficiencies are in other settings is not known.

Low-Intensity Cognitive Behavioural Therapy-Based Music Group (CBT-Music) for the Treatment of Symptoms of Anxiety and Depression: A Feasibility Study.

BACKGROUND: Music has the potential to be an effective and engaging therapeutic intervention in the treatment of mental illness. This research area remains underdeveloped. AIMS: This paper reports the feasibility of an innovative low-intensity CBT-based music (CBT-Music) group targeted to symptoms of depression and anxiety. METHOD: A total of 28 participants with symptoms of depression and anxiety who were attending community mental health services were recruited for the study and randomized into TAU (treatment as usual) plus low-intensity CBT-Music (treatment) or to TAU alone (control). The treatment group consisted of a 9-week music group that incorporated various components of CBT material into a musical context. Feasibility was the primary outcome. The secondary outcomes were a reduction in depression, anxiety (Hospital Anxiety and Depression Scale) and disability (WHO Disability Assessment Schedule 2.0) assessed at baseline and 10 weeks. RESULTS: Recruitment proved feasible, retention rates were high, and the participants reported a high level of acceptability. A randomized control study design was successfully implemented as there were no significant differences between treatment and control groups at baseline. Participants in the treatment group showed improvement in disability (p = 0.027). Despite a reduction in depression and anxiety scores, these differences were not statistically significant. CONCLUSIONS: A low-intensity CBT-based music group can be successfully administered to clients of community mental health services. There are indications of effectiveness in reducing disability, although there appears to be negligible effect on symptoms of anxiety and depression. This is the first report of a trial of a low-intensity CBT-based music group intervention.

Chronic prostatitis-like symptoms in African males aged 16-19 years.

INTRODUCTION: To estimate the prevalence of chronic prostatitis (CP)-like symptoms in African adolescents, examining the impact of demographic factors, CP-like symptoms (i.e., pain, urinary) and depressive symptoms on quality of life (QoL). MATERIALS AND METHODS: Community dwelling African males aged 16-19 years (M = 16.97; SD = .88; n = 166), attending secondary school participated. CP-like case identification was based on NIH-Chronic Prostatitis Symptom Index definition (NIH-CPSI; pain in perineum and/or with ejaculation and NIH-CPSI total pain score of ≥ 4 [mild] and ≥ 8 [moderate-severe]). The Patient Health Questionnaire (PHQ) assessed depressive symptoms. CP-like point prevalence was estimated and multivariable regressions predicted diminished QoL as screened in the NIH-CPSI QoL domain. Participants were consented by field researchers and all potential participants agreed to complete the measures in classroom setting. RESULTS: Prevalence of at least mild CP-like symptoms by NIH-CPSI case identification was 13.3%, with 5.4% of adolescents reporting moderate-severe symptoms. Greater pain, urinary and depressive symptoms and rural setting of school were associated with diminished QoL, and pain (ß = .36) most strongly predicted poorer QoL. CONCLUSIONS: As in North American adults and adolescents, African adolescents report CP-like symptom occurrence with pain associated with lower QoL. The data suggest an adolescent CP syndrome is an internationally important and understudied area for future epidemiological and clinical investigations.

Lithium: contributor to movement disorder sensitivity after anoxic brain injury?

Although lithium-induced dystonia has been well documented in the literature, conflicting evidence discusses whether a patient may be susceptible to adverse effects from the drug after an anoxic brain injury. More recent literature discusses that lithium may, in fact, be neuroprotective. This case report presents a 35-year-old male who, after an anoxic brain injury after a suicide attempt, developed lithium-induced dystonia with characteristic symptoms of sustained muscle contractions, repetitive movements, and postures, which was not markedly improved with benztropine or benzodiazepines. It is postulated that because this patient received a depot neuroleptic with a subsequent anoxic brain injury, he may have become more sensitive to lithium and its rare complications.

Pediatric Referrals for Urgent Psychiatric Consultation: Clinical Characteristics, Diagnoses and Outcome of 4 to 12 Year Old Children.

OBJECTIVES: 1) To describe clinical characteristics and outcomes of children referred for urgent psychiatric consultation to a Child and Adolescent Mental Health Urgent Consult Clinic (CAMHUCC); and, 2) To study the association between referral source, clinical characteristics, and post assessment outcome. METHOD: This is a 12-month retrospective cohort study of children aged 4 to 12-years referred to a CAMHUCC. The clinic's electronic data base contains demographic and clinical information including reason for referral, diagnosis, and consult outcome. Study data were extracted and analyzed using descriptive statistics and Mann-Whitney U tests. RESULTS: The study sample consisted of 120 children, 41.5% male, average age 9.03 years (SD=2.2). Fifty-percent were referred by Children's Mental Health Agencies (CMHA) and 31.7% by Emergency Departments. The most frequent reason for referral was aggression (64.1%). Most common diagnoses were externalizing disorders (76.7%). Thirty-percent had an identified learning disorder, 80% were referred back to the community and 14.2% were referred to outpatient clinic. There was a significant association between referral from an Emergency Department and female gender (p=0.048) and brief follow-up with CAMHUCC (p=0.006). CONCLUSION: Regardless of source of referral, the most common reason for urgent psychiatric referral was aggression and the majority of individuals did not require inpatient psychiatric care. Collaborative multiagency education in child and adolescent mental health disorders, including the role of learning disabilities in externalizing behaviors, may improve the capacity of CMHA and schools to identify and provide focused interventions that may, in turn, reduce behavioral crisis and visits to Emergency Departments and urgent clinics.

OBJECTIFS: 1) Décrire les caractéristiques cliniques et les résultats d'enfants référés à une consultation psychiatrique d'urgence dans une clinique de consultation d'urgence pour la santé mentale d'enfants et d'adolescents (CCUSMEA). 2) Étudier l'association entre la source de la référence, les caractéristiques cliniques, et le résultat après l'évaluation. MÉTHODE: Il s'agit d'une étude de cohorte rétrospective de 12 mois auprès d'enfants de 4 à 12 ans référés à une CCUSMEA. La base de données électroniques de la clinique contient des données démographiques et des renseignements cliniques dont le motif de la référence, le diagnostic et le résultat de la consultation. Les données de l'étude ont été extraites et analysées à l'aide de statistiques descriptives et des tests U de Mann-Whitney. RÉSULTATS: L'échantillon de l'étude consistait en 120 enfants, dont 41,5 % étaient des garçons, de 9,03 ans d'âge moyen (ET = 2,2). Cinquante pour cent ont été référés par des organismes de santé mentale pour enfants (OSME) et 31,7 % par des services d'urgence. Le motif le plus fréquent des références était l'agression (64,1 %). Les diagnostics les plus communs étaient les troubles externalisés (76,7 %). Trente pour cent avaient un trouble d'apprentissage dépisté, 80 % étaient renvoyés dans la communauté et 14,2 % étaient référés à une clinique ambulatoire. Il y avait une association significative entre une référence provenant d'un service d'urgence et le sexe féminin (p = 0,048) et un bref suivi à la CCUSMEA (p = 0,006). CONCLUSION: Peu importe la source de la référence, le motif le plus commun d'une référence à une urgence psychiatrique était l'agression et la majorité des personnes ne nécessitait pas d'hospitalisation pour soins psychiatriques. L'éducation en collaboration de multi-organismes en matière de troubles de santé mentale pédiatriques, y compris le rôle des difficultés d'apprentissage dans les comportements externalisés, peut améliorer la capacité des OSME et des écoles de reconnaître et de fournir des interventions ciblées qui peuvent à leur tour réduire les crises de comportement et les visites aux services et aux cliniques d'urgence.

Bullying among medical and nonmedical students at a university in Eastern Saudi Arabia.

BACKGROUND: Many medical students, junior doctors, and other health-care professionals have been affected by the negative experience of bullying. Research is scarce on bullying experienced by medical and nonmedical students in Saudi Arabia unlike what is found in Western countries. It is unclear whether being a nonmedical student modifies the risk of being bullied. MATERIALS AND METHODS: A cross-sectional study included 400 university students using convenient sampling. The sample comprised 295 students who responded and were stratified into medical (n = 176) and nonmedical (n = 119) groups. Statistical Package for the Social Sciences (SPSS) version 22.0 was used to analyze our data. Normality was measured using the Kolmogorov-Smirnov test. Statistical significance was tested using chi-square test for categorical variables, and t-test for continuous variables. RESULTS: Almost half of the respondents were found to have experienced some bullying, victimization, or other harassment during their medical education. The most common forms of bullying were verbal abuse and undue pressure to produce work (43.8%; n = 77). Nonmedical students experienced more bullying than medical students and were more likely to be female, single, and younger in age. The number of medical students subjected to sexual harassment (1.7%; n = 3) was higher than nonmedical students (0.8%; n = 1). Physical violence was more towards nonmedical (4.2%; n = 5) than medical students (1.1%, n = 2). The rates of bullying continue to be associated with anxiety and depression. CONCLUSIONS: Our data suggest similar bullying rates in the developed world but higher than previously reported in a Saudi study. Bullying or harassment affects both medical and nonmedical students and is associated with high levels of anxiety and depression.

The current status of culturally adapted mental health interventions: a practice-focused review of meta-analyses.

In recent years, there has been a steadily increasing recognition of the need to improve the cultural competence of services and cultural adaptation of interventions so that every individual can benefit from evidence-based care. There have been attempts at culturally adapting evidence-based interventions for mental health problems, and a few meta-analyses have been published in this area. This is, however, a much debated subject. Furthermore, there is a lack of a comprehensive review of meta-analyses and literature reviews that provide guidance to policy makers and clinicians. This review summarizes the current meta-analysis literature on culturally adapted interventions for mental health disorders to provide a succinct account of the current state of knowledge in this area, limitations, and guidance for the future research.

A retrospective analysis of personality disorder presentations in a Canadian university-affiliated hospital's emergency department.

BACKGROUND: Individuals with personality disorders often have extensive involvement with healthcare services including frequent utilisation of emergency departments. AIMS: The aim of this study was to identify factors associated with emergency department presentations by individuals with personality disorders. METHOD: A 12-month retrospective data analysis of all mental-health-related emergency department visits was performed. Age, gender, time and season of presentation, length of stay, mode of arrival and discharge arrangements for individuals with personality disorders were compared to individuals with other psychiatric diagnoses. RESULTS: There were 336 visits by individuals with personality disorders and 5290 visits by individuals with other psychiatric diagnoses. Individuals with personality disorders were significantly more likely to be female, young adults, brought in by police, arrive in the evening, discharged home and have a longer median length of stay. CONCLUSION: Knowing what factors are associated with emergency department presentations by individuals with personality disorders can help ensure that appropriately trained support staff are available. DECLARATION OF INTEREST: None. COPYRIGHT AND USAGE: © The Royal College of Psychiatrists 2016. This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) license.