Determinants of mechanical restraint in an acute psychiatric care unit

Aims and MethodA prospective descriptive study was set up to evaluate the feasibility, acceptability and activity of an innovative weekly primary care service for patients admitted for acute psychiatric care.ResultsDuring 10 months, 36 clinics were held and 123 appointments were attended. Presenting complaints included a wide range of acute and chronic conditions, affecting all body systems. As well as treating specific complaints, the doctor providing this service undertook considerable health promotion work and gave advice about patient management to junior psychiatrists.Clinical ImplicationsIt appears that there is considerable need for primary care expertise within an acute psychiatric unit, and that a weekly clinic is a feasible model of care.

Download Full-text

Architectural design and acute psychiatric care

Psychiatric Bulletin ◽

10.1192/pb.18.5.279 ◽

1994 ◽

Vol 18 (5) ◽

pp. 279-281 ◽

Cited By ~ 1

Author(s):

Rizwan Taj ◽

John Sheehan

Keyword(s):

Mental Health ◽

Mental Health Professionals ◽

Health Professionals ◽

Architectural Design ◽

Psychiatric Care ◽

Observation Station ◽

Initial Stage ◽

Psychiatric Units ◽

Acute Psychiatric Care ◽

Roof Garden

All staff based in a newly built acute psychiatric unit for more than six months were asked about the difficulties they encountered in the implementation of their duties and what changes they recommended. The problem areas identified included poor design and location of nursing observation station, lack of proper seclusion facilities, insufficient ventilation, unsafe position of the roof garden, exposed beams and supports, proximity to the lake and inadequate interview facilities for all staff. The urgent recommendations included alteration in the design and positioning of observation station, improving ventilation, making the roof garden safe, and covering all exposed beams and supports. The desirable changes included extra interviewing facilities and a spacious observable television room. Consultation by mental health professionals during the initial stage of designing of psychiatric units is essential.

Download Full-text

Recovery Following Peer and Text Messaging Support after Discharge from Acute Psychiatric Care: A Randomized Controlled Pilot Trial (Preprint)

10.2196/preprints.27137 ◽

2021 ◽

Author(s):

Reham Shalaby ◽

Marianne Hrabok ◽

Pamela Spurvey ◽

Rabab M. Abou El-Magd ◽

Michelle Knox ◽

...

Keyword(s):

Peer Support ◽

Text Messaging ◽

Psychiatric Care ◽

Text Message ◽

Text Messages ◽

Treatment As Usual ◽

Usual Condition ◽

Randomized Controlled ◽

Acute Psychiatric Care

BACKGROUND Peer support (PS) is emotional, social, and practical help that is provided by non-professionals to assist others in sustaining health behaviours. PS is valued in recovery-oriented models of mental health and is becoming implemented increasingly at the organizational level. Text messaging is a relatively low cost, high impact, and easily scalable program that uses existing technology, is devoid of geographic barriers, and is easily accessible to end users. OBJECTIVE This study aims to evaluate the effect of an innovative peer support system plus supportive text messaging program on the recovery of discharged patients from acute psychiatric care. METHODS This is a prospective, rater-blinded, pilot randomized controlled trial, including 180 patients discharged from acute psychiatric care. Patients were randomized to one of four conditions: treatment as usual (follow-up care), daily supportive text messages, peer-support only, or peer-support plus daily supportive text messages. A standardized self-report measure of recovery (Recovery Assessment Scale; RAS) was completed at baseline, six weeks, three months, and six months. Descriptive analysis, One-Way ANOVA, and repeated measures MANCOVA were deployed to examine the changes in RAS among the study groups and over the follow-up time points. RESULTS Sixty-five patients completed assessments at each time-point. For the overall sample, higher scores were found for the peer-support plus text message condition compared to the text message only and treatment as usual condition on several scales (i.e., Willingness to ask for help and Personal Confidence and Hope) and total score on the RAS. CONCLUSIONS Peer support plus supportive text messaging results in improved recovery compared to other interventions. It is advisable to incorporate the two interventions as a part of routine practice for patients with psychiatric disorders upon their hospital discharge. CLINICALTRIAL The study received ethical approval from the Health Ethics Research Board of the University of Alberta (Ref # Pro00078427) and operational approval from the Alberta Health Services regional health authority. All patients provided written informed consent. The study was registered with clinicaltrials.gov (Trial registration number NCT03404882).

Download Full-text

Monitoring inner London mental illness services

Psychiatric Bulletin ◽

10.1192/pb.19.5.276 ◽

1995 ◽

Vol 19 (5) ◽

pp. 276-280 ◽

Cited By ~ 35

Author(s):

◽

Bernard Audini ◽

Michael Crowe ◽

Joan Feldman ◽

Anna Higgitt ◽

...

Keyword(s):

Mental Illness ◽

Psychiatric Care ◽

Bed Occupancy ◽

Local Data ◽

Catchment Population ◽

The Poor ◽

Number Of Patients ◽

The Mean ◽

Acute Psychiatric Care ◽

The Impact

Our objective was to establish a mechanism for monitoring indicators of the state of health of inner London's mental illness services. Data were collected for a census week around 15 June 1994. Local data collection was coordinated by consultant pyschiatrists working in inner London services. Twelve services participated with a combined catchment population of 2.6 m. They included ten London services which were among the 17 most socially deprived areas of England. Main indicators were admission bed occupancy levels (including an estimate of the total requirement), proportion of patients detained under the Mental Health Act, number of assaults committed by inpatients, number of emergency assessments and CPN caseloads. The mean true bed occupancy (which reflects the number of patients who were receiving, or required, in-patient care on census day) was 130%. To meet all need for acute psychiatric care, including for patients who should have been admitted and those discharged prematurely because beds were full, a further 426 beds would have been required. Fifty per cent of patients were legally detained. Physical assaults were virtually a daily occurrence on the admission units. Average community pyschiatric nurse caseloads were 37, suggesting that the majority were not working intensively with limited caseloads of patients with severe mental illness. These indicators, although imperfect, will allow for some measurement of the impact of local and central initiatives on the poor state of London's mental illness services.

Download Full-text

Management of violent behaviour and rapid tranquillisation during acute psychotic episode: discrepancy between routine practice and evidence. The SIEP-DIRECT's Project

Epidemiology and Psychiatric Sciences ◽

10.1017/s1121189x00000142 ◽

2008 ◽

Vol 17 (4) ◽

pp. 349-357 ◽

Cited By ~ 3

Author(s):

Antonio Lora ◽

Carla Morganti ◽

Arcadio Erlicher ◽

Lorenzo Burti ◽

Giacinto Buscaglia ◽

...

Keyword(s):

Mental Health ◽

General Hospital ◽

Psychiatric Care ◽

Psychotic Episode ◽

Routine Practice ◽

Violent Behaviour ◽

Critical Areas ◽

Specific Care ◽

Acute Psychiatric Care

SUMMARYAims– To evaluate the quality of acute psychiatric care concerning the management of violent behaviour and rapid tran-quilization.Methods– Data concerning 13 indicators, drawn from NICE recommendations, were collected in 19 Departments of Mental Health, in the frame of the SIEP-DIRECT's Project, to evaluate the implementation of NICE recommendations in Italian Mental Health Services.Results– In about two thirds of Departments of Mental Health (DMHs) professionals were trained in the management of violent behaviour, while written procedures existed only in one fourth of DMHs. About a half of the professionals working in Psychiatric Wards in General Hospital were trained in rapid tranquilization, while procedures on this topic are practically absent and specific care for monitoring intensively the heavily sedated patient was not frequent.Conclusions– Management of violent behaviour and rapid tranquilization are two critical areas in the care performed by Psychiatric Wards in General Hospital. Training on these topics is more frequent than implementation of procedures. NICE recommendations and SIEP indicators are useful tools for improving the quality of acute psychiatric care.Declaration of Interest: None.

Download Full-text

Prevalence of serum anti-neuronal autoantibodies in patients admitted to acute psychiatric care

Psychological Medicine ◽

10.1017/s0033291716002038 ◽

2016 ◽

Vol 46 (16) ◽

pp. 3303-3313 ◽

Cited By ~ 22

Author(s):

M. Schou ◽

S. G. Sæther ◽

K. Borowski ◽

B. Teegen ◽

D. Kondziella ◽

...

Keyword(s):

Psychiatric Care ◽

Psychiatric Symptoms ◽

Psychiatric Patients ◽

Autoimmune Encephalitis ◽

International Classification Of Diseases ◽

Acid Decarboxylase ◽

Neuronal Autoantibodies ◽

Acute Psychiatric Care ◽

Receptor Antibodies ◽

Gad65 Antibodies

BackgroundAutoimmune encephalitis associated with anti-neuronal antibodies may be challenging to distinguish from primary psychiatric disorders. The significance of anti-neuronal antibodies in psychiatric patients without clear evidence of autoimmune encephalitis is unknown. We investigated the serum prevalence of six anti-neuronal autoantibodies in a cohort of unselected patients admitted to acute psychiatric care.MethodSerum was drawn from 925 patients admitted to acute psychiatric in-patient care. Psychiatric diagnoses were set according to International Classification of Diseases (ICD)-10 criteria. Antibody analysis was performed with an indirect immunofluorescence test for N-methyl d-aspartate receptor (NMDAR) antibodies and five other anti-neuronal autoantibodies of the immunoglobulin (Ig) classes IgA, IgG and IgM isotype.ResultsAnti-neuronal autoantibodies were found in 11.6% of patients: NMDAR antibodies in 7.6%, contactin-associated protein-like 2 (CASPR2) antibodies in 2.5%, glutamic acid decarboxylase-65 (GAD65) antibodies in 1.9%, and α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA) receptor antibodies in 0.1%. Leucine-rich glioma-inactivated protein-1 (LGI1) and γ-aminobutyric acid B (GABAB) receptor antibodies were not detected. NMDAR antibodies of class IgG were present in five patients only (0.5%). NMDAR antibodies of all Ig classes were equally prevalent in patients with and without psychosis. There were no significant differences in antibody prevalence in the different diagnostic categories, except for a higher odds ratio of being NMDAR antibody positive for patients without a specific psychiatric diagnosis.ConclusionsNMDAR IgG autoantibodies, which are known to be strongly associated with anti-NMDAR encephalitis, were rarely found. CASPR2 and GAD65 antibodies were more frequently encountered in the present study than previously reported. Further research on the clinical significance of anti-neuronal autoantibodies in patients with acute psychiatric symptoms is needed.

Download Full-text

A Safety and Coping Planning Intervention for Suicidal Adolescents in Acute Psychiatric Care

Cognitive and Behavioral Practice ◽

10.1016/j.cbpra.2019.08.003 ◽

2019 ◽

Author(s):

Kimberly H. McManama O'Brien ◽

Joanna Almeida ◽

Lauren View ◽

Molly Schofield ◽

William Hall ◽

...

Keyword(s):

Psychiatric Care ◽

Coping Planning ◽

And Coping ◽

Acute Psychiatric Care ◽

Planning Intervention

Download Full-text

The Nottingham Acute Bed Study: Alternatives to acute psychiatric care

The British Journal of Psychiatry ◽

10.1192/bjp.170.3.247 ◽

1997 ◽

Vol 170 (3) ◽

pp. 247-252 ◽

Cited By ~ 41

Author(s):

A. Beck ◽

T. J. Croudace ◽

S. Singh ◽

G. Harrison

Keyword(s):

Resource Use ◽

Psychiatric Care ◽

Community Support ◽

Decision Makers ◽

Psychiatric Services ◽

Community Based ◽

Residential Community ◽

Acute Psychiatric Wards ◽

Population Ratio ◽

Acute Psychiatric Care

BackgroundAlthough modern psychiatric services seek alternatives to hospitalisation wherever appropriate, the national trend toward higher bed occupancies on acute psychiatric wards has refocused attention on community-based alternatives and methods of assessing reed for acute care.MethodWe surveyed key decision makers in a community-oriented district service with a low acute psychiatric bed to population ratio, in order to examine alternatives to hospitalisation in a cohort of consecutive admissions over a six-month period.ResultsAlternatives to acute ward hospitalisation were identified for 29% of admissions, and for 42% of those with an admission duration of more than 60 days. Residential options were chosen more often than intensive community support. Simulated bed day savings were considerable.ConclusionsIn a community-oriented service, key decision-makers could identify further alternatives to acute ward hospitalisation, although relatively few non-residential, community support options were chosen. Although this methodology has limitations, data based upon keyworker judgements probably have greater local ‘ownership’, and the option appraisal process itself may challenge stereotyped patterns of resource use.

Download Full-text