Reporting Inpatients’ Experiences and Satisfaction in a National Psychiatric Facility: A Study Based on the Random Forest Algorithm

Understanding psychiatric inpatients’ experiences is important to establish a culture of patient-centric care and promote trust in healthcare. This study aimed to evaluate nine dimensions of patients’ experiences and investigate their association with patient satisfaction, revisit intention, and positive word-of-mouth (WoM) recommendation. Cross-sectional questionnaire data from five years of surveying (2016–2020) in the main psychiatric hospital in Bahrain were statistically analyzed, involving 763 psychiatric inpatients with an overall 65.6 ± 17.2 length of stay (days). The findings show that across the five years 2016–2020, the overall reported satisfaction was “very high” (4.75 ± 0.44) with no significant differences between these five years (F [4, 758] = 0.66, p = 0.620). The experience of confidentiality received the highest rating (4.72 ± 0.45). The experiences of ease of access, hospitality quality, and quality of responsiveness to one's needs significantly correlated with revisit intention ( p ˂ 0.05). Patients with high satisfaction had greater potential for revisit intention (r [761] = 0.08, p = 0.027), which was associated with WoM recommendation (r [761] = 0.08, p = 0.033). Overall, men were less likely than women to experience convenient access to psychiatric wards. The findings of the Random Forest algorithm indicate the tendency of female patients with short-term stays to demonstrate lower satisfaction rates, and thus innovative approaches are needed when managing these groups’ psychiatric problems.

A Descriptive Study on the Clinical Correlates of Conversion Disorder

Aim: Conversion disorder is defined by the presence of deficits affecting the voluntary motor or sensory functions lacking any known neurological cause. The aim of the study is to describe the sociodemographic profile and clinical characteristics including the frequency distribution of various types of presentations of patients with conversion disorders in a tertiary care psychiatric facility and to assess the presence of depression and anxiety and its level of severity in those patients. Methods: After obtaining informed consent, 50 consecutive patients who had met with the ICD-10 diagnosis criteria for conversion disorder and those who meet the inclusion/exclusion criteria, were enrolled for the study. They were interviewed using a semi-structured Performa and were administered Hospital Anxiety and Depression scale (HADS) and the results were analysed using SPSS software and interpreted. Results: Majority of the study patients were young adolescents (48%), females (76%), rural residents (60%), mostly unmarried (46%). Dissociative motor disorders (30%) were the most common presentation followed by mixed dissociative disorder (26%) and Dissociative convulsions (22%). HAD scale revealed that, both depression and anxiety scores were significantly high in major number of patients. Conclusion: The most common presenting symptom was that of dissociative motor type followed by dissociative convulsions with considerably high rates of depression (48%) and anxiety (54%). This made us to conclude that conversion as a phenomenon emerges to uphold its significance as a non-verbal communication process of the subconscious Mind. Keywords: Conversion, Dissociation, Hysteria, Dissociative Motor Disorder, Dissociative Convulsions, Laterality, Depression, Anxiety.

Characteristics and Co-Admissions of Mothers and Babies Admitted to Residential Parenting Services in the Year Following Birth in NSW: A Linked Population Data Study (2000-2012).

Background There is a tiered healthcare system in Australia to support maternal and child health, including, non-psychiatric day stay and residential parenting services (RPS) such as Tresillian and Karitane (in New South Wales [NSW]). RPS are unique to Australia, and currently there is limited information regarding the healthcare trajectory of women accessing RPS and if they are more likely to have admissions to other health facilities within the first-year post-birth. This study aimed to examine differences in hospital co-admissions for women and babies admitted to RPS in NSW in the year following birth compared to non-RPS admitted women. Methods A linked population data study of all women giving birth in NSW 2000-2012. Statistical differences were calculated using chi-square and student t-tests. Results In total 32 071 women and 33 035 babies were admitted to RPS with 5191 RPS women also having one or more hospital admissions (7607 admissions). There were 99 242 women not admitted to RPS but having hospital admissions (136 771 admissions). Women admitted to RPS who had a co-admission to a hospital were significantly more likely to be older, admitted as a private patient, born in Australia, having their first baby and be socially advantaged (p≤.001) compared to non-RPS admitted women also having a hospital admission. They also experienced more labour and birth interventions (induction, instrumental birth, caesarean section, epidural, episiotomy), and were more likely to have multiple births, a male infant and babies admitted to Special Care Nursery/Neonatal Intensive Care (p≤.001). Additionally, these women were more likely to have another admission for mental health and behavioural disorders (p≤.001), and this appeared to increase over time. There was no between cohort differences regarding the number of women admitted to a psychiatric facility; however, women attending RPS were more likely to have mood affective, or behavioural and personality disorder diagnoses. Conclusion Women accessing RPS in the year post-birth were more socially advantaged, had higher birth intervention and more co-admissions and treatment for mental health disorders than those not accessing RPS. More research is needed into the impact of birth intervention and mental health issues on subsequent parenting difficulties.

TREATMENT-RESISTANT EPILEPSY AND TREATMENT-RESISTANT SCHIZOPHRENIA; A REAL CHALLENGE FOR THE PSYCHIATRIC TEAM

Schizophrenia and epilepsy may exist together, but it is very rare to have a resistant form of both illnesses in one patient. We present a case report of a 49-year-old woman who was managed at our psychiatric facility suffering from treatment-resistant schizophrenia and epilepsy. She presented with suspiciousness, fearfulness and with a belief that people in the hostel wanted to harm her and were putting hair on her bed. She was also having recurrent seizures weekly due to her refractory epilepsy secondary to mesial temporal sclerosis. She was non-compliant with medication and refused surgical management of mesial temporal sclerosis. Whilst in the hospital was on five antiepileptic drugs prescribed by the neurology team and these control the seizures. Olanzapine and paliperidone depot was used for schizophrenia which had a partial response. Clozapine was notconsidered in view of her severe uncontrolled epilepsy. Concerns were raised regarding her capacity to decide about treatment options. The possibility of an organic cause for both schizophrenia and epilepsy were considered.

Nursing Staff Attitude, Subjective Norms, Perceived Behavior Control, and Intention to Provide Tobacco Treatment in a Psychiatric Hospital

Background: Although the nursing staff is fundamental in assisting individuals with mental illnesses (MI) to stop tobacco use, they often have mixed feelings about providing tobacco treatment (TT) services to people with MI in inpatient psychiatric settings. Objective: Therefore, this study aimed to understand factors associated with nursing staff’s intentions to provide TT interventions for individuals diagnosed with MI in a psychiatric facility using the constructs of the theory of planned behavior (TPB). Method: Secondary data analysis was performed using cross-sectional data collected from 98 nursing staff who worked in a state inpatient psychiatric facility. A 15-item questionnaire was used to assess nursing staff intentions to provide TT services based on TPB constructs, including attitudes (four items), subjective norms (four items), perceived behavioral controls (four items), and intentions (three items) toward providing TT. The mean scores of each subscale ranged from 1 to 7. A logistic regression analysis was used to examine the relationship between TBP constructs and nursing staff intentions to provide TT for people with MI. Results: Nursing staff had an acceptable mean score in the intentions subscale (4.34 ± 2.01). Only two constructs of TPB explained nursing staff intentions to provide TT: subjective norms (OR = 2.14, 95% CI [1.46, 3.13]) and perceived behavioral control (OR = 2.33, 95% CI [1.32, 4.12]). Conclusions: The constructs of the TPB, the subjective norms, and the perceived behavior control were able to predict nurses’ intentions to provide TT for inpatients in a psychiatric setting. Accordingly, we suggest implementing policies that make TT a normative practice while supporting the confidence and competence of nurses to deliver TT in psychiatric facilities.

Fragile minds, porous selves: Shining a light on autoethnography of mental illness

This article sheds light on autoethnographic accounts of mental illness, to address author and reader concerns and questions and to consider what practitioners can learn from these narrative accounts. Drawing from my own and others’ trajectories, I discuss the drawbacks and dangers of exposing a ‘flawed’ identity, the stigma of serious mental illness, intertextuality issues, the tangled nature of revelation and redemption, framing the ‘Other’ in mental illness autoethnography and depictions of ‘life in the asylum.’ I explain how in telling my own ‘psychiatric’ tale, I looked to the symbolic concept of ‘communitas’ as a means of examining inter-relational processes and collective experience in a psychiatric facility. I argue that, while the act of writing about one’s illness experience can be rightly perceived as a way of reclaiming personal ‘power’ and facilitating healing, attempts to ‘evidence’ recovery can run counter to the writer’s reality of life with or beyond mental illness as personally and socially messy. In answer to the question, ‘at what point does a ‘life in the asylum’ narrative become autoethnographic?' I argue for the potential of autoethnography to contribute to broader sociological, ethnographic and medical debates and thus impact on policy. Speaking up about mental health through autoethnography can help to promote awareness of the unpredictability and socially constructed nature of mental illness and can inform strategies toward reducing public stigma, tackle the cyclical impact of labels, highlight the need to change social and medical attitudes, and revisualize treatment and support.

Patients’ perspectives on the experience of absconding from a psychiatric hospital: a qualitative study

Background Absconding (i.e., escaping) is common among patients with mental illness admitted to psychiatric hospitals. Patients use various strategies to make absconding successful due to the experiences faced during admission. We conducted a study to identify patients’ perspectives on the experience of absconding from the psychiatry facility. Methods We conducted 10 in-depth interviews with patients with a history of absconding from the hospital who were accessing care at the Mbarara Regional Referral Hospital in Mbarara city Uganda. Interviews were audio-recorded, translated when required, transcribed into English, and analyzed thematically to identify relevant themes. Results Participants ranged in age from 18 to 55 and the majority (n = 9) were male. Most had absconded at least twice from a psychiatric facility. We identified different experiences that influenced patients’ engagement in absconding from the psychiatry hospital ward. These included: (1) stigma, (2) experiences with caregivers: mixed emotions, (3) poor resources and services, and (4) the influence of mental illness symptoms. The loneliness of stigma, negative emotions associated with the loss of important roles given the nature and framework of caregiving on the psychiatric ward, as well as the stress of limited resources were a salient part of the patient experience as it relates to absconding. Conclusion Our findings indicate that absconding is a symptom of a larger problem with a mental health system that perpetuates stigma in its design, isolates patients and makes them feel lonely, and forces patients to rely on caregivers who infantilize them and take away all their freedom in a facility with no basic services. For many patients, this makes absconding the only option. Within such a system, all stakeholders (policymakers, health-care providers, caregivers, and patients) should be involved in rethinking how psychiatric facilities should be operated to make the journey of patient recovery more positive.