psychiatric care
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2022 ◽  
Author(s):  
Fionneke Bos ◽  
Lino von Klipstein ◽  
Ando C. Emerencia ◽  
Erwin Veermans ◽  
Tom Verhage ◽  
...  

Background: Smartphone self-monitoring through ecological momentary assessment (EMA) provides insights into the daily lives of people in psychiatric treatment and has the potential to improve their care. Currently, no clinical tools are available that help clients and clinicians with creating personalized EMA diaries and interpreting the gathered data. Integration of EMA in treatment is therefore difficult.Objective: To develop a web-based application for personalized EMA in routine psychiatric care, in close collaboration with all stakeholders (i.e., clients, clinicians, researchers, and software developers). Methods: We engaged 52 clients with mood, anxiety, and/or psychotic disorders and 45 clinicians (psychiatrists, psychologists, and psychiatric nurses) in interviews, focus groups, and usability sessions. We used human-centered design principles to determine important requirements for the web-app and designed high-fidelity prototypes that were continuously reevaluated and adapted. Results: The iterative development process resulted in PETRA (PErsonalized Treatment by Real-time Assessment), which is a scientifically grounded web-app for the integration of personalized EMA in clinical care. PETRA includes a decision aid to support clients and clinicians with constructing personalized EMA diaries, an EMA diary item repository, a text-message-based diary delivery system, and a feedback module for visualizing the gathered EMA data. PETRA is integrated in electronic health record (EHR) systems to ensure ease-of-use and sustainability, and adheres to privacy regulations.Conclusions: PETRA was built to fulfill the needs of clients and clinicians for a user-friendly and personalized EMA tool embedded in routine psychiatric care. PETRA is unique in this co-development process, its extensive yet user-friendly personalization options, its integration in EHR systems, its transdiagnostic focus, and its strong scientific foundation in the design of EMA diaries and feedback. The clinical effectiveness of integrating personalized diaries via PETRA into care awaits further research. As such, PETRA paves the way for a systematic investigation into the utility of personalized EMA for routine mental health care.


2022 ◽  
Author(s):  
Ebba Noland ◽  
Mattias Strandh ◽  
Fia Klötz Logan

Abstract Background Little is known about the recidivism of mentally disordered offenders after discharge from forensic psychiatric services. This is problematic because such knowledge could (i) help professionals who come into contact with this group to better plan interventions to prevent recidivism and (ii) clarify the effectiveness of forensic psychiatric care. The aim of this study was to investigate the new crimes of mentally disordered offenders who had been reconvicted after discharge from forensic psychiatric care. Methods Included in this study were all individuals who had been discharged from forensic psychiatric care in Sweden during 2009-2018, were included in the Swedish National Forensic Psychiatric Register, and had been reconvicted in a criminal court within the follow-up period of 2009-2018 (n=157). Retrospective registry data along with coded data from criminal judgments (n=210) were used to create a database. Descriptive statistical analysis was performed. Results 75% of included individuals were reconvicted for at least one violent crime, but only 9 individuals were reconvicted for a serious violent crime, which can be compared to the 44 individuals with serious violent index crimes. The most common crime was “Other violent”. The most common sentence was probation. The offender’s most common relationship to the victim was having no known relationship, followed by the victim being a person of authority. The most common circumstance of the crime leading to the reconviction was that it occurred without apparent provocation; other common circumstances were related to the exercise of public authority. The most common crime scene was a public place. Conclusions Even though the reconvictions of this group included many violent crimes, there were very few serious violent crimes. The finding that the victims of the crimes of mentally disordered offenders are most commonly either unknown to the perpetrator or persons of authority, and that the crimes are often perpetrated without apparent provocation or reason, is important information for all professionals who come into contact with this group and should be taken into consideration in order to assess risk more accurately.


2022 ◽  
Vol 12 ◽  
Author(s):  
Julian Schwarz ◽  
Andrzej Cechnicki ◽  
Jan Godyń ◽  
Laura Galbusera ◽  
Daria Biechowska ◽  
...  

Background: The past decade has witnessed the establishment of flexible and integrative treatment (FIT) models in 55 German and Polish psychiatric catchment areas. FIT is based on a global treatment budget (GTB), which integrates funding of all acute psychiatric hospital services for a regional population. Prior research has identified 11 specific program components of FIT in Germany. In this paper we aim at assessing the applicability of these components to the Polish context and at comparatively analysing FIT implementation in Poland and Germany.Methods: Qualitative interviews about the applicability of the 11 FIT-specific components were conducted with the program managers of the Polish FIT models (n = 19). Semi-quantitative data on the FIT-specific components were then collected in 19 Polish and 10 German FIT models. We assessed the grading of each component, their overall degree of implementation and compared them between the two countries. In all study hospitals, structural and statistical parameters of service delivery were collected and compared.Results: The qualitative results showed that the German FIT-specific components are in principle applicable to the polish context. This allowed the comparative assessment of components grading and degree of implementation, which showed only subtle discrepancies between German and Polish FIT models. The little discrepancies point to specific aspects of care such as home treatment, peer support, and cooperation with non-clinical and social welfare institutions that should be further integrated in the components' definition.Conclusions: The specific program components of FIT as first defined from the German experience, serves as a powerful tool to measure, and evaluate implementation of integrated psychiatric care both within and between health systems.


2022 ◽  
Vol 12 ◽  
Author(s):  
Patrick Heller ◽  
Larisa Morosan ◽  
Deborah Badoud ◽  
Manon Laubscher ◽  
Lisa Jimenez Olariaga ◽  
...  

Background: Our main objective was to provide estimates of the prevalence rates of psychiatric disorders and comorbidities among youths in a juvenile detention center in Geneva, Switzerland. We also aimed to investigate potential positive effects of intensive psychotherapeutic and educational services this center provides. Finally, we examined psychiatric care prior to and after custody as well as the evolution of the youths' mental health during detention.Methods: We conducted a longitudinal study including a group of incarcerated (n = 86) and a group of non-incarcerated (n = 169) youths (12–18 years old). Measures included diagnoses of psychiatric disorders, cognitive functions, trauma, psychopathic traits and the Youth Self-Report (aggressive behavior, attentional disorders, criminal behavior, social withdrawal, anxiety, depression and somatic complaints) collected at baseline and at discharge for the incarcerated group. Data were analyzed using mixed-effect models.Results: Psychiatric disorders were prevalent in the incarcerated group (82.6, 95% CI: 71.6–90.7%), but young people also often suffered from several disorders simultaneously. Two-thirds of the incarcerated participants had a diagnosis of two or more psychiatric disorders. Regarding health care, most incarcerated participants (79.1%) had psychiatric care prior to detention. The planned care after detention was associated with psychiatric comorbidities, care being more likely planned for those with comorbidities (p = 0.030). Compared to the non-incarcerated group, the incarcerated group had lower scores on cognitive functioning (p < 0.001) and higher scores on trauma (p < 0.021) and psychopathic traits (p < 0.034). The youths' stay in the detention center was associated with a positive change of mental health, with externalized problems being significantly reduced at the end of their stay (p = 0.017).Conclusion: Our findings showed that youths in conflict with the law are characterized by (1) their internal vulnerabilities: a high prevalence of psychiatric disorders and psychiatric comorbidities, lower cognitive functions, externalized problems and psychopathic traits; (2) environmental factors: victims of violence and sexual abuse; and (3) their psychiatric history. Besides, the evolution of the most prevalent issues was favorable over time, which puts into question the usual perspective about the deleterious effect of detention.


2022 ◽  
Vol 22 (1) ◽  
Author(s):  
Evdokia Missouridou ◽  
Evangelos C. Fradelos ◽  
Emmanouel Kritsiotakis ◽  
Polyxeni Mangoulia ◽  
Eirini Segredou ◽  
...  

Abstract Background There is an increasing trend of door locking practices in acute psychiatric care. The aim of the present study was to illuminate the symbolic dimensions of doors in Greek mental health nurses’ experiences of open and locked working spaces. Results A sequential mixed-method designexplored the experiences of nurses working in both open and locked psychiatric acute care units. Participants experiences revealed four types of doors related to the quality of recovery-oriented care: (a) the open door, (b) the invisible door, (c) the restraining door, and (d) the revolving door. Open doors and permeable spacesgenerated trust and facilitated the diffusion of tension and the necessary perception of feeling safe in order to be involved in therapeutic engagement. When the locked unit was experienced as a caring environment, the locked doors appeared to be “invisible”. The restraining doors symbolized loss of control, social distance and stigma echoing the consequences of restrictingpeople’s crucial control over spaceduring the COVID-19 pandemicin relation toviolence within families, groups and communities. The revolving door (service users’ abscondence/re-admission) symbolised the rejection of the offered therapeutic environment and was a source of indignation and compassion fatigue in both open and locked spaces attributed to internal structural acute care characteristics (limited staffing levels, support, resources and activities for service users) as well as ‘locked doors’ in the community (limited or no care continuity and stigma). Conclusions The impact of COVID-19 restrictions on people’s crucial control of space provides an impetus for erecting barriers masked by the veil of habit and reconsidering the impact of the simple act of leaving the door open/locked to allow both psychiatric acute care unit staff and service users to reach their potential.


2022 ◽  
Author(s):  
Weronika Wolińska ◽  
Agata Gebel ◽  
Bożena Mroczek

Abstract Background: Insomnia is the most recognized sleep disorder. The time of the COVID-19 pandemic brings with it new challenges. During the COVID-19 pandemic, maintaining sleep hygiene is highly recommended as it helps to strengthen the immune system, and people infected with COVID-19 may be more prone to sleep problems.The aim of this study was to determine the incidence of insomnia among people aged 18-25 during the COVID-19 pandemic. Methods: The study involved 302 individuals. It was conducted using Google Forms. The mean age of the respondents was 23 ± 1.84 years. The research instruments used in the study were the Athenian Insomnia Scale (AIS), the Beck Depression Inventory (BDI), and the author’s questionnaire concerning sociodemographic data. Results: Insomnia was found in 29.5% (n = 89) of the respondents. Higher mean values (8 ± 4.19) in the AIS were noted in the group of people with higher education and those currently studying. Moderate depression was demonstrated in 12.6% (n = 38) of the subjects. One third (30.1%; n = 91) of the respondents indicated greater sleep problems during the COVID-19 pandemic than before. Conclusions: Insomnia and depression are significant problems in the study group of 18-25 year olds. Therefore, psychological and psychiatric care should be extended to this group of young people.


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