From Wish to Reality: Soteria in Regular Care—Proof of Effectiveness of the Implementation of Soteria Elements in Acute Psychiatry

Objective: This article examines the influence of the implementation of Soteria elements on coercive measures in an acute psychiatric ward after reconstruction in 2017, thereby comparing the year 2016 to the year 2019. The special feature is that this is the only acute psychiatric ward in Hennigsdorf Hospital, connected now both spatially and therapeutically to an open ward and focusing on the treatment of patients suffering from schizophrenia and schizophrenia spectrum disorders.Methods: The following parameters were examined: aggressive assaults, use of coercion (mechanical restraints), duration of treatment in open or locked ward, type of discharge, coercive medication, and dosage of applied antipsychotics. For this purpose, the data of all legally accommodated patients in the year 2016 (before the reconstruction) and 2019 (after the reconstruction) were statistically analyzed in a pre–post mirror quasi-experimental design.Results: In 2019, the criteria of the Soteria Fidelity Scale for a ward with Soteria elements were reached. In comparison to 2016 with a comparable care situation and a comparable patient clientele, there was now a significant decrease in aggressive behavior toward staff and fellow patients, a significantly reduced number of fixations, a significantly reduced overall duration of inpatient stay, and a significant increase in treatment time in the open area of our acute ward.Conclusion: The establishment of Soteria elements in the acute psychiatric ward leads to a verifiable less violent environment of care for severely ill patients and to a drastic reduction in coercive measures.

“Communitas in Crisis”: An Autoethnography of Psychosis Under Lockdown

In this article, I use autoethnography to examine time spent on an acute psychiatric ward during the COVID-19 lockdown. I employ the device of “communitas in crisis” to emphasize the precarious nature of this experience and the extent to which, for myself at least, informal social interactions with fellow patients and “communitas” were significant features of my hospital experience and subsequent discharge. I suggest that a lack of emphasis on inpatient to inpatient relationships in the recovery literature is an omission and a reflection of psychiatry’s authority struggles with both service users and professionals, along with a general perception of psychosis as individual rather than as a socially constructed phenomenon. I also suggest that, especially in the wake of greater social distancing, mental health and social services should safeguard against psychological and social isolation by creating more spaces for struggling people to interact without fear or prejudice.

A physicians' compliance in identifying patients’ as drivers and providing advice on the Driver & Vehicle Licencing Agency (DVLA) guidelines

AimsThe DVLA has strict guidelines regarding how long a driver should stay off driving when they have certain mental health illnesses or severity of symptoms. It is difficult to give such advice if we are unaware of the patients’ that drive; especially when they do not volunteer this information for various reasons.This audit was aimed at identifying people who have been admitted to the Ward 3 at the Mount Hospital and if they were asked about driving. The audit also looked at whether there were discussions around the driving requirements and DVLA guidelines in terms of their mental health diagnosis. The expected outcome of this project was to improve information gathering when clerking in a new patient and to ensure that elderly patients’ who drive are made aware of the DVLA guidelines.MethodThis audit retrospectively examined the care of 50 patients on Ward 3 at the Mount Hospital, a mixed acute psychiatric ward for older people, between 1st April 2020 and 11th November 2020. All patients’ aged 65 years and over who were on admission within that period were audited. Data collection took place between 17th November and 17th December 2020; this involved reviewing patient records throughout their inpatient stay including paper notes and electronic records (on Care Director). Results were compiled using a pre-determined data collection tool and analysed using Microsoft Excel. The audit used the standards within the DVLA Guidance- Psychiatric Disorders: Assessing fitness to drive.ResultOnly 1 (2%) patient had sufficiently documented evidence around driving and the impact of psychotropic medication on driving. DVLA information was given verbally in 3 (9%) patients and only 2 patients had this information passed on to their General Practitioner (GP). Only 3 (6%) patients were made aware of the DVLA guidelines and 2 (4%) patients made aware of their obligation to inform the DVLAConclusionGenerally, the compliance of psychiatrists in identifying all patients’ who drive is poor and seems even worse with elderly patients’. There was little documented evidence that patients were asked about their driving status on or during their admission, were given verbal or written information, had discussions around the impact of medication on driving or informed about their obligation to notify the DVLA. This study provides opportunity to improve practice by educating the medical workforce and raising awareness within the wider team. There also needs to be greater involvement and communication with GPs when completing discharge summaries.

Construct Validity of the Mentalization Scale (MentS) Within a Mixed Psychiatric Sample

Introduction: The concept of mentalizing is nowadays widely used in research as well as in clinical practice. Despite its popularity, the development of an economic assessment is still challenging. The Mentalization Scale appears to be a promising measurement with good psychometric properties but lacking convergent validity with the Reflective Functioning Scale.Objective: This study aims to test the construct validity of the Mentalization Scale through correlations with the gold standard, the Reflective Functioning Scale, within a clinical sample. Furthermore, it was of interest to replicate its internal consistency.Methods: Twenty-six inpatients of an acute psychiatric ward in Vienna were given the Mentalization Scale (MentS). They were interviewed with the Brief Reflective Function Interview, which was coded with the Reflective Functioning Scale. Correlations and internal consistency were calculated.Results: Concerning the primary aim of this study, the validity was satisfactory for the MentS whole-scale mentalizing as well as for the subscales self- and other-oriented mentalizing. Internal consistency was lower to the findings of the developer and close to the 0.70 threshold.Conclusion: Our findings could foster the psychometric properties of the MentS. Furthermore, the MentS seems to be a promising measurement tool for detecting different dimensions of reflective functioning. Limitations and further research are discussed.

The relationship of insight with psychopathological dimensions in patients with schizophrenia

Impaired insight in patients with schizophrenia results in less satisfactory clinical outcomes. This study was conducted to investigate the relationship between insight and individual psychopathological dimensions in inpatients with schizophrenia using a self-report questionnaire. In this study, 90 patients with schizophrenia aged 18–75 years admitted in the acute psychiatric ward of a medical center in Taiwan were enrolled. Patient insight was measured using the Self-Appraisal of Illness Questionnaire (SAIQ), and psychopathological dimensions were measured using the Positive and Negative Syndrome Scale (PANSS) and its five-factor structure model. A higher SAIQ score indicates greater insight. In bivariate correlation analyses, statistically significant correlations were observed between age, single marital status, educational level, and positive, excited, and depressed symptom factor of the PANSS and SAIQ score. In regression analyses, age and excited and depressed symptom factors were significantly associated with SAIQ score. No significant association was observed between insight and neurocognitive functions. Considering demographic characteristics, psychopathology, and neurocognition, in the acute phase of schizophrenia, younger patients with less severe excited symptoms and more severe depressive symptoms had greater insight.

Treatment with the direct oral anticoagulants (DOACs) apixaban and rivaroxaban associated with significant worsening of behavioural and psychological symptoms of dementia (BPSD)

We report the cases of two patients who developed worsening behavioural and psychological symptoms of dementia (BPSD), coinciding with starting the factor Xa inhibitor direct oral anticoagulant medications apixaban and rivaroxaban, respectively. Both patients required detaining under the Mental Health Act. Their symptoms improved significantly, within 2 weeks, on switching to alternative anticoagulant therapies and they were both discharged from the acute psychiatric ward. Front-line staff should partake in postmarketing surveillance of medications, completing the Medicines and Healthcare products Regulatory Agency yellow cards for example (UK). There is increasing evidence for an aetiological role of cerebral mitochondrial dysfunction in neuropsychiatric disorders. Development of a rating scale of drugs that are potentially less toxic to cerebral mitochondria could inform national prescribing guidelines and enable safer treatments to be offered to older people, reducing the likely hood of them experiencing apparent BPSD.