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Li W, Tian Y, Chen C, Li H, Chen H, Liu J, Chen X, Tang H, Zhou J, Wang S, Wang X, Cai W, Zhou J. Mapping Violent Behaviors and Psychiatric Symptoms Among Male Psychiatric Inpatients from a Network Perspective. Psychiatr Q 2023; 94:705-719. [PMID: 37831344 DOI: 10.1007/s11126-023-10056-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/02/2023] [Indexed: 10/14/2023]
Abstract
Psychiatric symptoms are common risk factors of violent behaviors among psychiatric patients. This study explored the interrelationship between violence and psychiatric symptoms in male psychiatric inpatients. This is a cross-sectional survey conducted in 2019. All patients admitted to the Male Psychiatry Unit of the Second Xiangya Hospital were consecutively recruited. The presence of five violent behaviors and eleven psychiatric symptoms were collected by reviewing medical records and were included as categorical variable in the network analyses. A total of 673 participants were included. The most central symptoms were "flight of ideas", "property-oriented violence", "emotional high", "verbal violence", "physical violence attempt", and "physical violence" in the network of psychiatric symptoms and violent behaviors. The bridge symptoms connecting violence and psychiatric symptoms were "verbal violence", "property-oriented violence", "hyperbulia", and "emotional high" according to the indices of bridge expected influence. The directed acyclic graph analysis revealed that "emotional high" and "hyperbulia" were the key psychiatric symptoms triggering violence, while "verbal violence" and "property-oriented violence" were the most upstream violent behavior. Verbal and property-oriented violence should be addressed in the risk assessment among male psychiatric inpatients. In addition, emotional high and hyperbulia are the potential treatment targets for violent behaviors.
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Affiliation(s)
- Wen Li
- Shanghai Key Laboratory of Forensic Medicine, Key Laboratory of Forensic Science, Shanghai Forensic Service Platform, Ministry of Justice, Academy of Forensic Science, Shanghai, 200063, China
| | - Yusheng Tian
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, the Second Xiangya Hospital of Central South University, Changsha, China
- Clinical Nursing Teaching and Research Section, The second Xiangya Hospital of Central South University, Changsha, China
| | - Chen Chen
- Shanghai Key Laboratory of Forensic Medicine, Key Laboratory of Forensic Science, Shanghai Forensic Service Platform, Ministry of Justice, Academy of Forensic Science, Shanghai, 200063, China
| | - Haozhe Li
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, the Second Xiangya Hospital of Central South University, Changsha, China
| | - Hui Chen
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, the Second Xiangya Hospital of Central South University, Changsha, China
| | - Jiali Liu
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, the Second Xiangya Hospital of Central South University, Changsha, China
| | - Xianliang Chen
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, the Second Xiangya Hospital of Central South University, Changsha, China
| | - Huajia Tang
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, the Second Xiangya Hospital of Central South University, Changsha, China
| | - Jiawei Zhou
- Shanghai Key Laboratory of Forensic Medicine, Key Laboratory of Forensic Science, Shanghai Forensic Service Platform, Ministry of Justice, Academy of Forensic Science, Shanghai, 200063, China
| | - Shujian Wang
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, the Second Xiangya Hospital of Central South University, Changsha, China
| | - Xiaoping Wang
- Shanghai Key Laboratory of Forensic Medicine, Key Laboratory of Forensic Science, Shanghai Forensic Service Platform, Ministry of Justice, Academy of Forensic Science, Shanghai, 200063, China
| | - Weixiong Cai
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, the Second Xiangya Hospital of Central South University, Changsha, China.
| | - Jiansong Zhou
- Shanghai Key Laboratory of Forensic Medicine, Key Laboratory of Forensic Science, Shanghai Forensic Service Platform, Ministry of Justice, Academy of Forensic Science, Shanghai, 200063, China.
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Punko D, Luccarelli J, Bains A, MacLean R, Taylor JB, Kontos N, Smith FA, Beach SR. The Diagnosis of Malingering in General Hospitals in the United States: A Retrospective Analysis of the National Inpatient Sample. Gen Hosp Psychiatry 2023; 85:133-138. [PMID: 38455076 PMCID: PMC10917147 DOI: 10.1016/j.genhosppsych.2023.10.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2024]
Abstract
Objective To characterize the socio-demographics and comorbid medical and psychiatric diagnoses of patients in the general hospital diagnosed with malingering. Method We conducted a retrospective observational cohort study using data from the 2019 National Inpatient Sample, an all-payors database of acute care general hospital discharges in the United States, querying for patients aged 18 and older discharged with a diagnosis of "malingerer [conscious simulation]," ICD-10 code Z76.5. Results 45,645 hospitalizations (95% CI: 43,503 to 47,787) during the study year included a discharge diagnosis of malingering. 56.1% were for male patients, and the median age was 43 years (IQR 33 to 54). Black patients represented 26.8% of the patients with a discharge diagnosis of malingering, compared to 14.9% of all patients sampled. Zip codes in the lowest household income quartile comprised 39.9% of malingering diagnoses. The top categories of primary discharge diagnoses of hospitalizations included medical ("Diabetes mellitus without complications"), psychiatric ("Depressive disorders"), and substance use ("Alcohol-related disorders") disorders. "Sepsis, unspecified organism," was the most common primary diagnosis. Conclusion The striking overrepresentation of Black patients in hospitalizations with diagnosis of malingering raises concern about the roles of implicit and systemic biases in assigning this label. The disproportionate number of patients of low socioeconomic status is further suggestive of bias and disparity. Another potential contribution is that the lower health literacy in these populations results in a limited knowledge of traditional ways to meet one's needs and thus greater reliance on malingered behavior as an alternative means. Accurate description of these patients' socio-demographics and comorbid medical and psychiatric diagnoses with reliable data from large samples can lead to improved understanding of how the malingering label is applied and ultimately better patient care.
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Affiliation(s)
- Diana Punko
- Department of Psychiatry, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114, United States
- Harvard Medical School, 25 Shattuck St, Boston, MA 02115, United States
| | - James Luccarelli
- Department of Psychiatry, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114, United States
- Harvard Medical School, 25 Shattuck St, Boston, MA 02115, United States
| | - Ashika Bains
- Department of Psychiatry, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114, United States
- Harvard Medical School, 25 Shattuck St, Boston, MA 02115, United States
| | - Rachel MacLean
- Department of Psychiatry, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114, United States
| | - John B. Taylor
- Department of Psychiatry, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114, United States
- Harvard Medical School, 25 Shattuck St, Boston, MA 02115, United States
| | - Nicholas Kontos
- Department of Psychiatry, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114, United States
- Harvard Medical School, 25 Shattuck St, Boston, MA 02115, United States
| | - Felicia A. Smith
- Department of Psychiatry, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114, United States
- Harvard Medical School, 25 Shattuck St, Boston, MA 02115, United States
| | - Scott R. Beach
- Department of Psychiatry, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114, United States
- Harvard Medical School, 25 Shattuck St, Boston, MA 02115, United States
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Simpson SA, Loh R, Goans CRR, Ryall K, Middleton M, Dalton A. Reply to Letter to the Editor. J Emerg Med 2022; 62:570-571. [PMID: 35065864 DOI: 10.1016/j.jemermed.2021.11.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 11/27/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Scott A Simpson
- Department of Behavioral Health Services, Denver Health and Hospital Authority, Denver, Colorado
| | - Ryan Loh
- Department of Behavioral Health Services, Denver Health and Hospital Authority, Denver, Colorado
| | | | | | - Molly Middleton
- Colorado Department of Public Health and Environment, Denver, Colorado
| | - Alicia Dalton
- Rocky Mountain Poison and Drug Safety, Denver, Colorado
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Iverson DA. Letter to the Editor. J Emerg Med 2022; 62:569. [PMID: 35065857 DOI: 10.1016/j.jemermed.2021.10.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 09/12/2021] [Accepted: 10/17/2021] [Indexed: 10/19/2022]
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More than Suicide: Mortality after Emergency Psychiatric Care and Implications for Practice. J Acad Consult Liaison Psychiatry 2022; 63:354-362. [PMID: 35017123 DOI: 10.1016/j.jaclp.2021.12.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 12/08/2021] [Accepted: 12/24/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Emergency departments (EDs) provide vital mental health services. ED patients with behavioral health presentations, particularly suicidal ideation, are at increased risk of death by suicide, medical illness, trauma, or overdose. Causes of death for patients who receive specialty emergency psychiatric services remain undescribed. OBJECTIVE We describe the incidence and cause of death after care in a psychiatric emergency service (PES). METHODS Mortality data were obtained for all adult patients treated in a safety net ED from April 2016 to June 2020. Causes of death were categorized as medical, external (accidents, overdoses, and homicide), or suicide and compared between PES patients and ED patients who were not treated in the PES. Correlates of mortality were described for PES patients. RESULTS We analyzed 164,422 encounters including 6,063 PES visits. Mortality in the 30 days after discharge was 0.3% among PES patients and 0.6% among medical ED patients. At both 30 and 365 days, PES patients were more likely to die by suicide than were medical ED patients, and ED patients were more likely to die by medical causes. Among PES patients who died within 365 days, 46% died by medical causes, 32% by external causes, and 23% by suicide. In multivariable analyses, age was associated with all-cause, medical, and external mortality after a PES visit; opioid and stimulant use disorders were associated with all-cause and external mortality. CONCLUSIONS Most patients who die after receiving emergency psychiatric care die by medical and external causes such as accidents, overdose, and homicide. Patients who are older and have opioid or stimulant use disorders are at higher risk of non-suicide mortality. We propose interventions to re-imagine emergency psychiatric care and address non-suicide mortality among psychiatric patients treated in emergency and crisis settings.
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