1
|
Profiles, correlates, and risk of death among patients with mental disorders hospitalized for psychiatric reasons. Psychiatry Res 2023; 321:115093. [PMID: 36764119 DOI: 10.1016/j.psychres.2023.115093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 09/19/2022] [Accepted: 02/03/2023] [Indexed: 02/07/2023]
Abstract
This study identified profiles of hospitalized patients with mental disorders (MD) based on their 3-year hospitalization patterns and clinical characteristics and compared sociodemographic profiles and other service use correlates as well as risk of death within 12 months after hospitalization. Quebec (Canada) medical administrative databases were used to investigate a 5-year cohort of 4,400 patients hospitalized for psychiatric reasons. Latent class analysis, chi-square tests and survival analysis were produced. Three profiles of hospitalized patients were identified based on hospitalization patterns and other patient characteristics. Profile 3 patients had multiple hospitalizations and early readmissions, worst health and social conditions, and used the most outpatient services. Profiles 2 and 1 patients had only one hospitalization, of brief duration in the case of Profile 2 patients, who had mainly common MD and made least use of psychiatric care. All Profile 1 patients were hospitalized for serious MD but received least continuity of physician care and fewest biopsychosocial interventions. Risk of death was higher for Profiles 3 and 2 versus Profile 1 patients. Interventions like early follow-up care after hospitalization for Profile 3, collaborative care between general practitioners and psychiatrists for Profile 2, and continuous biopsychosocial care for Profile 1 could be greatly improved.
Collapse
|
2
|
Schwerthöffer D, Scholz B, Longhi S, Bäuml J, Rentrop M. [The Intensive Psychiatric Care Unit at a Hospital with Maximum Care - An Analysis of Treatment Variables in the Therapy of Psychiatric and comorbid Somatic Disorders]. FORTSCHRITTE DER NEUROLOGIE-PSYCHIATRIE 2020; 89:346-353. [PMID: 32869237 DOI: 10.1055/a-1191-7637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
ZIEL DER STUDIE UND METHODIK Alle 873 Behandlungsakten einer psychiatrischen Intensivstation aus einem Zeitraum von 5 Jahren gingen in eine Analyse des Patientenkollektivs, des Behandlungsoutcomes und von Prädiktoren für die stationäre Behandlungsdauer ein. ERGEBNISSE UND SCHLUSSFOLGERUNG Auf der beschriebenen Station wurden sowohl Patienten mit psychiatrischen Notfallsyndromen als auch Patienten mit komorbiden psychischen und somatischen Erkrankungen behandelt. Somatische Zusatzerkrankungen beeinflussen den stationären Behandlungsverlauf psychisch Erkrankter erheblich, z. B. durch eine um durchschnittlich 2,4 Wochen kürzere intensivpsychiatrische stationäre Behandlungsdauer bei häufiger Notwendigkeit (41,3%) einer stationären, z. B. rehabilitativen Anschlussbehandlung. Die Stationsauslastung von 110 % und die durchschnittliche Behandlungsdauer von 63 Tagen deuten auf einen hohen Bedarf an interdisziplinären psychiatrisch-somatischen Behandlungsmöglichkeiten hin. In Zukunft ist ein Zusammenwachsen von Psychiatrie und somatischer Medizin anzustreben. Untersuchungen zu Versorgungssituation und Wirtschaftlichkeit interdisziplinärer Behandlungsangebote stehen aus. BACKGROUND AND METHOD All 873 medical files of psychiatric inpatients treated over a 5 year period at a psychiatric intensive care unit were analyzed in regard to characteristics of the patient group, outcome and predictors for the length of stay. RESULTS AND CONCLUSIONS Patients with psychiatric emergency syndromes and patients with comorbid psychiatric and somatic disorders were treated on the described unit. Somatic comorbidities have a considerable effect on the course of treatment for patients with psychiatric disorders. They have to receive stationary treatment for a shorter period (2.4 weeks) but often need further stationary, e. g. rehabilitative treatment. The utilization of this specific unit (110%) and the above average length of stay (63 days) point to an increasing need in inpatient treatment capacities for patients with psychiatric and somatic comorbidities. In future a growing together of somatic medicine and psychiatry in Germany is worthwhile. The evaluation of the treatment situation and aspects of cost effectiveness are yet to come.
Collapse
Affiliation(s)
- Dirk Schwerthöffer
- Klinik für Psychiatrie und Psychotherapieder TU-München, Klinikum rechts der Isar, 81675 München
| | - Benjamin Scholz
- Klinik für Psychiatrie und Psychotherapieder TU-München, Klinikum rechts der Isar, 81675 München
| | - Sarah Longhi
- Klinik für Psychiatrie und Psychotherapieder TU-München, Klinikum rechts der Isar, 81675 München
| | - Josef Bäuml
- Klinik für Psychiatrie und Psychotherapieder TU-München, Klinikum rechts der Isar, 81675 München
| | - Michael Rentrop
- Klinik für Psychiatrie und Psychotherapieder TU-München, Klinikum rechts der Isar, 81675 München.,Inn-Salzach-Klinikum Wasserburg, Wasserburg/Inn
| |
Collapse
|
3
|
Winkler D, Kaltenboeck A, Frey R, Kasper S, Pjrek E. Changes over time of the diagnostic and therapeutic characteristics of patients of a psychiatric intensive care unit in Austria. Compr Psychiatry 2019; 93:20-26. [PMID: 31280143 DOI: 10.1016/j.comppsych.2019.06.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 06/17/2019] [Accepted: 06/19/2019] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE The aim of this repeated cross-sectional study was to compare patients from a psychiatric intensive care unit (PICU) over ≫30 years regarding their diagnostic and therapeutic characteristics. METHOD Three samples including 100 consecutive inpatients each from the Viennese PICU were submitted to a chart review: sample no. 1 from the years 1985/86, no. 2 from 1995/96 and no. 3 from 2007/08. RESULTS Changes in referral modes were associated with a decrease of patients with substance induced disorders and an increase of patients with affective disorders over time. The rate of admissions after accidents and suicides was stable. The use of cranial MRI increased, while intravenous psychopharmacotherapy and parenteral nutrition decreased. Involuntary admission occurred in 43% and in 37% of patients physical restraints were necessary. We saw a shift from tricyclic antidepressants to SSRIs and SNRIs from sample 1 to 3. Likewise, we observed the emergence of atypical antipsychotics and a reduction of use of typical neuroleptics mainly from sample 2 to 3. The percentage of patients receiving benzodiazepines increased over time, while the mean dosage of benzodiazepines decreased. 7% of patients received electroconvulsive therapy. CONCLUSIONS The changes over time in our samples reflect the medical progress made during the last decades. Future studies should focus on evaluation of efficacy of psychiatric intensive care using standardized measurements.
Collapse
Affiliation(s)
- Dietmar Winkler
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Austria.
| | - Alexander Kaltenboeck
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Austria; Department of Psychiatry, University of Oxford, United Kingdom
| | - Richard Frey
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Austria
| | - Siegfried Kasper
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Austria
| | - Edda Pjrek
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Austria
| |
Collapse
|
4
|
Abstract
A wide breadth of research has recognized that seclusion and restraint affects patients, staff, and organizations alike. Therefore, it is essential to understand the viewpoints of all stakeholders to improve practices. The study aimed to understand the context in which seclusion and restraint practices are employed based on the perceptions of staff and inpatients in a psychiatric ward. A case study was performed using a participatory approach. Methods included a 56-hr immersion in the practice setting and individual interviews with staff and patients ( n = 17). The main themes discussed were patient characteristics (etiology of the violence, difficult experience), staff characteristics (feelings of safety, rationalization of seclusion use), and environmental characteristics. Both explicit (e.g., hospital protocol) and implicit (e.g., ward rules) standards seem to influence seclusion and restraint management. Our results point toward the potential for developing post-seclusion and restraint review in which both patient and staff perspectives are taken into account.
Collapse
|
5
|
Blair EW, Woolley S, Szarek BL, Mucha TF, Dutka O, Schwartz HI, Wisniowski J, Goethe JW. Reduction of Seclusion and Restraint in an Inpatient Psychiatric Setting: A Pilot Study. Psychiatr Q 2017; 88:1-7. [PMID: 26897657 DOI: 10.1007/s11126-016-9428-0] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The authors describe a quality and safety initiative designed to decrease seclusion/restraint (S/R) and present the results of a pilot study that evaluated the effectiveness of this program. The study sample consisted of consecutive admissions to a 120-bed psychiatric service after the intervention was implemented (October 2010-September 2012, n = 8029). Analyses compared S/R incidence and duration in the study sample to baseline (consecutive admissions during the year prior to introduction of the intervention, October 2008-September 2009, n = 3884). The study intervention, which used evidence-based therapeutic practices for reducing violence/aggression, included routine use of the Brøset Violence Checklist, mandated staff education in crisis intervention and trauma informed care, increased frequency of physician reassessment of need for S/R, formal administrative review of S/R events and environmental enhancements (e.g., comfort rooms to support sensory modulation). Statistically significant associations were found between the intervention and a decrease in both the number of seclusions (p < 0.01) and the duration of seclusion per admission (p < 0.001). These preliminary results support the conclusion that this intervention was effective in reducing use of seclusion. Further study is needed to determine if these prevention strategies are generalizable, the degree to which each component of the intervention contributes to improve outcome, and if continuation of the intervention will further reduce restraint use.
Collapse
Affiliation(s)
- Ellen W Blair
- The Institute of Living, Hartford Hospital, 200 Retreat Avenue, Hartford, CT, 06106, USA.
| | - Stephen Woolley
- Burlingame Center for Psychiatric Research and Education, The Institute of Living, Hartford Hospital, 200 Retreat Avenue, Hartford, CT, 06106, USA
| | - Bonnie L Szarek
- The Institute of Living, Hartford Hospital, 200 Retreat Avenue, Hartford, CT, 06106, USA
| | - Theodore F Mucha
- The Institute of Living, Hartford Hospital, 200 Retreat Avenue, Hartford, CT, 06106, USA
| | - Olga Dutka
- The Institute of Living, Hartford Hospital, 200 Retreat Avenue, Hartford, CT, 06106, USA
| | - Harold I Schwartz
- The Institute of Living, Hartford Hospital, 200 Retreat Avenue, Hartford, CT, 06106, USA
| | - Jeff Wisniowski
- Burlingame Center for Psychiatric Research and Education, The Institute of Living, Hartford Hospital, 200 Retreat Avenue, Hartford, CT, 06106, USA
| | - John W Goethe
- Burlingame Center for Psychiatric Research and Education, The Institute of Living, Hartford Hospital, 200 Retreat Avenue, Hartford, CT, 06106, USA
| |
Collapse
|
6
|
Ling S, Cleverley K, Perivolaris A. Understanding Mental Health Service User Experiences of Restraint Through Debriefing: A Qualitative Analysis. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2015; 60:386-92. [PMID: 26454726 PMCID: PMC4574714 DOI: 10.1177/070674371506000903] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To examine debriefing data to understand experiences before, during, and after a restraint (seclusion, chemical, and physical) event from the perspective of inpatients at a large urban mental health and addiction hospital. METHOD Audits were conducted on a purposeful sample of inpatient charts containing post-restraint event inpatient debrief forms (n = 55). Qualitative data from the forms were analyzed thematically. RESULTS Loss of autonomy and related anger, conflict with staff and other inpatients, and unmet needs were the most common factors precipitating restraint events. Inpatients often reported that increased communication with staff could have prevented restraint. Inpatients described having had various negative emotional states and responses during restraint events, including fear and rejection. Post-restraint, inpatients often desired to leave the unit for fresh air or to engage in leisure activities. CONCLUSIONS To our knowledge, our study is the first to use debriefing form data to explore mental health inpatients' experiences of restraint. Inpatients view restraint negatively and do not experience it as a therapeutic intervention. Debriefing, guided by a form, is useful for understanding the inpatient's experience of restraint, and should be used to re-establish the therapeutic relationship and to inform plans of care. In addition, individual and collective inpatient perspectives should inform alternatives to restraint.
Collapse
Affiliation(s)
- Sara Ling
- Advanced Practice Nurse, Centre for Addiction and Mental Health, Toronto, Ontario
| | - Kristin Cleverley
- Assistant Professor, Centre for Addiction and Mental Health Chair in Mental Health Nursing Research, Lawrence S Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario; Clinician-Scientist, Centre for Addiction and Mental Health, Toronto, Ontario
- Correspondence: University of Toronto, 155 College Street, Suite 130, Toronto, ON M5T 1P8;
| | - Athina Perivolaris
- Senior Project Manager, Centre for Addiction and Mental Health, Toronto, Ontario
| |
Collapse
|