Mood disorders (MD) are often associated with a higher incidence of suicidal behavior, especially in adolescent patients. However, the mechanisms by which depression affects suicide attempts in ...adolescents with MD remain poorly elucidated. Therefore, the purpose of this study was to determine the incidence, risk factors, and clinical correlates of suicide attempts in Chinese adolescent patients with MD, as well as the inter-relationship between depressive symptoms, rumination, and suicide attempts, and the role of rumination in mediating depression and suicide attempts. A total of 331 MD adolescent patients aged 11 ~ 18 years were recruited from a psychiatric hospital. Suicide attempts were assessed with the MINI Suicide Scale. Depressed symptoms were measured with the Patient Health Questionnaire-9 (PHQ-9). To assess rumination, we used the 21-item Chinese version of the Ruminative Responses Scale (RRS). Overall, the percentage of suicide attempts among MD adolescents was 51.96%, with a higher percentage of females (58.62%) than males (36.36%). Compared to non-suicide attempters, suicide attempters had higher scores on PHQ-9, RRS, depression-related, brooding, and reflective pondering. Gender and RRS were independently associated with suicide attempts. Rumination played a fully mediating role between depression and suicide attempts. In addition, the mediating effect of depression between rumination and suicide attempts was not significant. The incidence of suicide attempts was higher in MD adolescents than in general adolescents. Gender and rumination were associated with suicide attempts in MD adolescents. Moreover, rumination mediated the correlation between depressive symptoms and suicide attempts, suggesting that rumination may be an important intervention component for clinical staff to prevent suicidal behavior in adolescents with MD.
Purpose: To clarify the factors that influence recovery-oriented practice for inpatients as recognized by the nursing directors of psychiatric hospitals.Methods: A semi-structured interview survey ...was conducted to 20 nursing directors of psychiatric hospitals in Japan. The interview data were transcribed verbatim, and qualitative descriptive analysis was performed with reference to the data analysis method of Graneheim.Results: In terms of the factors influencing the practices facilitating the recovery of inpatients recognized by the nursing directors, 325 codes were extracted and classified into 21 categories and four core categories: nursing director’s recovery-orientation and communication to the staff, existence of colleagues who approve the idea of the nursing director, sense of professional fulfillment during discharge support, and culture and climate of the hospital organization.Conclusion: The following points were suggested for the introduction of practices facilitating recovery in psychiatric hospitals in the future. There is a need for education that enhances recovery-oriented attitudes of nursing directors, education on patient recovery for the hospital as a whole, including multiple occupations and other departments, and a need for seeing and listening to patients’ experience of the recovery process, including understanding of the patients’ lives after hospital discharge.
In Germany, people suffering from severe mental illness who have committed serious offenses and have considerably reduced or suspended criminal responsibility can be detained and treated in forensic ...psychiatric hospitals. In the German federal state of Baden-Wuerttemberg, all psychiatric hospitals including forensic psychiatric hospitals are obliged to record data on every coercive intervention and to submit them to a central registry. The objective of this study was to determine key measures for the use of seclusion and restraint and to compare them with data from the same registry on the use of coercion in general inpatient mental health care.
Data on the main psychiatric diagnosis according to ICD-10, type and duration of each coercive measure and number of treated cases according to diagnoses, and cumulated number of days of treatment from all 8 forensic facilities in the state of Baden-Wuerttemberg covering a catchment area with about 11 million inhabitants were collected at the treated-case-level for 3 years.
22.6% of the cases treated in 2017 in forensic psychiatric hospitals were subjected to seclusion, and 3.8% were subjected to mechanical restraint. The mean cumulated duration of seclusion episodes per affected case was 343.9 h and the mean cumulated duration of restraint episodes was 261.7 h. 13.2% of the treated cases were subjected to room confinement with a mean cumulated duration of 539.1 h per affected case. Involuntary medication was applied in 1.9% of the cases. In general psychiatry, 2.9% of the treated cases were subjected to seclusion, and 4.7% were subjected to mechanical restraint. The mean cumulated duration per affected case amounted to 32.2 h for seclusion episodes and to 37.6 h for restraint episodes. Involuntary medication was applied in 0.6% of cases.
Compared to general psychiatry, mechanical restraint is used in forensic psychiatry substantially less frequently and seclusion substantially more frequently. Room confinement is used only in forensic psychiatric hospitals. Use of involuntary medication is rare. On the one hand, recorded involuntary medication comprises only clear actions against the patient's expressed will as defined by law. Psychological pressure to take medication to avoid other forms of coercion and to achieve higher levels of freedom within the facility is not recorded. On the other hand, the low numbers of clear involuntary medication probably reflect the high legal threshold for such interventions, and, consequently, efforts by staff to motivate voluntary acceptance. The long duration of freedom-restricting coercive measures in forensic psychiatry probably reflects the selection of patients at high risk of violence.
Objective: To investigate whether electroencephalogram (EEG) requests at a psychiatric tertiary care center in urban Oman are being made according to guidelines for best practice. Methods: This study ...was carried out at a psychiatry tertiary care hospital in Muscat providing the most comprehensive psychiatric service in the country. Cases were examined retrospectively for11months from January to December 2018. Relevant information was recorded on a proforma prepared for this study. The request was judged as being appropriate or otherwise according to international best practice. Results: During the study period, 421 patients were referred to the EEG laboratory. Approximately 71% of them were males and 29% were females. Approximately 94% of EEG results were deemed as being normal. In terms of appropriateness of requesting EEG, only 5% of the requests were considered "appropriate" according to the guidelines. The factors associated with the appropriateness of requests included age, abnormality in EEG, and the reason given for the request. Conclusions: The majority of EEG referrals were not being made per guidelines. More studies are needed to uncover and examine the factors contributing to the overprescription of EEG among physicians in Oman. Educating the physicians on the judicious use of EEG is therefore warranted.
Introduction: National strategy for an inclusive and community-based living (NSCIL) for persons with mental health issues 2019 report informs us that the length of stay (LOS) of 36% of inpatients in ...43 state-funded tertiary care psychiatric hospitals (TCPHs) is above one year. This is concerning and its public health implications are not studied.
Objectives: This study was carried out to estimate the average duration of hospitalization by persons with prolonged hospitalization (PPH) in TCPH and to estimate the number of additional inpatient admissions that could have been offered.
Methodology: We analyzed the data in NSICL for calculating cumulative hospitalization years and the mean duration of stay by all PPH under each state. Based on the presumption that each psychiatric bed could cater to at least four admissions, a prediction is made on the number of additional inpatient admissions that could have been offered.
Results: The mean duration LOS of 4869 people in these TCPHs is 9.6 years (range 1 - more than 25 years) with significant variation between the states. An additional 190,153 persons could have been offered inpatient care in these TCPHs over 25 years duration, and a minimum of 7606 additional admissions could be accommodated every year.
Conclusions: Our predictions suggest a need for research on the possibility of deferred inpatient care to others with acute mental health needs and the scope for inpatient care to as many as in need by unblocking these beds.
There is limited evidence on the reliability and validity of the 12-item World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) in an Asian patient population with mental and ...physical disorders. The current study aimed to examine the psychometric properties of the WHODAS 2.0 among patients with schizophrenia, depression, anxiety, and diabetes. A total of 1076 patients (M = 40.9 years, SD = 14.7) were recruited from the outpatient clinics of a tertiary psychiatric hospital and a primary care clinic. Internal consistency and test-retest reliability, structural validity, convergent validity, agreement, and floor and ceiling effects were examined. Our confirmatory factor analysis (CFA) showed that the 1-factor model fits our data. Multigroup CFA demonstrated metric and scalar invariance, indicating the scores can be compared across the four conditions. The WHODAS 2.0 scale had excellent reliability in the overall sample and good to excellent reliability across conditions. The test-retest reliability and agreement between self-administered and interviewer-administered modes were good. The WHODAS 2.0 scores had moderate to strong correlations with the Social and Occupational Functioning Scale and the Sheehan Disability Scale scores in the overall sample and across four conditions.
They say that the road to hell is paved with good intentions, and our failed implementation of deinstitutionalization in the 1970s is a prime example of the point. In this symposium contribution--a ...response to Jeffrey Bellin's book Mass Incarceration Nation--I offer a historical account of deinstitutionalization of state mental hospitals, tracing how severely mentally ill patients were discharged from state hospitals and eventually made their way back to secure beds, but in our nation's jails and prisons instead. Mental health and mass incarceration are not separate crises, I argue, but rather interconnected problems with an interconnected past that require an interconnected solution. The lessons of deinstitutionalization's failures can inform how our decarceration story plays out, offering an opportunity to avoid the mistakes of our past and move toward a more just, humane, and equitable future--a future that takes the "mass" out of mass incarceration.
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