Elevated Rates of Restraint and Seclusion in Child and Adolescent Psychiatric Inpatients in China and Their Associated Factors

Child Psychiatry & Human Development - To investigate the rate of restraint and seclusion (R&S) use in child and adolescent psychiatric inpatients in China and to examine factors...     

Psychiatric Comorbidity in Subgroups of Eating-Disordered Inpatients

A variety of comorbid psychiatric conditions complicate eating disorders. Typically, emphasis has been on “dual diagnoses,” yet the impression of many clinicians is that such a focus is too narrow and that patients with eating disorders (EDs) often have multiple psychiatric diagnoses. To examine this possibility and to determine differences in the codiagnoses found within different ED subtypes, the Schedule for Affective Disorders and Schizophrenia, Lifetime version (SADS-L) was administered to 20 consecutive inpatients admitted to an eating disorder unit. The mean number of psychiatric codiagnoses was 3.15. The subgroup of food-restricting nonbulimic anorectics had significantly fewer codiagnoses than the group of anorectics with bulimic behavior (2.3 vs. 3.8); the only patients with no comorbid diagnoses were in the former subgroup. The group of normal weight bulimics had an intermediate number of codiagnoses (3.2). The proportion of patients meeting criteria for any affective disorder was high (85%). AU patients who had bipolar disorders also had bulimic symptoms. These results suggest that successful treatment of patients with ED wiU be enhanced by 1) thorough assessment for complicating comorbid conditions from Axes I and I I; 2) coordinated treatment of the ED in conjunction with the comorbid disorders; and 3) pragmatic recognition that EDs serious enough for inpatient treatment usually occur with a variety of other psychiatric conditions. Prognosis may ultimately depend more on comorbid complications than on the ED itself.     

高收缩压水平脑分水岭梗死急性期升压治疗对预后影响的前瞻性研究

目的 探讨升压治疗对收缩压（systolic blood pressure,SBP）在140～160 mmHg的急性脑分水岭梗死 患者预后的影响。 方法 本研究为前瞻性研究,连续选择2011年l月至2014年11月同济大学附属同济医院神经内科首次 发病48 h内SBP在140～160 mmHg的急性脑分水岭梗死患者64例,分为升压治疗组29例和常规治疗组 35例,升压治疗组除阿司匹林、阿托伐他汀等常规治疗外加用多巴胺升压治疗,使SBP较入院时血压 上升约20 mmHg,维持3天。于入院时和2周采用美国国立卫生研究院卒中量表（National Institute of Health Stroke Scale,NIHSS）评分、发病后6个月采用改良Rankin量表（modified Rankin Scale,mRS）评分 对患者神经功能缺损评价,NIHSS减少46%以上视为升压治疗显效;mRS≤2分为预后良好。 结果 两组患者入院时年龄、性别、发病时间和NIHSS评分等基线资料差异无显著性,入院2周时升 压治疗组显效率为27.6%,与常规治疗组的28.6%比较差异无显著性（P =0.930）。发病6个月升压治疗 组预后良好率为65.5%,高于常规治疗组的48.6%,但差异无显著性（P =0.174）。 结论 升压治疗对SBP在140～160 mmHg的急性脑分水岭梗死患者无明显疗效。     

Cigarette Smoking Among Adolescent Psychiatric Inpatients: Prevalence and Correlates

The aim of this study was to ascertain the rate of smoking among adolescent (13–17 years old) psychiatric inpatients and to examine factors related to smoking status in this population. The medical records of all adolescents admitted to a private psychiatric hospital during a 1-year period were reviewed. The rate of current smoking was 59.8%. Of the adolescents who reported smoking, 40% smoked at least 140 cigarettes per week, and 44.7% smoked 7 days a week. Smokers were more likely to be Caucasian, fall within the 13-year age group, and meet criteria for substance abuse/dependence. Adolescents who used no alcohol or illicit substances were least likely to report current smoking, followed by those who used alcohol only, followed by those who used illicit substances. Results of the current study suggest the need for both thorough assessment of smoking and specialized smoking interventions in this population, who are likely to mature into heavily dependent, recalcitrant adult smokers in the absence of intervention.     

Problems of Subject Inclusion in Psychiatric Research: Observations from Research with Psychiatric Inpatients

Abstract: In a recent study of psychiatric disturbance and decision making behaviour¹², it was observed that a significant number of psychiatric inpatients experienced difficulties in addressing themselves to the experimental tasks at hand. Despite the large number of studies that have used psychiatric inpatients as subjects, little, if any mention has been made of these difficulties. The following report describes the difficulties that have been observed in the above research project, and examines their possible implications for clinical assessment, research, and for clinical investigations and evaluation of treatment regimes (e.g. effectiveness of particular drug therapies), which use psychiatric inpatient populations as subject sources.     

Sexual Behavior of Psychiatric Inpatients: Hospital Responses and Policy Formulation

Historically, inpatient sexuality has been aneglected issue in hospital policy. Recent studies haveconfirmed sexual activity among individuals with mentalillness and have noted several areas of concern surrounding patient care and sexuality. Wesurveyed private mental health facilities within thestate of Ohio. Twenty-five percent of the respondinghospitals had a formal sexual policy and the majority (72%) said that sexual behavior was aninfrequent problem. Considering the short-term stayscommon at these facilities, policies at suchinstitutions should focus on dealing with situationswhen they occur and properly training and informing staff onissues surrounding sexual activity in psychiatricinpatients.     

Nonviolent Psychiatric Inpatients and Subsequent Assaults on Community Patients and Staff

Health care staff on psychiatric inpatient units are at high risk for work-related assaults by patients. Recent studies have begun to document similar patient assaults toward staff in community-based residences. Earlier community studies did not control for the level of patient assault prior to community discharge, and it remains unknown whether the community residence assaults were a function of community placement or a reflection of ongoing control issues by the recently discharged patients. This preliminary inquiry retrospectively tracked the nature and frequency of assaults by patients newly discharged to community residences from a state hospital setting where there had been no assaults by these patients for a two-and-one half-year period. While base rates remain to be determined, the findings in this study suggest the assaultive patients to be younger males with diagnoses of schizophrenia and histories of violence toward others, substance abuse, and violence toward self. Nine patients committed the majority of the assaults. There was a significant decline in the frequency of assaults nine months post-discharge. The implications are discussed.     

Clinical Characteristics of Older Psychiatric Inpatients with Borderline Personality Disorder

This case study investigation considers typical and potentially unique characteristics of older (> 50 years) Borderline Personality Disorder (BPD) patients and describes their impact on an inpatient psychiatric unit encompassing a therapeutic milieu setting and multidisciplinary treatment teams. The somatization of symptoms, in particular, and the associated therapeutic, medical, and psychopharmacological interventions, result in prolonged and elaborate treatments that undermine clinical and personal boundaries, clash with managed care directives, and engender frustrating and elusive transferential and countertransferential reactions. Moreover, the guilt-inducing nature of somatization and physical frailty in older individuals, combined with the well-documented ability of BPD patients, regardless of age, to incite stormy and split relationships, are linked characteristics that may describe a diagnostic subtype of BPD. Rather than suggesting a diminution of psychopathology as BPD patients age, the results of this investigation indicate that their persistent difficulties may only be altering in content and in pathological adaptation to changing needs.     

Psychiatric Comorbidity and Medical Illness

A substantial amount of evidence is available that indicates comorbid psychiatric disorders are frequently unrecognized and untreated in medical illness. Furthermore, often times medical illnesses are not examined as possible contributors to the psychiatric condition. Anxiety, depression, and psychosis are all common psychiatric manifestations witnessed as comorbid states in primary health care. It is vital to the overall outcome and well-being of patients that comorbid states be identified and treated to improve quality of life, increase rates of compliance, improve psychosocial functioning, and decrease the total costs of treating the disease state. The following article emphasizes the importance of recognizing psychiatric comorbidity with medical illness and how these comorbid states are often overlooked. A number of disease states are reviewed that have been studied and shown to have improved outcomes and decreased mortality rates when both the psychiatric conditions and medical illness are treated.     

Psychiatric Outcome of Temporal Lobectomy for Epilepsy: Incidence and Treatment of Psychiatric Complications

Summary: Purpose: To determine the incidence of psychiatric disorders before and after surgical treatment for partial epilepsy and to document the effectiveness of their treatment.
Methods: Fifty consecutive patients treated surgically for focal epilepsy (44 temporal and six frontal) were evaluated by established neuropsychiatric methods before surgery and over a mean period of 2 years after surgery. The patients with interictal dysphoric disorders, with or without psychotic episodes, were treated with tricyclic antidepressant medication alone or combined with serotonin selective reuptake inhibitors and, if necessary, with the addition of risperidone.
Results: Before surgery, 25 (57%) of the 44 patients with temporal lobe epilepsy had dysphoric disorders. After surgery, 17 (39%) of the 44 patients experienced either de novo psychiatric complications (six psychotic episodes, six dysphoric disorders, and two depressive episodes) or exacerbation of preoperative dysphoric disorder (three patients). Eight previously intact patients of the 19 (42%) developed dysphoric disorders after surgery that were significantly related to recurrence of seizures. All psychiatric complications occurred in the first 2 months after surgery, except for the six patients intact before surgery, who had a recurrence of seizures. A significant predictor of ultimate excellent psychiatric outcome was complete absence of seizures after surgery. All postoperative psychiatric complications remitted on treatment with psychotropic medication in the compliant patients.
Conclusions: An exceptional psychiatric morbidity is associated with the months after temporal lobectomy. Possible pathogenetic mechanisms are discussed. Antidepressant drugs are very effective in treating the psychiatric disorders of chronic epilepsy; their use in conjunction with the surgical treatment of epilepsy appears to be crucial for the overall positive outcome of a significant number of patients.     

Characteristics of Assaultive Psychiatric Inpatients in an Era of Managed Care

Prior to managed care, extensive research documented the characteristics of assaultive inpatients in traditional state mental hospital settings as primarily older, male, psychotic patients with histories of violence toward others and of substance abuse. Recent early studies in rural and urban hospital settings have suggested that the characteristics of assaultive patients may be changing to include younger, more frequently female, patients with personality disorders and histories of personal victimization. This two-points-in-time study sought to assess the nature of assaultive patients in a suburban traditional state mental hospital after the implementation of managed care initiatives, and compared to the nature of the assaultive patients before and after the downsizing of this state mental health facility. Before census reduction, the assaultive patients were of the traditional type. After census reduction, the assaultive patients reflected more recent trends. The implications of the findings are discussed, and strategies for fostering facility safety in light of the newer violent patient are outlined.     

Impaired Self-Regulation and Suicidal Behavior Among Adolescent and Young Adult Psychiatric Inpatients

The aim of this study was to examine the correlates of suicidal behavior among 64 adolescents (ages 13-17 years) and 62 young adults (ages 18-35 years) within a psychiatric inpatient setting. We investigated the influence of impairment in general self-regulation, including specific behavioral dysregulation, on suicidal behavior within these two groups. Results suggested that suicidal adolescents and young adults experienced similar degrees of overall disruption in self-regulation. However, compared to their young adult counterparts, suicidal adolescents were characterized by more self-injurious and self-mutilative behaviors, as well as greater outward expression of anger. Results indicated that adolescent attempters were particularly prone to self-harm behavior. These findings suggest that specific psychopathology associated with suicidal behavior may differ across these developmental stages.     

Mood and Anxiety Symptoms in Psychiatric Inpatients with Autism Spectrum Disorder and Depression

Recent reports suggest that individuals with autism spectrum disorders (ASD) may experience depression at a high frequency, yet few published studies address this issue, especially among adults. In the current investigation, we reviewed features of depression and comorbid traits among depressed inpatients with intellectual disabilities (ID) as a function of ASD. A retrospective chart review was performed for 53 inpatients meeting criteria for depression (13 individuals with ASD and ID and 40 matched individuals with ID but without ASD), all of whom had received a diagnosis of depression at the time of discharge from a specialty psychiatric unit for adults with ID. The depression diagnoses were based on a comprehensive clinical assessment; specific mood and anxiety symptoms were reported by informants at the time of intake using the Mood and Anxiety Semi-Structured (MASS) Interview for Patients with Intellectual Disabilities (Charlot, Deutsch, Hunt, Fletcher, & McIlvane, 2007 Charlot, L., Deutsch, C., Hunt, A., Fletcher, K. and McIlvane, W. 2007. Validation of the Mood and Anxiety Semi-Structured (MASS) Interview for Patients with Intellectual Disabilities. Journal of Intellectual Disabilities Research, 51: 821–834. [Crossref], [PubMed], [Web of Science ®] , [Google Scholar]). Overall, few qualitative differences were detected between the 2 groups. Both depressed inpatient groups had high rates of comorbid anxiety disorders as well as externalizing behaviors. Inpatients with ASD had a total of 2 more symptoms (out of 29 possible symptom items) than their depressed peers without an ASD diagnosis (mean scores of 12.23 and 9.85, respectively). Anxiety disorders were reported in 62% of individuals with ASD and 38% of those without ASD. Antipsychotic medication was prevalent among the patients with ASD and depression. Over 80% of the inpatients with ASD and depression, compared with 49% of the non-ASD group, were treated with these medications.     

Reliability and Validity of the Overt Agitation Severity Scale in Adult Psychiatric Inpatients

An instrument, that validly and reliably identifies and measures agitation is required to evaluate environmental modifications, interpersonal strategies, psychopharmacological interventions, directed toward managing these commonly occurring and highly-disabling emotions and behavior. The conceptualization of agitation on a continuum from anxiety to aggression provides a practical framework for guiding clinical practice toward the early identification and intervention of agitation. The results of this study established the reliability and validity of the Overt Agitation Severity Scale (OASS) in measuring agitation severity in young adult psychiatric inpatients based on objectifiable vocalizations and motoric upper and lower body behaviors. The OASS differs from other agitation scales in its ability to capture both the intensity and frequency of observable behavioral manifestations of agitation, as opposed to subjective interpretations and a diffuse range of symptoms and problem behaviors.     

The GAF and Psychiatric Outcome: A Descriptive Report

Since the Global Assessment of Functioning Scale (GAF) was introduced in DSM-III-R in 1987, it has been widely used, but minimally researched. This report provides information concerning the use of the GAF in routine clinical practice. Clinicians rated adult inpatients, adult day hospital patients, and adolescent inpatients at admission and discharge from psychiatric treatment. All samples were rated as significantly less dysfunctional at discharge. There were also significant differences in mean levels of dysfunction between the adult and adolescent samples at admission and discharge. These discrepancies were hypothesized to be associated with the GAF's unclear instructional format. Although this study concerned the GAF as described in the DSM-III-R, our findings are likely to be generalizable to DSM-IV, because no substantive changes have been made to the GAF.