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1
Mattsson, Monica, and Bengt Mattsson. "Physiotherapeutic Treatment in Out-Patient Psychiatric Care." Scandinavian Journal of Caring Sciences 8, no. 2 (June 1994): 119–26. http://dx.doi.org/10.1111/j.1471-6712.1994.tb00241.x.
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Moutoussis, Michael, Fiona Gilmour, Dave Barker, and Martin Orrell. "Quality of care in a psychiatric out-patient department." Journal of Mental Health 9, no. 4 (August 1, 2000): 409–20. http://dx.doi.org/10.1080/713680257.
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Moutoussis, Fiona Gilmour, Dave Bar, Michael. "Quality of care in a psychiatric out-patient department." Journal of Mental Health 9, no. 4 (January 2000): 409–20. http://dx.doi.org/10.1080/jmh.9.4.409.420.
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Moreno, A. Chinchilla, L. Mateo Mateos, M. Martín Larrégola, and A. Diez Saez. "Socio-Demographic Profile of Out-Patient Clinic First Assessment." European Psychiatry 24, S1 (January 2009): 1. http://dx.doi.org/10.1016/s0924-9338(09)71176-9.
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Introduction:Ramon y Cajal Hospital is the referencial center for the mental health unit used in this study, whose outpatients are attended by psychiatrist consultants. First assessment is conducted by general practicioners, or other specialists. Once assessed, a decision must be made: to follow-up, carry out psychological therapies, refer to social workers or other resources.Objectives:To investigate socio-demographic and clinical profiles at the psychiatric outpatients unit as a result of an analysis of the first assessment data.Methods:We include 9 variables from 104 first assessments carried out in our center.Results:48,27 is the age range of our sample, with 58,65% female and 50,1 % married. Most referrals are requested by primary care, being only 14,42% by psychiatric ward units and other medical specialities. Anxiety is the primary reason for requiring psychiatric care (36, 54%) and affective disorders (35,58%), followed by psychosomatic events. With respect to diagnosis at first consultation, we found, as expected, that the most frequent disorders are anxiety (37,50 %) and depression (32,69%).71,15% of our patients needed a follow up by us and 8,65 % are discharged after the first assessment. The rest are reffered to other mental health resources.Conclusions:As a result of the analysis we found out that minor pathology is the most common reason for care in our centre, being refered mostly by general practicioners. So psycho educational programmes and continuous training in general medicine could be needed in order to improve mental health and to reduce costs of the mental health system.
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Killaspy, Helen. "Psychiatric out-patient services: origins and future." Advances in Psychiatric Treatment 12, no. 5 (September 2006): 309–19. http://dx.doi.org/10.1192/apt.12.5.309.
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Psychiatric out-patient services originated in the early-20th century to enable triage of new referrals to the asylum in order to differentiate between treatable and untreatable cases. They evolved to provide community follow-up of patients discharged from hospital and assessment of those newly referred to psychiatric services. Non-attendance at out-patient appointments represents an enormous waste of clinical and administrative resources and has potentially serious clinical implications for those who are most psychiatrically unwell. The place of out-patient clinics in modern community mental health services is explored with reference to the reasons for, and clinical and cost implications of, missed appointments. An alternative model is described that incorporates recent UK government guidance on the roles and implementation of community mental health teams, liaison with primary care and new roles for consultant psychiatrists.
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Hautala-Jylhä, Pirjo-Liisa. "Patient and Personnel Conceptions of the Patient-Nurse Relationship in Psychiatric Post-Ward Out-Patient Services." International Journal of Human Caring 11, no. 4 (June 2007): 24–32. http://dx.doi.org/10.20467/1091-5710.11.4.24.
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The aim of this study was to analyze and describe the conceptions of patients and personnel concerning the patient-nurse relationship in psychiatric post-ward out-patient services. Aphenomenographic approach was used. The four main categories were patient’s appearance, behavior, and nonverbal expression; empowering of the patient; characteristics of patient-nurse relationship; and setting and maintaining limits. Especially in psychiatric nursing, the significance of the patient-nurse relationship needs to be emphasized. In a successful and collaborative patient-nurse relationship, the patient learns to care for him/herself and to restore interest in taking care of him/herself and surviving in everyday life.
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Sheikh, A. Jawad, and Christopher Meakin. "Consumer satisfaction with a psychiatric out-patient clinic." Psychiatric Bulletin 14, no. 5 (May 1990): 271–74. http://dx.doi.org/10.1192/pb.14.5.271.
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NHS out-patient clinics remain a major point of contact between psychiatrists and their patients. There are several advantages to this setting for consultation: it is time efficient, there is usually easy access to case records and contact with other disciplines and services is often available. With the current trend towards community care, increasing use of out-patient facilities is likely as home visiting becomes impractical and, moreover, may be undesirable for some patients.
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Johansson, Håkan, and Mona Eklund. "Helping alliance and early dropout from psychiatric out-patient care." Social Psychiatry and Psychiatric Epidemiology 41, no. 2 (January 1, 2006): 140–47. http://dx.doi.org/10.1007/s00127-005-0009-z.
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Goss, Claudia, Francesca Moretti, Maria Angela Mazzi, Lidia Del Piccolo, Michela Rimondini, and Christa Zimmermann. "Involving patients in decisions during psychiatric consultations." British Journal of Psychiatry 193, no. 5 (November 2008): 416–21. http://dx.doi.org/10.1192/bjp.bp.107.048728.
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BackgroundPatient involvement in the decision-making process is a key element for good clinical practice. Few data are available on patient involvement in psychiatry.AimsTo assess in a psychiatric out-patient context how psychiatrists involve patients in therapeutic decisions and to determine the extent to which patient and psychiatrist characteristics contribute to patient involvement.MethodEighty transcripts from audiotaped first out-patient consultations, conducted by 16 psychiatrists, were rated with the OPTION (observing patient involvement) scale. Interrater reliability indices were obtained for 30 randomly selected interviews. Associations between OPTION scores and some clinical and socio-demographic variables were tested usingt-test, ANOVA and Pearson's correlation coefficient where appropriate. The distribution of scores for each psychiatrist was assessed by intracluster correlation coefficients.ResultsInterrater reliability and internal consistency of the OPTION scale in the psychiatric setting were satisfactory. The total score and the ratings for the single OPTION items showed a skewed distribution, with a prevalence of scores in the low range of abilities, corresponding to minimal attempts to involve patients or a minimal skill level.ConclusionsThe OPTION scale proves to be a reliable instrument to assess patient involvement in a psychiatric setting. Psychiatrists showed poor patient involvement abilities parallel to previous findings in psychiatry and primary care. They need to be encouraged to share treatment decisions with their patients and to apply patient involvement skills. Further research is needed to establish which patient variables and clinical settings in psychiatry are more amenable to shared decisions, and how participation of psychiatric patients in treatment decisions will affect the outcome.
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Kessing, Lars Vedel, Hanne Vibe Hansen, Anne Hvenegaard, Ellen Margrethe Christensen, Henrik Dam, Christian Gluud, and Jørn Wetterslev. "Treatment in a specialised out-patient mood disorder clinicv.standard out-patient treatment in the early course of bipolar disorder: randomised clinical trial." British Journal of Psychiatry 202, no. 3 (March 2013): 212–19. http://dx.doi.org/10.1192/bjp.bp.112.113548.
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BackgroundLittle is known about whether treatment in a specialised out-patient mood disorder clinic improves long-term prognosis for patients discharged from initial psychiatric hospital admissions for bipolar disorder.AimsTo assess the effect of treatment in a specialised out-patient mood disorder clinicv.standard decentralised psychiatric treatment among patients discharged from one of their first three psychiatric hospital admissions for bipolar disorder.MethodPatients discharged from their first, second or third hospital admission with a single manic episode or bipolar disorder were randomised to treatment in a specialised out-patient mood disorder clinic or standard care (ClinicalTrials.gov: NCT00253071). The primary outcome measure was readmission to hospital, which was obtained from the Danish Psychiatric Central Register.ResultsA total of 158 patients with mania/bipolar disorder were included. The rate of readmission to hospital was significantly decreased for patients treated in the mood disorder clinic compared with standard treatment (unadjusted hazard ratio 0.60, 95% CI 0.37–0.97,P=0.034). Patients treated in the mood disorder clinic more often used a mood stabiliser or an antipsychotic and satisfaction with treatment was more prevalent than among patients who received standard care.ConclusionsTreatment in a specialised mood disorder clinic early in the course of bipolar disorder substantially reduces readmission to a psychiatric hospital and increases satisfaction with care.
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Benmebarek, Zoubir. "Psychiatric services in Algeria." BJPsych. International 14, no. 1 (February 2017): 10–12. http://dx.doi.org/10.1192/s2056474000001598.
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The paper describes the current provision of psychiatric services in Algeria – in particular, in-patient and out-patient facilities, child psychiatry and human resources. Education, training, associations and research in the field of mental health are also briefly presented. The challenges that must dealt with to improve psychiatric care and to comply with international standards are listed, by way of conclusion.
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Burns, Tom, E. S. Paykel, A. Ezekiel, and S. Lemon. "Care of Chronic Neurotic Out-patients by Community Psychiatric Nurses." British Journal of Psychiatry 158, no. 5 (May 1991): 685–90. http://dx.doi.org/10.1192/bjp.158.5.685.
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Ninety-nine neurotic patients from a controlled trial of CPN v. psychiatric out-patient aftercare were followed up seven years later. Of the 92 survivors, 76 were successfully interviewed. Few differences were found between the groups. Chronic mild symptoms and moderate social disability persisted, and tended to worsen a little. Treatment patterns persisted for one to two years beyond the original study; the CPN group had more CPN contacts, fewer psychiatric out-patient contacts and less psychiatric care. Thereafter, more out-patients were discharged from psychiatric care and care patterns for the two groups became similar. Out-patients attended more non-psychiatric out-patient clinics than the CPN group, but it is possible that this reflected pre-existing differences. About a third of patients remained in contact with the psychiatric service during follow-up.
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Awara, Mahmoud, and Christopher Fasey. "Patients' satisfaction and quality of care in psychiatric out-patient settings." Journal of Mental Health 17, no. 3 (January 2008): 327–35. http://dx.doi.org/10.1080/09638230701879219.
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Shakya, Dhana Ratna. "Psychiatric Morbidity Profiles of Child and Adolescent Psychiatry Out-Patients in a Tertiary-Care Hospital." Journal of Nepal Paediatric Society 30, no. 2 (July 13, 2010): 79–84. http://dx.doi.org/10.3126/jnps.v30i2.2604.
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Background: Psychiatric morbidity is ubiquitous, affecting children, adolescents and adults. Age factorsplay a great role in pattern of morbidity profile. Psychiatric morbidity profile of children and adolescentsmay indicate different needs and priorities. Objective: This study aims to sort out referral pattern, attitudeabout psychiatric referral and morbidity profile among child and adolescent psychiatric out-patients in atertiary-care general hospital. Methodology: A total of 100 consecutive child and adolescent patientsin psychiatry OPD coming into contact with investigator psychiatrist were enrolled during the studyperiod. Diagnoses were made according to the ICD-10. Results: Fifty three of the subjects were female,majority of the cases (79) were of age between 13-18 years. Main ethnicity-caste groups seeking carewere Mongol, Brahmin, Chhetri and indigenous Terai tribes. People from semi-urban and urban settingspredominated in this study. Great majority (more than 80%) had reached this service in the 4th or in morethan the 4th step of their help seeking. Most of the subjects were comfortable and happy about psychiatricreferral. More than half had presented mainly with physical and somatic complaints. Major psychiatricdiagnoses encountered were mood (affective), anxiety, seizure, dissociative conversion disorders andmental retardation. Four percent of subjects had suicidal behaviours and 17% migraine headache.Conclusion: Common psychiatric diagnoses among these child and adolescent out-patients are mood,anxiety, seizure, dissociative conversion disorders and mental retardation.Key words: Attitude to psychiatric consultation; child and adolescent; out-patient; psychiatric morbidityDOI: 10.3126/jnps.v30i2.2604J. Nepal Paediatr. Soc. May-August, 2010 Vol 30(2) 79-84
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Tyrer, P., M. Remington, and J. Alexander. "The Outcome of Neurotic Disorders After Out-patient and Day Hospital Care." British Journal of Psychiatry 151, no. 1 (July 1987): 57–62. http://dx.doi.org/10.1192/bjp.151.1.57.
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New psychiatric out-patients with depressive, phobic, and anxiety neurosis were randomly allocated to out-patient care or to one of two types of day hospital treatment one specialising in psychotherapy and the other offering all forms of day care. Of 106 patients who entered the study, 78 had assessments of psychiatric symptomatology and social adjustment both before treatment and after 4, 8 and 24 months. There was no significant difference in outcome between depressive, phobic, and anxiety neurosis, and no overall difference in response to treatment between the three types of care. Suicidal symptoms were significantly less common in out-patients. In many respects, neurotic disorder can be regarded as a single syndrome.
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Wikman, Anna, Rickard Ljung, Asif Johar, Ylva Hellstadius, Jesper Lagergren, and Pernilla Lagergren. "Psychiatric Morbidity and Survival After Surgery for Esophageal Cancer: A Population-Based Cohort Study." Journal of Clinical Oncology 33, no. 5 (February 10, 2015): 448–54. http://dx.doi.org/10.1200/jco.2014.57.1893.
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Purpose To determine the cumulative incidence of and risk factors for psychiatric morbidity and establish the impact on survival among surgically treated patients with esophageal cancer. Patients and Methods A nationwide Swedish cohort of 1,615 patients who underwent surgery for esophageal cancer between 1987 and 2010 with follow-up until 2012 was linked to national health registries for information on psychiatric morbidity (inferred from mental health care use). Multivariable logistic regressions were used to determine potential risk factors for postoperative psychiatric morbidity. A multivariable-adjusted Cox proportional hazard model was used to analyze overall survival. Results In patients without a history of psychiatric morbidity, the 2-year cumulative incidence for treatment in psychiatric in-patient care was 2.5%, for psychiatric out-patient care was 4.2%, and for treatment with psychotropic drugs was 32.3%. Married patients were less likely to be treated postoperatively in psychiatric in-patient care (odds ratio [OR], 0.42; 95% CI, 0.22 to 0.80) or out-patient care (OR, 0.41; 95% CI, 0.17 to 1.02), whereas patients with higher tumor stage were more likely to be treated in psychiatric out-patient care (OR, 4.99; 95% CI, 1.16 to 21.38) or with psychotropic drugs (OR, 2.78; 95% CI, 1.10 to 7.01). Bearing in mind possible residual confounding, new-onset psychiatric morbidity was associated with mortality (hazard ratio [HR], 1.65 [95% CI, 1.17 to 2.33] for treatment in psychiatric in-patient care; HR, 1.93 [95% CI, 1.18 to 3.16] for treatment in psychiatric out-patient care; and HR, 2.77 [95% CI, 1.72 to 4.44] for treatment with psychotropic drugs). Conclusion These results highlight the importance of recognizing and addressing psychiatric morbidity in surgically treated patients with esophageal cancer.
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Mitchell, A. R. K. "Participating in primary care." Psychiatric Bulletin 13, no. 3 (March 1989): 135–37. http://dx.doi.org/10.1192/pb.13.3.135.
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Traditionally, general practitioners and psychiatrists relate to one another through a system of cross referrals, from primary care to secondary care and back again, the referral being initiated by the GP through a request for a domiciliary visit or more usually for an out-patient assessment of the clinical problem. However, in the mid-1960s, individual psychiatrists began to report a new way of working, which consisted of the psychiatrist going by invitation into GPs' surgeries or health centres to work directly with the general practitioners and with other members of the primary health care team. A survey undertaken by Strathdee & Williams of the General Practice Research Unit of the Institute of Psychiatry, showed that by 1984 in England and Wales, one psychiatric consultant in five, sometimes with, sometimes without, junior staff, spent some time in a general practice setting. At the College meeting in Cambridge (April 1988), Pullen reported that in Scotland a similar survey showed that as many as 40 to 50% of psychiatric consultants spent some time in primary care settings.
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Hambridge, J. A. "Referrals to an out-patient forensic psychology service." Psychiatric Bulletin 16, no. 4 (April 1992): 222–23. http://dx.doi.org/10.1192/pb.16.4.222.
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Following the recommendations of the Butler Report (Home Office, 1975), there has been a slow growth in the number of Regional Secure Units (RSUs) (Snowden, 1985), which aim to assess and treat mentally disordered offenders in England and Wales in conditions of “medium security”. One particular recommendation of the Butler Report was that:“The main emphasis in forensic psychiatric services … should be on community care and out-patient work.” (paragraph 20.14)
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Gasilovskaya, T. A. "QUALITY OF SPECIALIZED OUT-PATIENT HEALTH CARE TO CHILDREN WITH PSYCHIATRIC PROBLEMS." Current pediatrics 11, no. 3 (May 17, 2012): 84. http://dx.doi.org/10.15690/vsp.v11i3.305.
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Veerbeek, Marjolein A., Richard C. Oude Voshaar, and Anne Margriet Pot. "Effectiveness and predictors of outcome in routine out-patient mental health care for older adults." International Psychogeriatrics 26, no. 9 (April 23, 2014): 1565–74. http://dx.doi.org/10.1017/s1041610214000647.
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ABSTRACTBackground:Meta-analyses show efficacy of several psychological and pharmacological interventions for late-life psychiatric disorders, but generalization of effects to routine mental health care for older people remains unknown. Aim of this study is to investigate the improvement of functioning within one year of referral to an outpatient mental health clinic for older adults.Methods:Pre-post measurement of the Health of Nations Outcome Scale 65+ (HoNOS 65+) in 704 older people referred for psychiatric problems (no dementia) to any of the seven participating mental health care organizations.Results:The pre-post-test Cohen's d effect size was 1.08 in the total group and 1.23 in depressed patients, the largest subgroup. Linear regression identified better functioning at baseline, comorbid personality disorder, somatic comorbidity and life events during treatment as determinants of a worse outcome.Conclusions:Functioning of older persons with psychiatric problems largely improves after treatment in routine mental health care.
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Dick, Peter H., M. Leonie Sweeney, and Iain K. Crombie. "Controlled Comparison of Day-patient and Out-patient Treatment for Persistent Anxiety and Depression." British Journal of Psychiatry 158, no. 1 (January 1991): 24–27. http://dx.doi.org/10.1192/bjp.158.1.24.
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The effectiveness of day care versus out-patient care in the treatment of persistent severe anxiety and depression was compared in a controlled clinical trial. Of 96 consecutively referred patients meeting the entry criteria, 92 were followed up for six months. Patients were randomised to day care or out-patient care, and assessed at entry and at six months using the Standardised Psychiatric Interview and in terms of their time structuring and socialisation. Marked improvement in all three measures was seen for most of the day patients, but for few of the out-patients: this difference was highly significant for each measure. Day patients also rated themselves as coping more effectively and as more satisfied with their treatment. These differences could not be explained by differences in use of medication. Day treatment should remain an option for patients with persistent anxiety and depression resistant to outpatient treatment.
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Smyth, Marcellino, Panos Vostanis, and Christine Dean. "Psychiatric out-patient non-attenders: a cause for relief or concern?" Psychiatric Bulletin 14, no. 3 (March 1990): 147–49. http://dx.doi.org/10.1192/pb.14.3.147.
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In daily clinical practice, out-patient non-attendances are, unfortunately, regular occurrences. With the current trend towards community based care, out-patient facilities have become increasingly important, and the failure of patients to attend is both disruptive and worrying for professionals in this area. It is difficult to predict which of the non-attenders will progress to join the ranks of those “lost to follow-up”. This study was conceived in an attempt to clarify this question, in the setting of adult general psychiatric out-patient services.
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Algin, Sultana, Sumaiya Nawsheen Ahmed, and Redwana Hossain. "Pattern of Psychiatric Referral in a Tertiary Care Hospital in Bangladesh." Bangladesh Journal of Medicine 31, no. 2 (August 8, 2020): 76–80. http://dx.doi.org/10.3329/bjm.v31i2.48536.
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Introduction: Consultation-liaison Psychiatry (CLP) is the study, practice and teaching of the relationbetween medical and psychiatric disorders.
Aim of the study: The aim of this study is to find out the referring department, reason for consultation,common psychiatric comorbidities and sociodemographic of the referred patients to psychiatrydepartment from the other departments of Bangabandhu Sheikh Mujib Medical University of Dhaka.
Methodology: This cross-sectional study was carried out from May 2018 to February 2020. Patientsreferred from different inpatient departments every Thursday were taken as study population.Psychiatric diagnoses of the patients were assigned by the consultant psychiatrist as per DSM-5criteria. Semi structured questionnaire was used to collect socio-demographic data.
Results: Among the referred patients (n= 89) 56% were female; 63% were aged between 19-59years; 65% were married; 58% were from urban background and 51% studied up to higher secondary.More than half of the patients were referred from different branches of Medicine (68%). Referral fromInternal Medicine was 14.6%, Rheumatology 13.5%, Neurology and Nephrology 10% respectively.The rest were from the branches of pediatrics, surgery and gynecology. Most common psychiatricdisorder was Major Depressive Disorder (37%) followed by Obsessive-Compulsive Disorder (17%)and Delirium (10.11%). 15% patient received no psychiatric diagnosis.
Conclusion: Psychiatric comorbidities in general medical illness are very common. CLP provides anopportunity to improve health outcomes for inpatients and reduce burden on the healthcare system.
Bangladesh J Medicine July 2020; 31(2) :76-80
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Brown, R. M. A., G. Strathdee, J. R. W. Christie-Brown, and P. H. Robinson. "A Comparison of Referrals to Primary-Care and Hospital Out-patient Clinics." British Journal of Psychiatry 153, no. 2 (August 1988): 168–73. http://dx.doi.org/10.1192/bjp.153.2.168.
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All referrals from two general practices to psychiatrists in hospital and primary-care out-patient clinics were examined. Women in all diagnostic groups were preferentially referred to the primary-care clinics, which provided especially for psychotic and chronic illnesses, and at which attendance rates on first and subsequent appointments were substantially higher than at the hospital clinics. The hospital crisis-intervention clinic dealt particularly with acute psychosis and personality disorder. Patients referred to the traditional hospital out-patient service were those with the less common neuroses and personality disorder. These results are reviewed in the context of the criticism that psychiatric clinics in primary care serve only the “worried well”.
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Van Hemert, Albert M., Michiel W. Hengeveld, Jan H. Bolk, Harry G. M. Rooijmans, and Jan P. Vandenbroucke. "Psychiatric disorders in relation to medical illness among patients of a general medical out-patient clinic." Psychological Medicine 23, no. 1 (February 1993): 167–73. http://dx.doi.org/10.1017/s0033291700038952.
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SynopsisIn many patients clinical care in general medical settings is complicated by the presence of psychiatric disorders in addition to the presenting physical symptoms. In the present study the prevalence and type of psychiatric disorders was assessed in relation to the medical diagnostic findings in a general internal medicine out-patient clinic. The Present State Examination, a standardized psychiatric interview, was used to detect psychiatric disorders in 191 newly referred patients. Psychiatric disorders were found to be particularly prevalent among patients with medically ill-explained or unexplained symptoms. The prevalence of psychiatric disorders was 15% for patients with a medical explanation for their presenting symptom, 45% for patients with ill-explained and 38% for those with unexplained symptoms. Approximately 40% of the patients with psychiatric disorders met DSM-III-R criteria for somatization disorder or hypochondriasis, suggesting that these disorders contributed in particular to general medical out-patient referrals.
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Gelas-Ample, B., L. Fau, A. Bailly, and F. Pillot-meunier. "Psychiatry and Primary Care: A Global Medical Care." European Psychiatry 41, S1 (April 2017): S234. http://dx.doi.org/10.1016/j.eurpsy.2017.01.2247.
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Patients suffering from psychiatric disorders have a decrease in life expectancy of 15 years compared to the general population. This excess mortality is not related predominantly to suicide but mostly to a higher frequency of somatic diseases, such as cardiovascular, neoplastic, metabolic diseases. Their high prevalence and their low diagnoses are related to a poorer access to screening, prevention and somatic care than in the general population. Indeed, we estimated that more than 60% of patients treated in public psychiatry do not have a general practitioner (GP) in France. The GP has a role in the coordination, prevention and management of patient health care circuit. To allow a better access to general practitioner, a consultation and a somatic network have been created in Lyon. The purpose is to bring the user back into the primary care system, to ensure a durable monitoring, and a better prevention of avoidable diseases. Patients without GP are oriented to the consultation by their referent psychiatry team. During three consultations with a doctor and a nurse, an assessment of the patient's overall health is realized as well as a synthesis and a redirection to the city network. This reinstatement also allows a better communication between somatic and psychiatric care, to insure a more global view of the patient. A work around the re-empowerment and social rehabilitation is carried out to re-anchor the person in the city and in the care, which every citizen is entitled.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Ballard, C. G., and A. W. T. McDowell. "Psychiatric in-patient audit – the patient's perspective." Psychiatric Bulletin 14, no. 11 (November 1990): 674–75. http://dx.doi.org/10.1192/pb.14.11.674.
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Consumer attitudes are of the utmost importance in achieving adequate care of a psychiatric population and may directly influence compliance with drug treatment, attendance at out-patient appointments and willingness to accept admission to a psychiatric unit. It is therefore surprising that despite the original Griffiths Report (1987) highlighting the need for consumer input into the psychiatric audit process, little research has been undertaken in this area and knowledge into the quality of inpatient care is especially sparse.
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Hawton, Keith, Steve McKeown, Alexandra Day, Pauline Martin, Marianne O'Connor, and Jackie Yule. "Evaluation of out-patient counselling compared with general practitioner care following overdoses." Psychological Medicine 17, no. 3 (August 1987): 751–61. http://dx.doi.org/10.1017/s0033291700025988.
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SynopsisIn a randomized prospective treatment study, 80 overdose patients (not requiring intensive psychiatric intervention) received either brief out-patient counselling or were returned to the care of their general practitioners with advice on management. There was little difference in outcome between the two groups. However, two sub-groups of patients benefited more from out-patient counselling than from general practitioner care, these were: (a) women, and (b) patients with dyadic problems. Counselling following overdoses should be focused on groups of patients such as these who are most likely to benefit from it. Further work is needed to identify treatment approaches that will help other groups who take overdoses, especially men.
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Wallace, John, and Gnanie Panch. "Pain clinics, a new role for psychiatrists." Psychiatric Bulletin 25, no. 12 (December 2001): 473–74. http://dx.doi.org/10.1192/pb.25.12.473.
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Aims and MethodThe aim of this study was to find out the extent of psychiatric involvement in pain clinics and also clarify the treatment approaches taken for the significant psychiatric comorbidity reported in these clinics. A questionnaire survey was conducted, by a psychiatrist and an anaesthetist, of the 31 pain clinics in the Greater London area.ResultsPsychiatric involvement in the management of patients with chronic pain is extremely limited, despite the extensive psychiatric morbidity associated with these patients (response rate, 74%). The majority of surveyed pain clinics wish to provide a multi-disciplinary approach to these patients, utilising the skills of a psychiatrist for both assessment and management. Only a small minority of pain clinics, however, have sufficient access to a liaison psychiatry service that could provide the broad multi-disciplinary approach and the psychiatric treatment options that they believe chronic pain patients require.ImplicationsThe involvement of psychiatrists in pain clinics is very limited. Increased involvement is desired and would likely lead to an improved profile of pain clinics, a more realistic and comprehensive treatment approach and, in turn, enhanced patient care.
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Troquete, Nadine A. C., Rob H. S. van den Brink, Harry Beintema, Tamara Mulder, Titus W. D. P. van Os, Robert A. Schoevers, and Durk Wiersma. "Risk assessment and shared care planning in out-patient forensic psychiatry: cluster randomised controlled trial." British Journal of Psychiatry 202, no. 5 (May 2013): 365–71. http://dx.doi.org/10.1192/bjp.bp.112.113043.
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BackgroundForensic psychiatry aims to reduce recidivism and makes use of risk assessment tools to achieve this goal. Various studies have reported on the predictive qualities of these instruments, but it remains unclear whether their use is associated with actual prevention of recidivism in clinical care.AimsTo test whether an intervention combining risk assessment and shared care planning is associated with a reduction in violent and criminal behaviour.MethodA cluster randomised controlled trial (Netherlands Trial Register number NTR1042) was conducted in three outpatient forensic psychiatric clinics. The intervention comprised risk assessment with the Short Term Assessment of Risk and Treatability (START) and a shared care planning protocol formulated according to shared decision-making principles. The control group received usual care. The outcome consisted of the proportion of clients with violent or criminal incidents at follow-up.ResultsIn total 58 case managers and 632 of their clients were included, in the intervention group (n=310), 65% received the intervention at least once. Findings showed a general treatment effect (22% of clients with an incident at baseline v. 15% at follow-up, P<0.01) but no significant difference between the two treatment conditions (odds ratio (OR)=1.46, 95% CI 0.89-2.44, P = 0.15).ConclusionsAlthough risk assessment is common practice in forensic psychiatry, our results indicate that the primary goal of preventing recidivism was not reached through risk assessment embedded in shared decision-making.
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Petersson, Lena, and Gudbjörg Erlingsdóttir. "Open Notes in Swedish Psychiatric Care (Part 1): Survey Among Psychiatric Care Professionals." JMIR Mental Health 5, no. 1 (February 2, 2018): e11. http://dx.doi.org/10.2196/mental.9140.
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Background When the Swedish version of Open Notes, an electronic health record (EHR) service that allows patients online access, was introduced in hospitals, primary care, and specialized care in 2012, psychiatric care was exempt. This was because psychiatric notes were considered too sensitive for patient access. However, as the first region in Sweden, Region Skåne added adult psychiatry to its Open Notes service in 2015. This made it possible to carry out a unique baseline study to investigate how different health care professionals (HCPs) in adult psychiatric care in the region expect Open Notes to impact their patients and their practice. This is the first of two papers about the implementation of Open Notes in adult psychiatric care in Region Skåne. Objective The objective of this study was to describe, compare, and discuss how different HCPs in adult psychiatric care in Region Skåne expect Open Notes to impact their patients and their own practice. Methods A full population Web-based questionnaire was distributed to psychiatric care professionals in Region Skåne in late 2015. The response rate was 28.86% (871/3017). Analyses show that the respondents were representative of the staff as a whole. A statistical analysis examined the relationships between different professionals and attitudes to the Open Notes service. Results The results show that the psychiatric HCPs are generally of the opinion that the service would affect their own practice and their patients negatively. The most striking result was that more than 60% of both doctors (80/132, 60.6%) and psychologists (55/90, 61%) were concerned that they would be less candid in their documentation in the future. Conclusions Open Notes can increase the transparency between patients and psychiatric HCPs because patients are able to access their EHRs online without delay and thus, can read notes that have not yet been approved by the responsible HCP. This may be one explanation as to why HCPs are concerned that the service will affect both their own work and their patients.
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Sharma, B., A. Devkota, and SC Pant. "Profile of new Patients attending Psychiatry Out-patient Department at Lumbini Medical College-Teaching Hospital, Palpa." Journal of Psychiatrists' Association of Nepal 6, no. 2 (November 22, 2018): 42–44. http://dx.doi.org/10.3126/jpan.v6i2.21759.
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Introduction: Study on prevalence of psychiatric disorders in Palpa and nearby districts which lie in western Nepal, is not much studied till date. We therefore conducted this study aiming to see the pattern of psychiatric illness in an Outpatient Department of Lumbini Medical College which is a tertiary care centre located in Palpa district.Material And Method: : This is a retrospective study where outpatient record of all new cases attending the Psychiatry OPD from 29th Oct 2014 to 29th Dec 2014 were studied and statistical analysis were done. The number of new patients were 107.Results: Out of 107 patients, 60.74 % (65)) were females and 39.26 %( 42) were males. Patients of age group 31-40yrs showed the largest proportion (27.49%) followed by age group 41-50yrs (24.29%). Majority cases were illiterate (69.15%) followed by primary level of education (14.95%). The occupation of most of the cases were household work (35.51%) followed by farming (31.77%). Anxiety disorder (27.10%) was the most frequent diagnosis ahead of “Others” (18.69%) followed by depressive disorder (15.88%).Conclusion: Most of the new patients attending the psychiatry OPD of Lumbini Medical College were females, of 31-40 age group and most of the patients suffered from anxiety disorders. J Psychiatrists’ Association of Nepal Vol. 6, No. 2, 2017, Page: 42-44
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Crepet, Paolo. "A Transition Period in Psychiatric Care in Italy Ten Years after the Reform." British Journal of Psychiatry 156, no. 1 (January 1990): 27–36. http://dx.doi.org/10.1192/bjp.156.1.27.
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Ten years after the passing of the Italian psychiatric reform bill, the author assesses the state of the national mental health services. Albeit slowly, the decrease in the number of in-patients in mental hospitals is accompanied by a numerical increase in district and out-patient services. However, the quality of care provided and the regional distribution of services are not acceptable. The reorganisation has benefited hospital and out-patient services, but community care facilities remain inadequate. The mental health of the general population seems to be unaffected by the ongoing transition in psychiatric care.
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Kitcheman, J., C. E. Adams, A. Pervaiz, I. Kader, D. Mohandas, and G. Brookes. "Does an encouraging letter encourage attendance at psychiatric out-patient clinics? The Leeds PROMPTS randomized study." Psychological Medicine 38, no. 5 (October 15, 2007): 717–23. http://dx.doi.org/10.1017/s0033291707001766.
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BackgroundThe aim was to reduce non-attendance for first-time consultations at psychiatric out-patient clinics.MethodThe study was a pragmatic randomized controlled trial; the setting was seven inner-city UK out-patient clinics in Leeds. The participants were 764 subjects of working age with an appointment to attend a psychiatric out-patient clinic for the first time. The intervention was an ‘orientation statement’ letter delivered 24–48 h before the first appointment compared with standard care. The primary outcome measure was attendance at the first appointment; secondary outcomes included hospitalization, transfer of care, continuing attendance, discharge, presentation at accident and emergency and death by 1 year.ResultsFollow-up was for 763 out of 764 subjects (>99%) for primary and for 755 out of 764 subjects (98.8%) of secondary outcome data. The orientation statement significantly reduced the numbers of people failing to attend [79 out of 388 v. 101 out of 376 subjects, relative risk 0.76, 95% confidence interval (CI) 0.59–0.98, number needed to treat 16, 95% CI 10–187].ConclusionsPrompting people to go to psychiatric out-patient clinics for the first time encourages them to attend. Pragmatic trials within a busy working environment are possible and informative.
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Killaspy, Helen, Julia Gledhill, and Sube Banerjee. "Satisfaction of ottenders and non-attenders with their treatments at psychiatric out-patient clinics." Psychiatric Bulletin 22, no. 10 (October 1998): 612–15. http://dx.doi.org/10.1192/pb.22.10.612.
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Aims and methodNon-attendance at psychiatric outpatient appointments has a substantial financial cost, and may also have clinical significance. To prevent non-attendance and formulate effective responses, its determinants need to be understood. Patient dissatisfaction with services has been suggested as a reason for non-attendance, we therefore investigated the role of patient satisfaction in attendance at psychiatric out-patients appointments. All patients booked for adult psychiatric out-patient follow-up appointments in a three-month period were studied using a brief, self-report questionnaire.ResultsSixty-three per cent (340/538) of offenders and 54% (118/219) of non-attenders responded. Responders expressed high levels of satisfaction with their treatment (92% offenders, 91% non-attenders) and with the service (96% attenders 92% non-attenders). Despite adequate statistical power, there were no statistically significant differences in satisfaction between the two groups.Clinical implicationsIn conclusion, patient satisfaction with psychiatric out-patient care was reported to be relatively high and did not seem to be an important determinant of non-attendance. Further work is needed to determine the impact of variables such as relapse and social disorganisation on attendance.
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Low, C. Bruce, and Ian Pullen. "Psychiatric Clinics in Different Settings." British Journal of Psychiatry 153, no. 2 (August 1988): 243–45. http://dx.doi.org/10.1192/bjp.153.2.243.
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Out-patient referrals to the Edinburgh adult psychiatric service between 1981 and 1985 were studied using the Edinburgh Psychiatric Case Register. The hypotheses that primary-care clinics have more patients with less severe illnesses and fewer patients with psychotic illnesses were confirmed.
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Vigod, Simone N., Paul A. Kurdyak, Cindy-Lee Dennis, Talia Leszcz, Valerie H. Taylor, Daniel M. Blumberger, and Dallas P. Seitz. "Transitional interventions to reduce early psychiatric readmissions in adults: systematic review." British Journal of Psychiatry 202, no. 3 (March 2013): 187–94. http://dx.doi.org/10.1192/bjp.bp.112.115030.
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BackgroundUp to 13% of psychiatric patients are readmitted shortly after discharge. Interventions that ensure successful transitions to community care may play a key role in preventing early readmission.AimsTo describe and evaluate interventions applied during the transition from in-patient to out-patient care in preventing early psychiatric readmission.MethodSystematic review of transitional interventions among adults admitted to hospital with mental illness where the study outcome was psychiatric readmission.ResultsThe review included 15 studies with 15 non-overlapping intervention components. Absolute risk reductions of 13.6 to 37.0% were observed in statistically significant studies. Effective intervention components were: pre- and post-discharge patient psychoeducation, structured needs assessments, medication reconciliation/education, transition managers and in-patient/out-patient provider communication. Key limitations were small sample size and risk of bias.ConclusionsMany effective transitional intervention components are feasible and likely to be cost-effective. Future research can provide direction about the specific components necessary and/or sufficient for preventing early psychiatric readmission.
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M., Venkatesh Perumal, Surendra Kumar Bouddh, Nirmal S. R., Ashok Deshpande, Jai Singh, and Natesh Prabhu. "Drug utilization study and prescribing patterns in psychiatry patients at a tertiary care hospital." International Journal of Basic & Clinical Pharmacology 7, no. 4 (March 23, 2018): 774. http://dx.doi.org/10.18203/2319-2003.ijbcp20181185.
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Background: The Drug utilization research (DUR) compares drug use between different countries and regions and is used to assess the rationality of prescribing pattern of the drug therapy. With this background we decided to evaluate antipsychotic drugs prescribing pattern in the psychiatric patients in a tertiary care hospital.Methods: the study was carried out at Department of Psychiatry, DSMCH. It was open label, cross - sectional, prescribed Documents based study. Duration of the study was one month (May-2017). Out-Patient number, age, sex, diagnosis, prescribed generic name, brand name, dose, route of administration, duration of therapy obtained from the Prescription register of Out - Patient Department of the Psychiatry.Results: The clinical experiences of the Psychiatrist I, II and III were 17 years, 35 years and 10 years respectively. The Psychiatrist I, II and III prescribed treatment for 36 (31.9%), 61 (54%) and 16 (14.2%) patients respectively. Among overall (n=113) patients (average age 38.9 years), male n=56 (49.6%) and female=57 (50.4%) were treated by all the three psychiatrists. The percentage of prescription of various drugs used were: Escitalopram (15.7%), Clonazepam (14.6%), Sertraline (8.7%), Risperidone (7.5%), Propranolol (6.7%), Olanzapine (6.3%), Quetiapine (5.9%), Trihexyphenidyl (5.5%), Amitriptyline (5.1%) and Other prescribed drugs, were between (0.4 to 2.8%).Conclusions: From this study, it can conclude that rational usage of drugs were followed in this study. All three prescribers (Psychiatrist I, II, and III) prescriptions were found to be rationale.
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VUORILEHTO, MARIA S., TARJA K. MELARTIN, HEIKKI J. RYTSÄLÄ, and ERKKI T. ISOMETSÄ. "Do characteristics of patients with major depressive disorder differ between primary and psychiatric care?" Psychological Medicine 37, no. 6 (March 5, 2007): 893–904. http://dx.doi.org/10.1017/s0033291707000098.
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Background. Despite the need for rational allocation of resources and cooperation between different treatment settings, clinical differences in patients with major depressive disorder (MDD) between primary and psychiatric care remain obscure. We investigated these differences in representative patient populations from primary care versus secondary level psychiatric care in the city of Vantaa, Finland.Method. We compared MDD patients from primary care in the Vantaa Primary Care Depression Study (PC-VDS) (n=79) with psychiatric out-patients (n=223) and in-patients (n=46) in the Vantaa Depression Study (VDS). DSM-IV diagnoses were assigned by the Structured Clinical Interview for DSM-IV Axis I disorders (SCID-I in PC-VDS) or Schedules for Clinical Assessment in Neuropsychiatry (SCAN in VDS), and SCID-II interviews. Comparable information was collected on depression severity, Axis I and II co-morbidity, suicidal behaviour, preceding clinical course, and attitudes towards and pathways to treatment.Results. Prevalence of psychotic subtype and severity of depression were highest among in-patients, but otherwise few clinical differences between psychiatric and primary care patients were detected. Suicide attempts, alcohol dependence, and cluster A personality disorder were associated with treatment in psychiatric care, whereas cluster B personality disorder was associated with primary care treatment. Patients' choice of the initial point of contact for current depressive symptoms seemed to be independent of prior clinical history or attitude towards treatment.Conclusions. Severe, suicidal and psychotic depression cluster in psychiatric in-patient settings, as expected. However, MDD patients in primary care or psychiatric out-patient settings may not differ markedly in their clinical characteristics. This apparent blurring of boundaries between treatment settings calls for enhanced cooperation between settings, and clearer and more structured division of labour.
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Gournay, Kevin, and Julia Brooking. "Community Psychiatric Nurses in Primary Health Care." British Journal of Psychiatry 165, no. 2 (August 1994): 231–38. http://dx.doi.org/10.1192/bjp.165.2.231.
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Background.Community psychiatric nurses (CPNs) are increasingly working in primary health care with non-psychotic patients. This study was designed to test the efficacy of this work.Method.The study was carried out in six health centres in north London with a total of 36 participating general practitioners (GPs) and 11 CPNs. Using a randomised controlled trial, 177 patients were referred by their GP and randomly allocated to continuing GP care, immediate community psychiatric nursing intervention, or placed on a 12-week waiting-list, after which time the patient was offered CPN intervention. A range of measures of symptoms and social function were used, and ratings were carried out at assessment and at 24 weeks.Results.Patients improved on all measures over time (P < 0.001 for all measures). However, there was no difference between the group of patients receiving GP care and patients seen by the CPN. Improvements seemed to be independent of the amount of contact. Drop-out rates from CPN intervention were high (50%). CPN drop-outs were more disabled to start with, but did as well as CPN treatment completers. Patients were more likely to drop out with trained than untrained CPNs. There was no evidence that referral to a CPN saved GP time.Conclusions.The results add weight to the argument that CPNs should refocus their activity on people with serious mental health problems, and indicate that CPN education should focus on skill acquisition and interventions of proven effectiveness.
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Belbase, M., J. Adhikari, T. A. Khan, and R. K. Jalan. "Demographic profile and pathway to care in patients with schizophrenia in a tertiary care hospital from western Nepal." Journal of Psychiatrists' Association of Nepal 4, no. 1 (February 21, 2017): 27–29. http://dx.doi.org/10.3126/jpan.v4i1.16739.
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Introduction: Schizophrenia is one of the severe mental health problem and its guarded treatment response and association with as the stigma makes it a chronic debilitating personal, family and social problem of all the psychiatric illness. Timely Identification and management of this condition is important as early diagnosis and management gives better treatment response.Methods: This is a descriptive study done in patients attending psychiatry OPD of Nepalgunj Medical College, Kohalpur for 12 months from June 2013 to May 2014.Results: Out of the 86 study subjects (n=86), males were 54 in number followed by 32 females. The most common age group was 21-40 years representing 46(53.4%), followed by 41-60 years 24(28%), <20 years 12(13.9%) and >60 years 4(4.7%). The most common first contact of the patient with schizophrenia was with faith healers 54 (62.8%) followed by consultation with psychiatrist 18(20.9%). Among the study population, 38(44.2%) visited to the psychiatrist after >41 weeks of the beginning of the illness followed by 34(39.5%) visited in <10 weeks of the beginning of the schizophrenia.Conclusions: Faith healers were the most common first contact person for the patients with schizophrenia followed by psychiatrist . Most of the schizophrenia patients come to psychiatrist after 40 weeks of their illness.
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Jackson, Gayle, Richard Gater, David Goldberg, Digby Tantam, Linda Loftus, and Helen Taylor. "A New Community Mental Health Team Based in Primary Care." British Journal of Psychiatry 162, no. 3 (March 1993): 375–84. http://dx.doi.org/10.1192/bjp.162.3.375.
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A new community multidisciplinary team based in primary care is described and the experience of the first year discussed. The effect the team has had on the use of psychiatric services in its first year was studied. There was a threefold increase in the rate of inception to care, leading to a doubling in the prevalence of treated psychiatric disorder. There has been a reduction in the demands made on the hospital out-patient services, but no change in the use of in-patient resources or emergency contacts.
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Payne, Ann, and Julius Essem. "Management of patients' physical health in an acute psychiatric unit." Irish Journal of Psychological Medicine 25, no. 4 (December 2008): 127–30. http://dx.doi.org/10.1017/s079096670001123x.
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AbstractObjective: The aim of this study was to help clarify the range of acute medical problems experienced by patients on an acute psychiatric unit during a period of 28 days and nights, as encountered by psychiatric trainees, and to document any difficulties experienced by the trainee during these patient contacts.Method: This survey was carried out prospectively over 28 days and nights in an acute psychiatric ward attached to a teaching University Hospital. Following contact with an individual patient, the trainee recorded diagnosis, intervention and any difficulties encountered.Results: Thirty-three patient contacts were recorded (n = 33). Trainees faced a range of primary care problems 22/33 (67%), but moreover, three patients demonstrated more serious and potentially life threatening problems, leading to 11/33 (33%) patient contacts requiring urgent interventions.Conclusions: While the debate continues as to who is best placed to provide medical healthcare for psychiatric patients, this study provides evidence that psychiatry trainees are required to draw on their previous medical and surgical experience on an almost daily basis. As psychiatrists we should consider our options on how best to manage medical problems on the acute psychiatric unit and consequently ensure confident liaison with our medical and surgical colleagues.
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Bird, V. J., D. Giacco, P. Nicaise, A. Pfennig, A. Lasalvia, M. Welbel, and S. Priebe. "In-patient treatment in functional and sectorised care: patient satisfaction and length of stay." British Journal of Psychiatry 212, no. 2 (February 2018): 81–87. http://dx.doi.org/10.1192/bjp.2017.20.
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BackgroundDebate exists as to whether functional care, in which different psychiatrists are responsible for in- and out-patient care, leads to better in-patient treatment as compared with sectorised care, in which the same psychiatrist is responsible for care across settings.AimsTo compare patient satisfaction with in-patient treatment and length of stay in functional and sectorised care.MethodPatients with an ICD-10 diagnosis of psychotic, affective or anxiety/somatoform disorders consecutively admitted to an adult acute psychiatric ward in 23 hospitals across 11 National Health Service trusts in England were recruited. Patient satisfaction with in-patient care and length of stay (LoS) were compared (trial registration ISRCTN40256812).ResultsIn total, 2709 patients were included, of which 1612 received functional and 1097 sectorised care. Patient satisfaction was significantly higher in sectorised care (β = 0.54, 95% CI 0.35–0.73, P<0.001). This difference remained significant when adjusting for locality and patient characteristics. LoS was 6.9 days shorter for patients in sectorised care (β = −6.89, 95% CI –11.76 to −2.02, P<0.001), but this difference did not remain significant when adjusting for clustering by hospital (β = −4.89, 95% CI –13.34 to 3.56, P = 0.26).ConclusionsThis is the first robust evidence that patient satisfaction with in-patient treatment is higher in sectorised care, whereas findings for LoS are less conclusive. If patient satisfaction is seen as a key criterion, sectorised care seems preferable.Declarations of interestNone.
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Lesage, Alain D., Doris Clerc, Isabelle Uribé, Jocelyne Cournoyer, José Fabian, Valérie Tourjman, Ian Van Haaster, and Chi-Hsing Chang. "Estimating Local-Area Needs for Psychiatric Care: A Case Study." British Journal of Psychiatry 169, no. 1 (July 1996): 49–57. http://dx.doi.org/10.1192/bjp.169.1.49.
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BackgroundDifferent approaches to estimating local catchment-area needs for psychiatric services are illustrated and compared.MethodData from an epidemiological morbidity survey of a random sample of 496 adults were available, as were actual service utilisation rates. Four types of utilisation were modelled (i.e. overall out-patient, in-patient, emergency clinic) using social indicators available from Statistics Canada census-tract data. Finally, a case–control study compared out-patients from a deprived and an affluent catchment area, matched case by case for primary diagnosis, age, sex and residential status (n=52).ResultsModelling proved highly predictive of utilisation, the overall-use model accounting for 73% of the variance. The case–control study indicated a higher rate of Axis II traits, substance abuse and needs for social care in the deprived catchment area.ConclusionsResource allocation based on the social indicators modelling method was more consistent with sensible distribution of human resources. None of the methods, however, appear to reflect adequately the severity of caseloads evidenced in the case–control study.
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Fovet, T., and P. Thomas. "Forensic Care in France." European Psychiatry 41, S1 (April 2017): S61. http://dx.doi.org/10.1016/j.eurpsy.2017.01.050.
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In France, the number of inmates with psychiatric disorders has grown substantially during the last two decades. In this context, significant changes occurred in France's forensic psychiatry service provision in recent years. Especially, full-time inpatient units for inmates (called unités d’hospitalisation spécialement aménagées, UHSA) have been created in 2010. These changes clearly improved access to mental health care for inmates. Moreover, some recent trends in indicators such as the suicide rate in French prison, which has fallen slightly, are promising [1].However, the practice of psychiatry in prisons is a subject of debate between the proponents of the development of a specific care system for inmates and those considering that psychiatric teams must stay out of prison. One should insist on the dichotomy between the justice system and the health system, which appears constitutional in France. Indeed, the professional independence of caregivers from the judiciary system and the medical confidentiality are fundamental values on which French model has been built. Furthermore, the improvement of the quality of health care in prisons could alarmingly lead the judges to preferentially choose imprisonment for patients suffering from mental disorders committing offences while prison should in no way be considered as a patient care setting. This trend is evidenced by the low rate of individuals judged irresponsible for their crime because of mental health status currently observed in France.Disclosure of interestThe authors have not supplied their declaration of competing interest.e
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Prajapati, Nisha K., Nimesh C. Parikh, Nilima D. Shah, Vinodkumar M. Darji, Heena B. Jariwala, and Manthan T. Miroliya. "Evaluation of Psychiatric Morbidity in COVID-19-Positive Inpatients Referred to Consultation Liaison Psychiatry in a Tertiary Care Hospital." Indian Journal of Psychological Medicine 43, no. 4 (June 29, 2021): 330–35. http://dx.doi.org/10.1177/02537176211022146.
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Background: The COVID-19 pandemic has led to the risk of common mental illnesses. Consultation liaison psychiatry has been one of the most requested services in the face of this pandemic. We aimed to assess (a) the prevalence of psychiatric illness, (b) different types of psychiatric diagnoses, (c) presenting complaints, (d) reasons for psychiatric referrals, and (e) psychiatric intervention done on COVID-19 positive inpatients referred to consultation liaison psychiatry at tertiary care hospital. Method: This was a retrospective study of data collected from April 1, 2020, to September 15, 2020. Total 300 patients were referred and diagnosed with clinical interview and Diagnostic and Statistical Manual for Mental Disorder Fifth Edition criteria. Analysis was done using chi-square test, Kruskal–Wallis test, and fisher exact test. Results: Out of 300 patients, 26.7% had no psychiatric illness. Adjustment disorder was the commonest psychiatric diagnosis (43%), followed by delirium (10%). Statistically significant differences were found for parameters like Indian Council of Medical Research Category 4 of the patient, (hospitalized severe acute respiratory infection) (P value < 0.001), medical comorbidity (P value = 0.023), and past history of psychiatric consultation (Fisher exact test statistic value <0.001). Behavioral problem (27.6%) was the commonest reason for psychiatric referral. Worrying thoughts (23.3%) was the most frequent complaint. A total of 192 (64.3%) patients were offered pharmacotherapy. Conclusions: Psychiatric morbidity was quite high (73.3%) among them and adjustment disorder was the commonest (43%) psychiatric diagnosis followed by delirium (10%). Pharmacotherapy was prescribed to 64.3% patients and psychosocial management was offered to most of the referred patients.
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Lelliott, Paul, and Geraldine Strathdee. "The one-day census in clinical audit." Psychiatric Bulletin 16, no. 10 (October 1992): 614–15. http://dx.doi.org/10.1192/pb.16.10.614.
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Psychiatric care is delivered by a wide range of workers (psychiatrists, hospital nurses, community psychiatric nurses, occupational therapists, psychologists, social workers, counsellors and general practitioners) who work as teams with some patients and as individuals with others. Health authority resources for psychiatric care are widely distributed among facilities both hospital-based (wards, day hospitals, out-patient departments, social work departments, occupational therapy departments) and community-based (community psychiatric nursing departments, community mental health centres and facilities funded jointly with social services and voluntary agencies).
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Birkeland, Soren, and Frederik A. Gildberg. "Mental Health Nursing, Mechanical Restraint Measures and Patients’ Legal Rights." Open Nursing Journal 10, no. 1 (March 28, 2016): 8–14. http://dx.doi.org/10.2174/1874434601610010008.
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Coercive mechanical restraint (MR) in psychiatry constitutes the perhaps most extensive exception from the common health law requirement for involving patients in health care decisions and achieving their informed consent prior to treatment. Coercive measures and particularly MR seriously collide with patient autonomy principles, pose a particular challenge to psychiatric patients’ legal rights, and put intensified demands on health professional performance. Legal rights principles require rationale for coercive measure use be thoroughly considered and rigorously documented. This article presents an in-principle Danish Psychiatric Complaint Board decision concerning MR use initiated by untrained staff. The case illustrates that, judicially, weight must be put on the patient perspective on course of happenings and especially when health professional documentation is scant, patients’ rights call for taking notice of patient evaluations. Consequently, if it comes out that psychiatric staff failed to pay appropriate consideration for the patient’s mental state, perspective, and expressions, patient response deviations are to be judicially interpreted in this light potentially rendering MR use illegitimated. While specification of law criteria might possibly improve law use and promote patients’ rights, education of psychiatry professionals must address the need for, as far as possible, paying due regard to meeting patient perspectives and participation principles as well as formal law and documentation requirements.
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Burns, Tom, James Raftery, Alan Beadsmoore, Sean McGuigan, and Mark Dickson. "A Controlled Trial of Home-Based Acute Psychiatric Services." British Journal of Psychiatry 163, no. 1 (July 1993): 55–61. http://dx.doi.org/10.1192/bjp.163.1.55.
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Treatment records of 94 patients treated in an experimental home-based psychiatric service and 78 control patients in standard care were collected over one year. There was a substantial reduction in in-patient care in the experimental group, both in terms of proportion admitted and duration of admissions, despite similar out-patient and general practice care. The total treatment costs were significantly larger (>50%) for standard care when controlled for by diagnostic grouping. Costs were further examined by including all specialist psychiatric care, and by excluding patients with primary diagnoses of brain damage or alcoholism. Sensitivity analysis explored the effects of increasing the cost of home visits. The relative cost effectiveness of the experimental service persisted. Clinical and social outcome was similar in control and experimental groups.