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PubMed2005

The safe treatment of the suicidal patient in an adult inpatient setting: a proactive preventive approach.

This paper focuses on the work of an inpatient service in an acute care safety net hospital in the prevention of suicide on its inpatient service and during the high-risk period post discharge. The strategy utilized a comprehensive proactive systems approach to the suicidal patient including: a formalized suicide assessment jointly done by medical and nursing staff, accurate diagnosis and best practice treatment, a flexible nursing observation policy, groups on inpatient units focused on suicide and key risk factors and triggers, and a communication tool to the next level of care that describes the strategies learned by the patient to deal with his or her suicidality. Incidents of self-injurious behaviors and special observation hours were monitored.

Adolescent↗
PubMed1993

Pastoral needs and support within an inpatient rehabilitation unit.

Because patients reported concerns regarding the adequacy of pastoral service delivery during their inpatient rehabilitation hospitalization, a study was performed to ascertain the patient's pastoral needs and the extent of pastoral services provided. After discharge from the inpatient rehabilitation hospital, patients were surveyed as to their perceived religious and spiritual needs, as well as to the extent of religious, spiritual, and pastoral services provided during their inpatient stay. The majority of responders (74%) reported their religious and spiritual beliefs were important. Forty-five percent of responders indicated not enough attention was repaid to their religious or spiritual needs, whereas only 1% felt that too much attention was paid. A majority of patients (54%) desired pastoral visitation. Other needs were elicited, including expanded pastoral services, increased staff empathy for the patient's spiritual and religious needs, and improved availability of church or synagogue services or sacraments. Many Jewish patients reported concerns of being punished by God, whereas Christian patients were concerned that God was unaware of their personal needs. Some responders, regardless of personal faith, were also troubled with fears of death, God's failure to heal, and loss of purpose in life. There is a clear need to establish a mechanism to identifying the religious and spiritual needs of each individual patient. These needs must be considered with both sensitivity and compassion by all members of the rehabilitation staff. The rehabilitation facility must also develop a mechanism to identify pastoral care resources available within the hospital and local community, and to assure that the patient's needs are addressed.

Aged↗
PubMed1985

An inventory to measure staff knowledge of behavioral methods with inpatient children and adolescents.

A 35-item multiple choice inventory to assess inpatient staff's knowledge of behavioral methods with children and adolescents is described. The instrument appears to possess satisfactory content validity for basic behavioral principles and good internal consistency and reliability. It appears useful for research and staff inservice educational assessment in inpatient treatment settings where a measure of this type in needed. The inventory may also be useful in identifying newly employed staff who may benefit from behavioral training before assuming direct services roles on inpatient wards.

Adolescent↗
PubMed1986

Inpatient behavior therapy: the St. Louis University model.

Many of the problems that impede the practice of behavior therapy on traditional psychiatric and medical inpatient services can be avoided by a separate behaviorally-oriented inpatient unit, but few guidelines exist for establishing such a unit. The present paper describes the inpatient Behavioral Treatment Unit developed at St. Louis University Medical Center. Critical administrative and clinical features of the Unit are discussed, including the administrative philosophy which emphasizes unit autonomy and participative management, the central role of nursing staff, the importance of the clinical team system, the development of referral sources, admission procedures and criteria, and basic approaches to assessment and treatment.

Academic Medical Centers↗
PubMedDate not supplied

Continuous observation for psychiatric inpatients: a critical evaluation.

Continuous observation is a procedure used in most psychiatric inpatient units to manage acute and escalating risk in patients. Yet, it is virtually unstudied and unreported. The present study, conducted in a psychiatric teaching hospital, compared 102 inpatients who required continuous observation with 102 control subjects. Continuous observation was provided by nursing staff, and was used for 13% of inpatients. The most common reasons for continuous observation were risk of self-harm, overstimulation by the environment, and violence. Five clinical factors that predicted the use of continuous observation as well as another set of factors that correlated with a history of violence were found. Almost two thirds of patients required brief episodes lasting less than 72 hours (mean, 28 hours). These appeared to be effective and practical. However, when continuous observation exceeded 72 hours, it often became problematic and ineffective. We recommend that after 72 hours of continuous observation, patients' clinical management should be reviewed by the treatment team and changed.

Arousal↗
PubMedDate not supplied

Prevalence and patterns of "dual diagnosis" among psychiatric inpatients.

Studies of patients admitted to public mental hospitals have consistently found high rates of comorbid substance use disorders. We sought a better understanding of this comorbidity among psychiatric inpatients, in particular differentiating two groups of "dual diagnosis" patients, (1) those with independent mental disorders complicated by substance use disorders, and (2) those with psychoactive substance use disorder-induced organic mental disorders (PSUD-induced OMD). The diagnoses of 435 consecutively admitted inpatients from an inner-city catchment area were ascertained with the Structured Clinical Interview for DSM-III-R (1987 Inpatient Version [SCID-P]), modified to describe more accurately the relationships between psychiatric syndromes and substance use. More than half (55.9%) of these psychiatric patients had current substance use disorders. Over half (53.6%) of these "dually diagnosed" patients had no lifetime history of an independent mental disorder, but rather had psychiatric syndromes related to psychoactive substance use. The dual diagnosis subgroups differed on treatment history, principal psychiatric diagnoses, and the types of substances used. The results underscore the heterogeneity of dual diagnosis patients admitted to psychiatric hospitals and the potential importance of differentiating among these subgroups.

Adolescent↗
PubMed1991

Incontinence management scale for elderly inpatient men.

For many elderly inpatients, urinary incontinence cannot be successfully treated and the management objective is identifying a suitable method for containment of urine loss. In elderly inpatient men, an external catheter is utilized in many cases for incontinence management. The role of the severity of incontinence and the use of an external catheter was investigated in 66 elderly inpatient men. Quantitative incontinence measurements showed incontinent patients having an external catheter had approximately 6.3 (SD = 2.5) episodes per day compared with 3.2 (SD = 2.0) episodes per day in the noncatheter incontinent patients. The clinical management method used in these patients was associated with the measured severity of incontinence.

Aged↗
PubMed1993

Suicide after discharge from psychiatric inpatient care.

People with a history of psychiatric disorder are at higher risk of suicide than people without such a history. The policy of reducing inpatient care in psychiatry has probably meant that some of the risk of suicide has shifted from the hospital to the community setting. We have quantified the risk of suicide within a year of psychiatric discharge in a population-based study in the Oxford health region, UK. We calculated suicide rates per 1000 person-years at risk (time from discharge to death, subsequent readmission, or the end of the study) and the standardised mortality ratio (SMR) for suicide, taking the value among the general population as 1. Among male patients the SMR for suicide (defined by coroner's verdict of suicide) in the first 28 days after discharge from inpatient care was 213 (95% CI 137-317); the equivalent SMR for female patients was 134 (67-240). The result was similar when we defined suicide more broadly as a suicide, open, or misadventure verdict. The suicide rate in the first 28 days after discharge was 7.1 (4.1-12) times higher for male patients and 3.0 (1.5-6.0) times higher for female patients than the rate during the remaining 48 weeks of the first year after discharge. Most of the patients studied (both those who committed suicide and those who did not) had been psychiatric inpatients for only a short time. The findings confirm that there is significant clustering of suicide soon after discharge from psychiatric care. Skilled support after discharge for high-risk patients in the community is essential. Audit of suicides that occur soon after discharge may help identify the patients at highest risk and thereby reduce the number of avoidable deaths.

Adolescent↗
PubMed1989

Somatoform disorders in the general hospital inpatient setting.

The somatoform disorders present dilemmas on acute inpatient medical/surgical services because they may closely mimic authentic physical illness and result in misapplied medical treatment. However, there have been few diagnostic studies of this important group in the medical/surgical inpatient setting. Inpatient psychiatric consultations at Mount Sinai Medical Center during 1980-1987 were recorded using a 384-item computerized data base protocol. DSM-III somatoform disorders were identified in 33 of 1801 initial consultations (1.8%) and in 35 of 1363 at time of termination (2.6%); demographic and diagnostic characteristics of somatoforms and others were compared. The question of a psychogenic component to the illness and problem with pain management were the most common stated reasons for consultation. Somatoform patients were more likely than others to be female (p less than 0.05), Hispanic (p less than 0.05), and to have Axis II comorbidity (p less than 0.001). Axis III comorbidity was present in 94%. Thirty-one percent of patients diagnosed as somatoform on final follow-up assessment had not been diagnosable as somatoform on initial assessment. The findings emphasize the necessity of ongoing assessment in improving diagnostic certainty, as well as the prevalence and importance of medical comorbidity among patients with somatoform disorders in this setting.

Hospitals, General↗
PubMed1994

Medical psychiatry units and the roles of the inpatient psychiatric service in the general hospital.

The medical-psychiatric unit concept has been the most important influence in the development of general hospital inpatient psychiatry in the last decade. This concept and style of unit organization is reviewed in the context of the history of general hospital inpatient psychiatry. It is suggested that elements of the medical-psychiatry unit model will become more important in the organization of general hospital psychiatric units. Modifications of the medical psychiatry unit concept are suggested to take into account the heterogeneity of many general hospital inpatient services. Implications of these factors are discussed in the context of unit design, models of staff organization, and the formation of networks of care.

Adult↗
PubMed1996

Atypical depression among psychiatric inpatients: clinical features and personality traits.

OBJECTIVE: This study investigates the frequency and characteristics of Atypical Depression (AD) among depressed inpatients. METHOD: Twenty-one depressed inpatients received DSM-IV diagnoses, were rated on the Hamilton Depression Rating Scale (HAMD), and assessed for AD using the Atypical Depressive Disorder Scale. AD was defined as the presence of mood reactivity and two of four associated features: hyperphagia, hypersomnia, leaden paralysis, rejection sensitivity. Mood reactivity was defined as the ability to reach 50% of a non-depressed mood. All subjects completed the SCL-90, MCMI-II, and a suicide survey. RESULTS: Seven patients (33%) met criteria for AD. AD and non-AD patients did not differ in terms of severity of depression, history of suicide attempts, levels of clinical symptomatology, age of onset of depression, prior hospitalizations, and most personality characteristics. However, AD patients scored significantly higher than non-AD patients on the SCL-90 Interpersonal Sensitivity and MCMI-II Avoidant scales, and were more likely to be single. CONCLUSION: AD is fairly prevalent on an inpatient service, comparable to the frequency found in outpatient settings. AD is not a milder form of depression. The only differences between AD and non-AD patients reflect the personality trait of rejection sensitivity which is a defining feature of AD.

Adolescent↗
PubMed1983

Family conflict, psychopathology, and dangerous behavior by schizophrenic inpatients.

Data supporting the hypothesis that history of severe discipline and parental conflict in childhood is related to current violence were obtained in a study of 100 schizophrenic inpatients. In addition to a relation between inpatient violence and degree of schizophrenic symptoms, inpatient assaults and other dangerousness measures were positively and significantly correlated with severity of parental discipline, especially involving the father, and with degree of family conflict, particularly fights between parents and others outside the home.

Conflict, Psychological↗
PubMedDate not supplied

Eating disorders in female inpatients with versus without substance use disorders.

This study assessed the relationship between substance use disorders and eating disorders in female psychiatric inpatients. Structured diagnostic interviews were reliably administered to a series of inpatients with substance use disorders (n = 67) and a comparison sample without substance use disorders (n = 69). Eating disorder diagnoses as a whole, including eating disorder not otherwise specified, were distributed significantly more frequently among subjects with substance use disorders than among psychiatric controls. Frequencies of the specific diagnoses of bulimia nervosa and anorexia nervosa, however, did not differ significantly between groups. The results suggest that eating disorder features may be overrepresented among female inpatients with substance use disorders.

Adolescent↗
PubMed1979

Differences in heroin addicts seeking inpatient detoxification, ambulatory detoxification, or methadone maintenance.

Fifteen psychosocial characteristics of 300 male and 90 female heroin addicts admitted for inpatient detoxification, ambulatory detoxification, and methadone maintenance within the same multiphasic drug-abuse program were compared to determine whether or not their characteristics differentiated those seeking each type of treatment approach; there were 100 men and 30 women randomly drawn to represent each of the three approaches. Only two variables differed among the three approaches for both men and women--length of daily heroin use and educational attainment. The ambulatory detoxification patients had started using heroin daily at a later age than the inpatients who, in turn, had started using heroin daily at a later age than the methadone maintenance patients, and the ambulatory detoxification patients were more educated than the inpatients. The other variables differentiating the three approaches for each sex were discussed, and the conclusion was drawn that addicts with higher socioeconomic levels preferred ambulatory detoxification over methadone maintenance.

Adult↗
PubMedDate not supplied

Initial encounters with tobacco cessation on the Inpatient Substance Abuse Unit of the Medical College of Virginia.

When the Medical College of Virginia became a smoke-free facility on May 1, 1990, the inpatient unit of the Division of Substance Abuse Medicine decided that it would require tobacco abstinence of its patients, and that it would treat nicotine addiction in a similar fashion as other chemical dependencies. Surreptitious alcohol and drug use on the unit was minimal, but clandestine cigarette smoking prevailed. The succeeding restrictive environment and enforcement efforts became counterproductive. Beginning December 23, 1990, the inpatient unit decided to re-allow smoking. A motivational curriculum for all patients and an optional cessation program for those patients who wish to quit smoking during their inpatient stay is planned. Methods to effectively address nicotine addiction during chemical dependency treatment need to continually be refined and explored.

Adult↗
PubMedDate not supplied

Assessment of alcoholism among dually diagnosed psychiatric inpatients.

Alcohol is an increasingly abused substance among psychiatric inpatients, and the extent to which alcohol dependence history is documented and the alcoholism subsequently treated is a compelling issue. This study is a retrospective review of the extent to which alcohol dependence history was obtained, and if applicable, whether a diagnosis and/or treatment plan were made, for acute psychiatric inpatients. For these purposes, an original instrument was constructed. Our results indicate that the predominant focus for acute inpatients is on diagnostic assessment of the severity of the alcohol problem, reflecting the need to deal with those issues requiring the most immediate attention. For patients with schizophrenia, attention to alcoholism diagnosis and treatment was less than that for nonschizophrenic patients. The implications of these findings are discussed with reference to the evaluation and treatment of dually diagnosed patients, along with further directions for research.

Adult↗
PubMedDate not supplied

Enkephalinase inhibition and precursor amino acid loading improves inpatient treatment of alcohol and polydrug abusers: double-blind placebo-controlled study of the nutritional adjunct SAAVE.

We investigated the effects of the amino acid and vitamin mixture SAAVE in inpatient, chemically-dependent subjects to evaluate the role of neurotransmitters in facilitating recovery and adjustment to a detoxified, sober state. SAAVE is formulated from amino acids that are precursors for neurotransmitters and neuromodulators thought to be involved in alcohol and drug seeking behavior. In a double-blind, placebo-controlled, randomized study of 62 alcoholics and polydrug abusers, SAAVE patients had a significantly reduced stress response as measured by the skin conductance level (SCL), and significantly improved Physical Scores and BESS Scores (behavioral, emotional, social and spiritual). After detoxification there was a six-fold decrease in AMA rates when comparing SAAVE vs. placebo groups. In this inpatient treatment experience SAAVE facilitated the rate of recovery and allowed patients to respond more fully and more quickly to the behavioral goals of the program, for example as measured by the BESS Score. The use of SAAVE to achieve enkephalinase inhibition and precursor amino acid loading in the acute inpatient treatment environment provides the practitioner with the potential ability to restore the neurochemical changes inherent to alcoholism and drug abuse. These findings increase our understanding of the clinically relevant neurobiological mechanisms which underlie compulsive disease.

Alcoholism↗
PubMed1996

The role of functional status in predicting inpatient mortality with AIDS: a comparison with current predictors.

To assess the independent prognostic role of functional status, as reflected by a measure of an inpatient's global requirement for nursing assistance with basic activities of daily living (Global ADL), we compared Global ADL with three validated AIDS mortality predictors: the Clinical AIDS Prognostic Staging (CAPS); the Severity Classification System for AIDS Hospitalization--version 2 (SCAH-2); and CD4 cell count. Our study sample consisted of 1392 patients with AIDS and a hospital stay of 3 or more days at one of 20 hospitals in 11 U.S. cities with high AIDS incidence. Data were collected from September 1990 through December 1991. Two percent of patients refused participation, and 26% were eliminated due to incomplete data collection, leaving an analytic sample of 1003 patients. Only 30% of patients had a CD4 count measured at any time during hospitalization. Cox regression was used to measure the hazard of inpatient mortality adjusted for length of stay. Overall mortality was 12%. Mortality rates for patients in Global ADL stages I-IV were 3%, 8%, 19%, and 51%, respectively (p < 0.0001). Global ADL more effectively discriminated mortality than CAPS (p < 0.001), SCAH-2 (p < 0.001), or CD4 count (p < 0.001). Global ADL also added independent information in analyses adjusted for both CAPS and SCAH-2: a single stage increase of Global ADL demonstrated a 1.9-fold increased hazard of death (CI: 1.6, 2.3). SCAH-2, assigned at discharge, was not strongly correlated with admission predictors (Global ADL: r = 0.17; CI: 0.11, 0.23 or CAPS: r = 0.03, CI: 0.02, 0.17). We conclude that Global ADL, alone or in tandem with other severity systems, provides an excellent severity adjustment for inpatient mortality with AIDS. Finally, CD4 cell counts were not routinely available and were not as predictive as Global ADL in the patients for whom both were available.

Acquired Immunodeficiency Syndrome↗