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PubMed2026

Applications and outcomes of virtual reality in inpatient psychiatry: A systematic review.

BACKGROUND: Virtual reality (VR) has been widely used in outpatient psychiatric services and has demonstrated benefits across several clinical diagnoses, but its use and effects in inpatient settings remain to be explored. This systematic review aimed to examine the use of VR during psychiatric hospitalization, including types of VR applications, barriers and facilitators of implementation, and effects on various outcomes. METHODS: The review was registered in PROSPERO (#CRD42023446524). Following PRISMA guidelines, databases (Ovid, SciVerse, Web of Science, Cochrane Library, ProQuest, and WorldCat) were searched from 1983 to 2025 using keywords related to VR and psychiatric disorders. Studies involving the use of VR with psychiatric inpatients (≥85%) were included. Descriptive statistics and narrative syntheses were used to summarize findings. Study quality was assessed with the Mixed Methods Appraisal Tool. RESULTS: After full-text screening, 37 studies (N = 1,004) met inclusion criteria. VR was used for both assessment and intervention, with cognitive-behavioral therapy/exposure (35%) and assessment (24%) being the most frequently used. VR use in inpatient units appeared feasible, acceptable, and safe for inpatients and clinicians, though findings remain preliminary. Several facilitators (e.g. adequate staff training and supervision) and common barriers (e.g. technical difficulties and limited resources) were identified. The most consistent improvements were observed in clinical symptoms (e.g. anxiety) compared with psychosocial, cognitive, and physiological outcomes. CONCLUSIONS: These findings suggest that inpatient settings represent a promising, yet understudied context for VR-based assessments and interventions. High-quality trials and systematic reporting of implementation are needed in future studies to inform research and clinical practice.

Humans↗

PubMed1979

Field dependence and extraversion neuroticism on an inpatient psychiatric service.

Compared relationship between field dependence (FD) and the scales of Neuroticism (N) and Extraversion (E) using paraprofessionals (N = 22), professionals (N = 42) and psychiatric inpatients (N = 35) to elucidate the high FD found among the psychiatric inpatients. Recent evidence contradicts Witkins' (1965) early view that as a group, psychiatric inpatients would show psychopathology at the extremes of the FD continuum. The N scale was chosen because it taps a narrow behavior band, the individual's vulnerability to break down under stress. The major hypothesis that FD and N would be functionally related was based on previous empirical findings (Cattell, 1955) and Seligman's (1975) theory of "learned helplessness." Similarly, it was expected that age and sex (i.e., being female) were related functionally to FD. The latter hypotheses were supported. The hypothesis that the profiles of inpatients, professionals and paraprofessionals would throw more light on the high FD found among inpatients was not supported. The relationship between FD and N was discussed in terms of Seligman's (1975) concept of learned helplessness.

Adult↗

PubMed1976

Hypnotic and minor tranquilizer use among inpatients and after discharge.

A major concern in prescribing hypnotics and minor tranquilizers in the hospital is that long-term habituation might develop. Former psychiatric inpatients were surveyed to assess hypnotic and minor tranquilizer use following discharge. Patients who used flurazepam and chloral hydrate as inpatients were no more likely to use these hypnotics as outpatients than patients who received no hypnotics as inpatients. There was a significant association between inpatient and outpatient use of minor tranquilizers. Outpatient use of minor tranquilizers was also significantly associated with outpatient hypnotic use.

Aftercare↗

PubMed1978

Liver biopsy: complications in 1000 inpatients and outpatients.

We prospectively evaluated risk factors in 1000 consecutive patients who underwent liver biopsy: 829 outpatients and 171 inpatients. The two groups were similar except that the outpatient group had a higher percentage of patients with hepatitis-cirrhosis and a lower percentage with neoplasia when compared with the inpatient group (P less than 0.01). The inpatient group had more relative contraindications (P less than 0.01). Among the 1000 patients, none died and none required laparotomy. If moderate to severe pain or hypotension or both developed (5.9%), they first became manifest during a 3-hr period of observation after biopsy. Forty-four outpatients (5.3%) were hospitalized; 39 were dismissed within 36 hr and 5 within 4 days. Complications were more often experienced by those with relative contraindications (P less than 0.05) and increased number of passes (P less than 0.01). Inpatients with hepatitis-cirrhosis experienced more complications (P less than 0.05) than did patients with other diagnoses (12.8 versus 3.8%). Complications were not related to type of needle, site of entry, or experience of operator. Liver biopsy as an outpatient procedure is safe if facilities are available for 3 hr of observation and hospital support; 5% of patients will require immediate hospitalization.

Adult↗

PubMed2026

Intravenous Ketamine reduces psychological pain in suicidal inpatients: A secondary analysis of a six-week randomized placebo-controlled trial.

BACKGROUND: Psychological pain has been conceptualized as an unbearable inner experience and a possible precondition for suicidal ideation. No randomized placebo-controlled study has specifically investigated psychological pain as a treatment target in psychiatric populations. We examined ketamine's effect on psychological pain in suicidal psychiatric inpatients. METHODS: This secondary analysis used KETIS, a 6-week randomized, double-blind, placebo-controlled trial. Participants received two 40-minute intravenous infusions of ketamine (0.5 mg/kg) or placebo (0.9% saline) 24 h apart, alongside usual care and medication. Psychological and physical pain were assessed at baseline, repeatedly during 96 h, and at weeks 2, 4, and 6 using the self-rated PPP-VAS. Longitudinal mixed models compared pain trajectories. RESULTS: The trial randomized suicidal inpatients to ketamine (n = 73) or placebo (n = 83). Psychological pain decreased in both groups but was lower with ketamine during the first 96 h. Pointwise scores were lower with ketamine from 40 min to 96 h, largest at 40 min, 2 h, 4 h, and 24 h (all p < 0.001), but not at weeks 2, 4, or 6. This early difference remained significant after adjustment for depressive symptoms and hopelessness. The early reduction appeared more pronounced in the bipolar subgroup. No robust baseline predictors of outcome were identified. CONCLUSIONS: Intravenous ketamine was associated with a greater reduction in psychological pain than placebo in suicidal inpatients, with the clearest effects emerging within the first hours after treatment and remaining evident through the first 96 h. Ketamine may represent a clinically relevant option as a psychological pain reliever in psychiatric patients.

Humans↗

PubMed2025

Patient Ethnicity and Staff Use of Restraints and Restrictive Practice in Inpatient Psychiatric Services: A Systematic Review.

Restrictive practices such as restraints, seclusion, and forced medication are only intended to be used when the threat is at a level whereby an individual is likely to inflict harm on themselves or another individual. Demographic variations, including ethnicity, may be associated with the use of these practices. However, there is no systematic review on patient ethnicity specifically. The review therefore aimed to establish whether a patient's ethnic identity was associated with staff use of restrictive practices in inpatient psychiatric services. The systematic review followed the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines. Four databases were searched (PsycINFO, Medline, Embase, and CINAHL). Methodological quality was assessed using the Critical Appraisal Skills Program Checklists. Fifteen studies met the inclusion criteria. A variety of ethnicities were identified within the studies. These were driven by the location of the study. Seclusion (14 studies), forced medication (4), and physical restraint (4) were explored. There were mixed findings, with ethnicity shown to predict restrictive practices in studies having larger participant numbers, longer follow-up periods and less methodological bias. It remains unclear whether ethnicity is a genuinely independent predictor of restraint and coercive practices or interacts with other risk factors. Staff working in inpatient settings should be aware of how unconscious biases might affect clinical practice. Recruiting a diverse workforce from minority ethnic groups into inpatient psychiatric services would be a positive step. However, support for these staff members is important, and all staff should be equipped to respond to ethnic diversity. Future research should explore beyond patient-level factors.

Humans↗

PubMed1979

Psychological test comparison of day hospital an inpatient treatment.

Tested hypotheses, empirically generated from rating scales, which predicted that patients treated in partial, day hospital settings improve more in intellectual efficiency and social interaction than patients treated in full-time, inpatient settings. Thirty matched pairs of day hospital and inpatient volunteers were administered a group psychological test battery at the beginning of treatment and then 5 weeks later. The day hospital sample differed significantly on 7 of 24 pre- and posttest measures, the inpatient sample on 2. Gains occurred primarily in increased intellectual efficiency and social interaction. Multiple discriminant function analyses yielded no significant pretest differences, but posttest differences approached significance (p less than .06); day hospital patients registered increased Extraversion (Eysenck Personality Inventory).

Adult↗

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↗

PubMed1979

A family-oriented psychiatric inpatient unit.

This article presents the structure and policies of a psychiatric inpatient unit that was developed with the goal of fully integrating family-oriented treatment approaches into its therapeutic program. There is an explanation of different methods to involve families in the hospital treatment process and delineation of a variety of treatment techniques specific for families of inpatients. The role of the nursing staff is described as well as some of the contradictions and paradoxes that are inherent in this type of inpatient unit.

Adolescent↗

PubMed1978

Day hospitalization as a cost-effective alternative to inpatient care: a pilot study.

Two private day hospitals and an insurance company offering group health coverage to federal employees undertook a pilot study to determine if providing insurance coverage for day hospitalization on the same basis as for inpatient treatment was a feasible means of controlling the cost of psychiatric care. The study included 31 patients who otherwise would have been hospitalized; most had histories of severe psychiatric disorders and extensive treatment. Using the measure that the day hospital patients would have been in inpatient treatment for the same number of days, the authors estimate that the use of day treatment saved the insurer more than $255,000. They recommend that day hospitalization be reimbursed on the same basis as inpatient care if a day hospital can meet stringent criteria ensuring that it provides active, appropriate treatment, and they present a list of such criteria.

Adolescent↗

PubMed1979

Differences in the severity of disturbance of behaviors in children receiving inpatient and outpatient psychiatric treatment.

This study was conducted to determine if there are differences in the severity of disturbance of behaviors exhibited by children receiving inpatient psychiatric treatment and those receiving outpatient psychiatric treatment based on their parents' judgments of the frequency of occurrence of those behaviors. The same behaviors were found to exist in both treatment groups, but the severity of disturbance of those behaviors in the inpatient sample was significantly greater than in the outpatient sample. The scale used in this study was found to be a valid and useful instrument for predicting inpatient and outpatient status of children. Pratice and research implications of this study are also discussed.

Ambulatory Care↗

PubMed2026

Feasibility and effectiveness of the Bergen 4-Day Treatment for obsessive-compulsive disorder in Australia: A pilot comparison with 3-week inpatient obsessive-compulsive disorder treatment.

OBJECTIVES: Obsessive-compulsive disorder is a debilitating and chronic condition that, when untreated or unresponsive to treatment, imposes a significant health and economic burden on individuals and families. This prospective non-randomised inpatient study compared the acceptability and clinical outcomes of the Bergen 4-Day Treatment programme with those of a standard 3-week specialised treatment programme for obsessive-compulsive disorder in Australia. METHOD: Twenty-five participants diagnosed with obsessive-compulsive disorder were non-randomly assigned to Bergen 4-Day Treatment (n = 12) or a 3-week standard (n = 13) inpatient programme. Independent assessments were completed at pre-treatment, 10 days post treatment and at 3-month follow-up. The Yale-Brown Obsessive-Compulsive Scale was rated to assess obsessive-compulsive disorder severity, while secondary measures of depression, anxiety, obsessive beliefs and wellbeing were self-rated by participants. RESULTS: Baseline characteristics of both groups were comparable, with obsessive-compulsive disorder symptom severity within the moderate to severe range. After treatment, obsessive-compulsive disorder symptoms as well as secondary depression and anxiety symptoms were reduced in both treatment groups. Participants receiving Bergen 4-Day Treatment had significantly lower Yale-Brown Obsessive-Compulsive Scale scores at 10 days (M = 13.46) and 3 months (M = 11.84), compared to standard treatment (M = 19.04 and M = 19.15, respectively). Response (91.9%) and remission (45.8%) rates for the Bergen 4-Day Treatment group were significantly higher at both post-treatment timepoints, compared to the standard treatment group. No dropouts occurred in the Bergen 4-Day Treatment group, and participant satisfaction was high. CONCLUSION: The findings of this pilot open-label study suggest that Bergen 4-Day Treatment shows promise as an acceptable, efficient and effective treatment for obsessive-compulsive disorder, warranting further investigation as a scalable alternative for improving access to specialised obsessive-compulsive disorder treatment in Australia.

Humans↗

PubMed1975

Labeling effects in psychiatric hospitalization. A study of diverging patterns of inpatient self-labeling processes.

This report explores two theoretical positions regarding psychiatric inpatient self-labeling processes over time. One position suggests that acceptance of the deviant label "mentally ill" is benign; the other suggests that such label acceptance may be harmful to patients. Employing empirical, longitudinal data from a sample of 43 inpatients, three complex, but discernible, patterns of "acceptance," "rejection," or "denial" of the "deviant" label of mental patient emerged over time within a short-term hospital setting. The three patient groups varied on Minnesota Multiphasic Personality Inventory scales, staff behavioral ratings over time, involvement in approved ward activities, and length of hospitalization. Results were discussed in terms of patient-staff interaction and its possible relation to patient self-labeling.

Adult↗

PubMed1977

Family intervention with severely disturbed inpatients.

Although there is considerable evidence that family variables and interaction patterns affect the duration of hospitalization and frequency of readmission of psychiatric patients, it is rare to find inpatient facilities having psychotherapeutic programs that systematically stress family interventions. This article discusses the difficulties encountered by both families and staff as they cope with the issues of hospitalization, suggests a structured, patient-oriented family approach, and recommends some specific techniques for short-term work with families of severely disturbed inpatients.

Acute Disease↗

PubMed1978

Breast biopsy. A comparison of outpatient and inpatient experience.

Nine hundred ninety-seven breast biopsies that were performed at one hospital over the five-year period from 1971 through 1975 were reviewed because of a changing pattern in the use of breast biopsies on outpatients who were under local anesthesia. In 1971, 17% of all breast biopsies were performed as outpatient procedures; by 1975, the figure was 60%. In 1971, 5% of all malignant neoplasms were diagnosed by the use of biopsies as outpatient procedures and 30% in 1975. Hospital charges for biopsy on an inpatient basis of benign breast disease were 7.2 times higher than for biopsy on an outpatient basis. Interviews of 102 patients clearly suggested that most patients were satisfied with the outpatient breast biopsy experience. Outpatient breast biopsy under local anesthesia is a safe procedure that is more economical in terms of medical cost, surgeons' time, and patients' time away from home and/or job. Preliminary biopsy of malignant lesions using local anesthesia permits more efficient use of diagnostic procedures to stage the extent of disease prior to treatment. Patient acceptance of breast biopsy as an outpatient procedure under local anesthesia was similar to their acceptance of biopsy on an inpatient basis under general anesthesia.

Ambulatory Care↗

PubMed1979

A study of mental status and anamnestic factors related to the decision for inpatient or outpatient treatment.

Reviewed previous studies of the determinants of disposition decision-making. Experimental flaws in these studies are indicated. A study of the intake decision process and its relationship to mental status and anamnestic variables obtained during the intake examination is presented (N = 523). Results suggest that diagnoses of psychosis and personality disorder are rleated to inpatient care, while the diagnosis of neurosis is related to outpatient care. In addition, depressed/suicidal symptomatology is found to be related to inpatient treatment, while a previous history of either sexual maladjustment or stubbornness/retardation is found to be related to outpatient care. Results are discussed in terms of universal and local criteria that are involved in intake decision-making.

Adult↗

PubMedDate not supplied

Inpatient bed needs for psychiatric care.

Along with other types of hospital inpatient care, acute psychiatric units are subject to state certificate-of-need review under Public Law 93-641. A study of 15 hospitals in Virginia suggests that prevailing techniques for determining inpatient bed needs are not appropriate for psychiatric beds, if indeed they are for other types of care. An alternative technique is offered, not as a substitute for judgment in such matters, but as assistance to it.

Beds↗

PubMed1979

The interaction of family therapy and psychodynamic individual therapy in an inpatient setting.

Although individual psychotherapy is an established treatment modality in psychoanalytically oriented hospitals, family therapy is a relative newcomer. When family therapy is introduced into such an inpatient setting, it raises issues which have not yet been widely discussed. On the one hand there is the question of how inpatient family therapy differs from outpatient family therapy, and what its special characteristics are. This question has only begun to be discussed. On the other hand there is the question of how family therapy relates to individual therapy that is being conducted simultaneously with a member of the same family. In general the individual psychotherapy literature tends to speak as if family therapy did not exist, and the family therapy literature speaks as if individual therapy should be abolished and supplanted by family therapy. Some authors have begun to try to build bridges between the two fields on the level of theory, but almost none have reported on the interaction between the two treatment modalities on a pragmatic level when they are conducted simultaneously (Kugel, 1974).

Adult↗