bluuebunny/crossref_metadata_2025_split huggingface dataset:
Psychiatric intensive care units - designed for the patient ….designed for the environment
Authors: Kandasamy S. , Dooldeniya D. , Beezhold J. , Prabhu A. , Heffernan C. 
Published: May 2011

AimsThis poster explores how Psychiatric Intensive Care Units can be designed using “green” technology in order to be environment-friendly whilst also meeting patient needs.MethodAnalysis of the new PICU at Hellesdon Hospital, Norfolk and Waveney Mental Health NHS Foundation Trust, United Kingdom. We describe how the architecture has been adapted from the standard mental health unit model to facilitate more intensive supervision. We will also examine the building design features that have been incorporated to ensure the lowest possible carbon footprint.ResultsRollesby Ward (PICU) at Hellesdon Hospital won the Broadland design award 2009. It is a new, purpose built, building that provides a safe, user-friendly unit with en-suite accommodation; and rooms for seclusion, therapeutic activities and one to one sessions. The use of key cards and the layout of the bedrooms and lounge areas maintain patient privacy and dignity. A number of technologies have been used to minimise the building's carbon footprint. These include maximising usage of natural light and ventilation, underground rainwater tanks for flushing toilets, photovoltaic roof panels, and ground source heat pumps. Since the PICU has opened, 62.63 mwh of energy (35.57 tons of carbon) has been saved.ConclusionNew build psychiatric units can successfully incorporate design features that deliver a better patient and therapeutic environment whilst also minimising the consumption of energy and the size of the carbon footprint.
Psychiatric advance directives: A stakeholders’ analysis on a multistage scenario
Authors: Lorant V. 
Published: May 2011

IntroductionInvoluntary admissions for the treatment of mental disorders affect 10% of mental health services users. Psychiatric Advance Directives (PADs) are documents that allow users notifying treatment preferences for crisis relapses. PADs have been experienced in several countries to improve users’ empowerment and reduce involuntary treatment. However, PADs take-up rate remains low and its effectiveness inconsistently evaluated. A hypothesis is that PADs should be considered as a process including its completion, registration, and honouring.AimA Multi-Criteria Stakeholders’ Survey was carried out to understand what an optimal PAD process should be, and what the main hurdles are in implementing it.Method102 Belgian stakeholders were selected among users and non-users groups, and face-to-face interviewed. Each interviewee scored 20 different options in designing, completing, registering and honouring a PAD. Four criteria were assessed: patient's autonomy, therapeutic relationship, mental care continuity and feasibility.ResultsOverall, the PAD options aiming at improving access to the document and honouring statements received lower scores than options aiming its design or completion. Therapeutic relationship was a more important criterion than autonomy for the non-users than for the users group (p = 0.03). Options with the highest scores emphasized that PADs should be requested by the user, drafted in an outpatient setting, include de-escalating methods, justify treatment preferences, allow appointing a surrogate decision-maker, and need health providers training or a case-coordinator to be honoured.ConclusionPAD access and honouring are problematic steps of the process and should be developed to improve the use of PADs and its possible effectiveness
An audit of medical and nursing records of 100 emergency short-term (< 7 dys) psychiatric admissions to acute adult wards in Dumfries
Authors: Muir A. , Paul S. 
Published: May 2011

IntroductionThe study population is served by CMHTs and in addition (in one sector) by a Crisis and Home Treatment Team.ObjectivesTo evaluate the recorded admission and discharge processes in the medical and nursing notes.To record relevant clinical characteristics of the admission and the patient.AimsTo assess recorded admission and discharge processes against standards defined in the protocol.MethodsA random sample of 100 records, which met inclusion criteria, was selected. A protocol evaluating the recorded processes, and relevant information re the admission was completed by psychiatric trainees and senior nurses.Results51% of admissions occurred on week-ends and 58% occurred “out of hours”. In 35% of admissions a further admission had occurred within 4 weeks. 34% of admissions derived from 2 areas, highly correlated with deprivation. Alcohol or drug misuse contributed to 69% of admissions. In 77% of admissions, the patient was known to the service. 10% of patients had a diagnosis of major mental illness.Recorded medical and nursing assessments of admission were incomplete i.e. 66% of medical records and 80% of nursing records. Assessment of discharge records indicated similar failings in record -keeping.ConclusionsThe recurrent pattern of admissions(33%), the association with deprivation(34%) and drug or alcohol misuse(69%), indicate the need for more effective management of these patients. The failings in recording admission and discharge information are significant. Improvements in these processes could identify those patients who require additional support and /or are at risk of futher admissions.
Emergency pshychiatric treatment in a multy-type hospital
Authors: Pyrkov P.P. 
Published: May 2011

ObjectivesWe have studied the treatment modes and therapies of patients with acute psychotic disorders, in a general hospital for 1600 bedsMethodsClinicopshycopathologic, clinicotherapeutic, and statistical.Results1982 patients, 18–92 years of age, 64% of them males, have been examined.All the patients have been primary admitted with acute somatic disorders:insult - 18%,skull injury - 21%,myocardial infarction - 23%,exogenic poisoning - 31%,parasuicides -4%,operations on the thoracic organs - 3%.The mental disorders diagnosed were following:amnesic syndrome, organic - F04 - 29%,depression - F43.20 - 5%,organic hallucinosis - F06.0 - 12%,organic delirium - F05 - 33%,psychotic disorder - or drug induced - F1 - 21%.ConclusionAfter psychiatric examination by an attending psychiatrist, the patients have been moved to the resuscitation department where they have been treated up to their recovery. No one patient has been moved to the mental hospital.
The mental health assessment unit; A novel method for assessing new inpatients
Authors: Ulhaq S. , Ratnayake T. , Agius M. 
Published: May 2011

IntroductionThe Mental Health Assessment Unit (MHAU) isa gateway between community services and in-patient services. It aims to provide an acute setting in which to assess patients within 72 hours, with the view to reducing in-patient hospital admissions. We aimed to ascertain the number of referrals made to the MHAU and admissions over a one month period. The presentation and length of stay was investigated and the diagnosis and follow up plans made were explored.MethodData was collated from a one month period. Crisis and home treatment team (CRHT) notes were reviewed.Results100 referrals were made to the MHAU; 48 patients were admitted. 25 patients had care coordinators. In the majority of cases the source of referral was through the Emergency Department. There was a range of presenting complaints.Diagnoses included a wide variety of nature and severity. Average length of stay was 2 nights. Patients deemed to require in-patient management had shorter length of stay with swift transfer to treatment units. Shorter stays were also associated with milder degrees of illness. Longer length of stay was associated with more complex illness.37 patients were discharged home, 11 were transferred to in-patient treatment units. Most patients discharged home were followed up by the CRHT.5 patients were admitted to the MHAU more than once. This may represent a subgroup of more complex patients.ConclusionWe recommend study into patients’ experiences with care coordinators at times of need. We also plan to re-audit for a longer time frame.
Hypokalemia, psychomotor agitation and prolonging the QTc
Authors: Vega M. , Riaza C. , Chinchilla A. , Gobernado I. 
Published: May 2011

IntroductionThere is a growing concern about the potential risk that the use of certain antipsychotics may have on the QTc prolongation, electrocardiographic parameter key to assess the potential risk of developing a potentially lethal ventricular tachyarrhythmia:“Torsade de Pointes”. Previous studies highlights the existence of low levels of potassium in severely agitated patients versus moderately agitated ones (1). So if we take into account that seriously agitated patients tend to receive higher antipsychotic doses, and mainly antipsychotic with a more sedative profile, we face a hotbed for causing a potentially lethal tachyarrhythmia.AimsEvaluate the presence of hypokalemia in agitated psychiatric patients.MethodsWe chose a random sample of 31 agitated psychotic patients attending emergency room and we make a determination of potassium level at that time, compared to a sample of 33 others randomly as control who donate their blood in the hospital blood bank group. Final results, showed that agitated patients presented potassium figures significantly lower than the control group. (3.88 average in agitated versus 4.14 control group), (p = 0,048).ConclusionsThese data confirm our hypothesis of work and the relationship between hypokalemia and psychomotor agitation in psychotic patients attending the emergency ward, increasing notably the risk for “Torsade de Pointes”.
Relational ethics and psychiatry
Authors: Barbosa A. 
Published: May 2011

In relationship centred medicine perspective it is essential to take into account an ethical principle model for our actions, in a meta-analytical foundational perspective, facing concrete and at the same time complex problems in health care, we have to frame them not in terms of strictly defined principles, either formulate them by general acontextual interpretations or resolve them through abstract procedures.Clinical ethics has been enriched by several contributions that deepen a strict principalist perspective. It is from the observation that the clinic relationship creates, in a space and a time, conditions for the emergence of experiential values of the patient and of the professionals through which you can build a relationship of trust (and not through a process merely procedural), that other ethical questionings emerged in this problematization area (ethics of care, hermeneutics, narrative ethics, responsibility ethics).We describe the way this theoretical and deliberative relational ethical model can be easily applied to different ethical issues in psychiatry practice and research.Relational ethics integrates three basic polarities: creating conditions of personhood authenticity, developing a process of reciprocal mutuality and generating an opportunity of growth, development and enhancement. The hermeneutic helical deliberative process takes always in consideration the context relativity and contingency, the other's perspectives and, by creative co-authorship cooperation, allows the emergence of new possibilities of transformative developmental issues.
Trust and psychosis services: Bridging the gap between managing risk and meeting need
Authors: Brown P. , Calnan M. 
Published: May 2011

IntroductionResearch suggests that trust is vital for quality healthcare and effective outcomes. Trust becomes necessary in conditions of vulnerability and uncertainty. These conditions may be especially relevant to the experience and treatment of mental illness - not least psychosis. There currently exists a paucity of research into trust and mental health services.Aims and objectivesTo develop an understanding of trust as it relates to psychosis services and their users. To identify practical contexts where trust may be particularly relevant and where research may inform policy, service organization and individual practice.MethodSemi-structured interviews were carried out with 21 stakeholders - service-users, professionals, managers, carers - across 3 different types of service working with people experiencing psychosis: early intervention; assertive outreach; and a more standard community mental health team.FindingsTrust appears to be salient and yet problematic for mental health services, not least in terms of approachability, disclosure and cooperation with treatment programmes. Organizing services around understandings of trust, rather than risk, may be more effective both at meeting need and managing risk.ConclusionsThrough an improved understanding of trust and its effect on the engagement of service-users, there are clear potential benefits for mental health services through an enhanced ability to facilitate access and develop effective cooperation towards healthcare outcomes.
Attitudes and experiences to the implementation of the Mental Health Act 2001
Authors: Doherty A.M. , Jabbar F. , Kelly B.D. 
Published: May 2011

IntroductionThe Mental Health Act 2001 was implemented in November 2006 and its introduction has heralded many important changes in the provision of mental health care in Ireland.ObjectivesTo examine the impact of the Act on the time and patterns of attention given to patients since its implementation, and to look at some of the difficulties encountered.AimsTo propose amendments to the legislation, based on the experiences elicited.MethodsThis cross-sectional survey was conducted by questionnaire which we distributed along the chain of command in nursing management. They contained questions looking at attitudes to the Act and the resultant changes in nursing practise. The questionnaire also examined the levels of training with regard to the Act received by members of nursing staff. There was a space given for comments not encompassed by the questions.Results317 questionnaires were returned. 56% of nursing staff believed that their workload had increased as a result of the change in legislation. Of those who made a comment, 76.5% were negative in relation to the new legislation, with increased paper work, lack of clarity and an excessive focus on legal technicalities being the most common difficulties reported.ConclusionNursing staff have shown mixed attitudes to the Mental Health Act 2001. However, as a majority have reported a need for increased training, this is an important need which needs to be met.
The informed consent not to be informed - a cross sectional survey on the use of placebo in clinical practice
Authors: Nitzan U. , Feffer K. , Lichtenberg P. , Lev-Ran S. , Becker G. , Fennig S. 
Published: May 2011

IntroductionCurrent clinical practice excludes placebo usage on ethical grounds. No attempt was made to clarify the viewpoint of the general population regarding the matter.ObjectiveTo evaluate the opinion of young-adults towards the use of Placebo in clinical practice.Aim1)Investigate the willingness of our study population to receive placebo for the treatment of depression or other general medical conditions, and2)assess whether prescribing placebo would affect the study population's view regarding doctor-patient relationship or patient's autonomy.MethodWe enrolled 344 students from five academic institutes in Israel, and briefed them thoroughly about the effects of placebo, its efficacy and limitations in treating depression. Understanding was verified and only then did the subjects complete a 32 item self-report questionnaire (include sociodemographic, health related data, past experience in medical encounters and willingness of subjects to be treated with Placebo medication).ResultsIn contrast to our main hypothesis 70% (N = 243) of the subjects expressed consent to be treated with placebo as a first line treatment had they suffered from depression, and 73% (N = 248) agreed to receive placebo for other general medical conditions. Eighty-eight percent of the subjects (N = 297) did not perceive a physician using placebo as a deceiver or the act of prescribing it a deceit.ConclusionsThe majority of our study population was willing to use placebo medication in general, and in particular, as first line treatment for depression. This study results should promote physicians to rethink and discuss the legitimacy of using placebo in clinical practice.
Research and psychiatric disease
Authors: Friedrich O. , Heinrichs J.-H. 
Published: May 2011

Research with psychiatric patients raises frequently discussed, ethical questions, one of which is: Can psychiatric patients give consent to participation in research at all? To answer this and similar questions adequately, it is - according to our thesis - necessary to analyze first, which theoretical assumptions are made in established practice.To solve the question after the possibility of consent, compatible understandings of ‘disease’, ‘illness’ and ‘autonomy’ are crucial, but there is no consensual use of these terms in philosophy. Therefore we first are going to explain different concepts of ‘autonomy’ and ‘disease’. Subsequent to this we will test how the different conceptualizations of ‘autonomy’ and ‘disease’ can be related to each other and how the reasonable combinations shape possible answers to the opening question. It will become apparent that an adequate analysis of ‘autonomy’ and ‘disease’ raises ethical dilemma in psychiatry, for which we shall suggest possible solutions.
An alert in the psycho-social-health intervention. A graphic testimony of a real case with autism spectrum disorder
Authors: García J.A. , Raya A.S. , del Arco E.S. 
Published: May 2011

The graphic papers of Pablo, 14 years, diagnosed of autism of high functioning, serve as a sign of alert when facing what underlies after the specializing professional intervention.A few letters, a few drawings, and a few words that show the powerlessness, the suffering and the absence of contextual specific adequacy.In this work we study, from the analysis of a real case, some excellent aspects in the psychosociosanitary attention, such as:-The need for compilation of pertinent information-The need for elimination of prejudices-The need for respect to the family-The need for specialized formation-The need for search of a shared communicative code-The need for search of strategies of social interaction-The need for empathy-The need for search of contextual specific adequacy-The need for rigorous rules in the physical containment.-The need of a turned over of adapted information-The need to respect the psychoevolutive situation of the patient-The need to give priority to the person on the illness.A testimony that should serve as a warning for those institutions, administrations and professionals who are thinking of having put all the resources to its scope.A testimony that should serve to contribute information and new challenges to those other professionals who do not stop their determination of conceptual and/or clinical anxious research.
Impact of disease concepts on attitudes towards alcohol dependent patients
Authors: Heberlein A. , Schuster R. , Frieling H. , Glahn A. , Bleich S. , Hillemacher T. 
Published: May 2011

IntroductionStigmatizing attitudes regarding mentally ill people are common (Rusch et al., 2010). Study result suggest that the degree of stigmatization may depend on concepts of psychiatric diseases (Crisafulli et al., 2008).AimsWe aimed to investigate the impact of a sole neurobiological vs. a sole sociodynamic disease concept on the attitudes of students towards the alcohol dependent patients (Crisafulli et al., 2008).Methods200 students were randomly assigned to read information explaining alcohol dependence sole neurobiologically/sociodynamically. Subsequently, the students completed a series of questionnaires (adapted from Crisafulli et al. (2008)) regarding their attitudes towards the alcohol dependent patients. Attitudes were compared to attitudes of students not exposed to any disease concept.ResultsConsistent with former study results we found increased blaming and decreased willingness to finance therapy in those students exposed to the sociodynamic explanation. Attitudes regarding blaming and harmfulness of the alcohol dependent patients were increased in the neurobiological and sociodynamic group compared to the un-exposed control group.ConclusionsInformation regarding possible causalities regarding the development of alcohol dependence is associated with more negative attitudes towards alcohol dependent patients in the questioned students compared to unexposed controls. This may be reasoned by the recognition of alcohol dependence as a manifestation of mental illness and the subsequent inclusion of the alcohol dependent patients in the prejudices and acts of discrimination commonly leveled against the mentally ill. Therefore, multimodal interventions rather than medicinal information seem to be necessary in order to decrease stigmatization of the alcohol dependent patients.
Psychiatry, politics and national socialism
Authors: Pereira S.M. , Bohun J. , Guimarães S. 
Published: May 2011

IntroductionThe misuse of psychiatry by politics during dictatorships has mainly happened in the first half of the last century during the Third Reich and Stalinist period in Soviet Union. Even today the psychiatric diagnoses may be changed in an abusive way for politic purposes as they were in the past. This may undermine the credibility of psychiatry. The psychiatric professional organizations only recently start to discuss and investigate this issue.MethodsThe authors made a literature review in historic and psychiatric books. They also visited some memorial sites were psychiatry and dictatorship were sadly connected in history. Using as main example the abuse made by psychiatrists as a politic instrument in the Third Reich period, the authors aim to make a historic review about the relationship between psychiatry and politics.ConclusionAbuse and misuse in psychiatry may also easily be done nowadays. Psychiatry is a science with not so clear boundaries, what is normal or abnormal may be sometimes unclear mainly if not seen in a serious and ethic perspective. Because of this psychiatrists should be very clear about their position in ethics, science and society.The psychiatric professional organizations should face the facts of the tragic relationship between psychiatry and politics in history, discussing this issue more openly for an appropriate understanding of the past and for preventing new errors in the future.
“I am gaining weight- get me out of here.” what happens to body mass index (BMI) following admission to a medium secure unit?
Authors: Abbasi Y. , Bowlie S. , Bloye D. 
Published: May 2011

IntroductionA diagnosis of mental illness has been associated with weight gain, particularly among patients suffering from schizophrenia1.Aims & objectivesThis study aims to establish trends in weight gain among inpatients and the effects of several public health interventions between 2006 and 2009.MethodsA body mass index (BMI) was calculated on admission and one of the authors has routinely measured the BMI of all inpatients on an annual basis since 2005 as part of a regular audit cycle.ResultsAdmission BMIs are comparable to the male general population2. The vast majority of patients are prescribed antipsychotic medication, approximately 50% receiving clozapine or olanzapine at any given time. There is a wide range of weight change from admission to discharge (−8.5 kg to +60 kg) but the average BMI of each sample exceeds the general population such that a majority of patients in each sample are clinically obese (BMI ≥30).In response to the audit findings the unit promoted public health and individual care plans (2006–09) aimed at addressing the high rates of obesity. Despite these initiatives there was a substantial rise in mean BMI between July 2007 and February 2008.ConclusionsAdmission to a medium secure unit results in substantial weight gain for the majority of patients. The causes of weight gain in a relatively closed institution are probably multi-factorial in origin.