Community meeting: review, update, and synthesis

The community meeting is a frequent regular meeting in a psychiatric ward or institution that is attended by all staff and patients. It meets for the purpose of communication, ward management, or psychiatric treatment. The conditions of the current hospital psychiatric treatment environment are very different from the treatment environment where the therapeutic community concept was first established, particularly in terms of the shortened length of hospital stay and the emphasis on pharmacologic rather than psychotherapeutic methods of treatment. However, even with these changes, an admixture of psychopharmacologic treatment and therapeutic community principles has been advocated as an effective, realistic, and desirable treatment modality in today's hospital environment. A synthesis of an extensive literature review from both a theoretical and research perspective on the community meeting is presented. A schema has been developed listing elements for practice in today's hospital climate.     

综合医院心理病房管理模式的探讨研究

为了探讨建立综合医院开放式心理病房新型管理模式的意义及可行性,对郑州市第九人民医院心理科病房采用开放式管理模式,分析480例住院患者的疗效。结果显示,综合医院哥放式心理病房管理模式具有疗效好、住院周期短等优点,提示综合医院开放式心理病房有利于精神病的治疗。     

The psychiatric infant—family ward at Tampere University Hospital

This article describes a new integrated evaluation and intervention program for infants, small children and their families, a child psychiatric infant–family ward treatment model at Tampere University Hospital. A centerpiece of the model is a 3-week treatment period for the whole family at the infant–family day ward. The work of the multidisciplinary team on the ward focuses on family relationships, on representational level, and on the interactional behavior of the family. Interaction and relationships are used as tools, including a reflective working model and sharing concrete interaction with the family. Theoretically, the treatment is based on an integrative model where psychoanalytical and systems theories as well as a behavioral approach are applied in defining the strengths and problems of the family and of the infant and in choosing the best intervention techniques. The fact that the whole family is present at the ward creates a strong therapeutic holding relationship context and an open therapeutic reflection, which are the cornerstones of this new and encouraging treatment model. © 1998 Michigan Association for Infant Mental Health     

A virtual psychiatric ward for orientating patients admitted for the first time

Misconceptions about psychiatric wards frequently cause newly admitted mental patients to stay away from these wards despite their need for treatment. Although ward orientation is typically conducted by nurses in an attempt to help patients to adapt to the new environment, it is considered time-consuming, and the method of orientation and the explanations given may vary among different nurses. This situation calls for a more effective and standardized approach to orientating mental patients on their first admission. To this end, a computer-based interactive virtual environment was developed based on a real psychiatric ward by using virtual reality (VR) technologies. It enables the patient to navigate around to gain understanding about the ward through a virtual guided tour. The effectiveness of this VR orientation approach was investigated by a randomized controlled trial with consecutive sampling. Fifty-four Chinese participants were randomly assigned to undergo ward orientation by either using the VR-based approach or reading text-based electronic information sheets about the ward with a computer. Subjective and objective measures were obtained respectively using the Chinese version of the State-Trait Anxiety Inventory questionnaire and the heart-rate variability measurement before and after the intervention. In addition, a test on the level of understanding about the ward was administered at the end of the session. The results showed that the VR orientation approach is helpful in reducing patients' anxiety while also improving their level of understanding about the ward.     

Family Psychiatric Ward Treatment in India

The evolution of family psychiatric ward treatment is reviewed with special reference to the developments at the National Institute of Mental Health and Neuro Sciences, Bangalore, India. The set-up and philosophy of the Family Psychiatric Center are highlighted. Case reports are included.
The effects of the patient's preference to be accompanied by a particular relative during family ward treatment was studied. The patient's preference for a particular relative was determined by means of a questionnaire. It was found that staying with the preferred relative was associated with a shorter stay and also that different preferred relatives had a differential effect on the duration of the hospital stay of the patient.     

A Short-Term,Family-Oriented,Child and Adolescent Psychiatric Inpatient Treatment Program

We describe a short-term inpatient treatment program whose purpose is to integrate the different interventions in the child, his or her family, and the outpatient professional network. The interaction between the family and the ward is the basic structural element of child psychiatric inpatient treatment. The child, the family, the professional outpatient network, and the ward community together form an extended therapeutic system. Inpatient treatment can be understood as a coevolving process between these systems. The essential feature in our working model is the continuous, daily nursing staff supervision and a focus on interactions in the extended therapeutic system.     

Schlafstörung – Symptom der Depression?

Sleep disorders are an interdisciplinary health issue. Among western industrialized countries, many people suffer from poor quality of sleep. Especially, psychiatric patients have a high prevalence of sleep disorders. The treatment of sleep disorders should follow a detailed sleep history and polysomnographic work-up, which is often not possible in daily work. Thus, patients with sleep disorders are often not treated accurately. Mobile inhospital polysomnography is an attractive alternative that allows tests to be performed already during normal hospitalization on any ward. The following case report shows that the diagnostic work-up of sleep disorders can significantly affect further treatment decisions.     

Group Activities to Promote Early Rehabilitation in an Acute Psychiatric Ward: A Relationship-Based Approach Focusing on Movies

Our Psychiatry Institute has a long-standing tradition of providing training in the importance of relational and emotional skills and helping relationships. Here we describe techniques that are routinely used on our psychiatric ward (Maggiore della Carità Hospital, Novara, Italy) to promote early rehabilitation of acute psychiatric inpatients. We focus on the Cinema group, which is typical of our approach to informal, therapeutic group activity. Targeting social and relational issues as adjunct to treatment as usual is useful in acute settings and can begin at an early stage of hospitalization. Our intervention is designed to improve patients’ coping strategies, relational and communication skills, and overall quality of life.     

The use of a resident daily scheduling procedure to increase appropriate social,ward, and scheduling behavior in adult psychiatric residents (patients)

The purpose of the present experiment was to investigate the efficacy of a goal orientation procedure in their treatment of apathy, isolation, and insufficient goal setting skills in chronic psychiatric residents. The experiment was conducted in a behaviorally-oriented deinstitutionalization program in a state psychiatric hospital. Three male and four female chronic psychiatric residents served as research participants. A group repeated measures design with four within-participant phases (ABA‘B’) was utilized. The goal orientation procedure included a written schedule that was completed by each research participant daily. This Daily Living Schedule required that a behavior be specified by the participant for every half-hour period during the day (8:30 a.m. to 9:00 p.m.). During all four phases of the experiment, research participants were observed on the ward from 8:30 a.m. to 12:00 noon and 1:00 p.m. to 5:00 p.m. for engagement in scheduled target behaviors. The daily scheduling procedure produced substantial increases in appropriate behavior such as social activities, ward jobs, and participation in treatment programs, whereas decrease were produced in inappropriate behavior such as isolation and day time sleeping.     

Die psychiatrische Vorgeschichte schizophrener Maßregelpatienten -Rahmenbedingungen der Deliktprävention durch die Allgemeinpsychiatrie

Background

People suffering from schizophrenic disorders are at increased risk of committing violent crimes. In the present study, we investigated the conditions of preventing offences by general inpatient psychiatric services.

Method

The sample enclosed 75 patients treated at forensic hospitals in Baden-Württemberg, Germany. Data on frequency and date of previous delinquency and general psychiatric treatments were collected from the clinical records and from the psychiatric expertise provided for the sentencing.

Results

Prior to the severe offence leading to forensic detainment, eighty-three per cent of the cases had been treated at least once at a general psychiatric hospital while indications of a risk of delinquency were already present. Even if more specific risk indicators were used and patients with only one general psychiatric treatment episode were excluded, nearly two thirds of cases remain as target group for prospective general psychiatric prevention programs. On average, six inpatient treatments during the course of six years would have provided opportunities to prevent delinquency. However, in twenty-five per cent of the cases, the crime leading to admission to a forensic unit took place within an institutional environment (wards, penal institution). Of the offences that were committed outside of an institution, fifty per cent occurred during the first year after a general psychiatric treatment. Two thirds of the sample had committed an offence before first admission to general psychiatric treatment. On average, the first offence preceded the first admission by 4,6 years.

Conclusions

General psychiatric services provide promising opportunities to prevent delinquency among schizophrenics at risk for criminal offending. Specific programs that are effective beyond discharge from a general psychiatric ward should be developed and evaluated.     

Clinical pastoral training in an emergency psychiatric service

Summary This paper reports the utilization of an emergency psychiatric service as a new factor in the clinical pastoral training experience. The usual pattern of clinical setting for these students is the hospital ward, where the patient has already been admitted and is making some adjustment to hospital routine and treatment. In such a setting the student misses the opportunity to see the patient at the crisis point of the illness and does not see the large numbers of individuals troubled enough to require psychiatric help but not sick enough to be hospitalized. The latter group constitute the largest portion seen by the parish minister even before psychiatric referral is arranged. During a twelve-week clinical pastoral training program, each student spent a major portion of his time for two of the weeks working on an emergency psychiatric service with a psychiatrist and social worker and seeing a large variety of patients, most of whom were not hospitalized. The experience provided an opportunity to develop evaluative skills and knowledge of appropriate community resources, and offered some experience in brief counseling under supervision. The clinical pastoral training student and the personnel of the emergency service all felt that this was an experience of mutual value and that it should be for a longer period. It is suggested that other clinical pastoral training programs would find it of value to utilize emergency psychiatric clinic settings where available.     

Situational determinants of inpatient self-harm

Auto-aggressive individuals have a higher likelihood of engaging in interpersonal violence, and vice versa. It is unclear, however, whether ward circumstances are involved in determining whether aggression-prone patients will engage in auto-aggressive or outwardly directed aggressive behavior. The current study focuses on the situational antecedents of self-harming behavior and outwardly directed aggression of psychiatric inpatients. Inwardly and outwardly aggressive behavior were monitored on a locked 20-bed psychiatric admissions ward for 3.5 years with the Staff Observation Aggression Scale-Revised (SOAS-R). A map of the ward was attached to each SOAS-R form, enabling staff members to specify locations of aggressive incidents. Time of onset, location, and provoking factors of auto-aggressive incidents were compared to those connected to aggression against others or objects. Of a total of 774 aggressive incidents, 154 (20%) concerned auto-aggressive behavior. Auto-aggression was significantly more prevalent during the evening (i.e., 50% compared to 32%), and reached its highest level between 8 and 9 P.M. (17% compared to 7%). The majority of self-harming acts (66%) were performed on patients' bedrooms. Outwardly directed aggression was particularly common in the day-rooms (24%), the staff office (19%), the hallways of the ward (14%), and the dining rooms (10%). Provoking factors of auto-aggressive behavior are less often of an interactional nature compared to outwardly directed aggression. The results suggest that a lack of stimulation and interaction with others increases the risk of self-injurious behavior. Practical and testable measures to prevent self-harm are proposed.     

Self-Induced Water Intoxication in a Psychiatric Asylum: A Case Study of Diagnostic Categorization and Regulation

In this article, we examine the regulation of psychiatric patients becoming intoxicated from drinking excessive amounts of liquids at a large psychiatric asylum in Canada. We analyze how medical staff created a formalized diagnostic category and a specialized ward for its treatment. We consider the institutional context in which “water intoxication” was developed as a diagnostic category and we examine the impact of this diagnosis on the regulation of asylum patients. Finally, we discuss the patients’ opposition to treatment as well as the impact of “water intoxication” on their self-identity and institutional status.     

The team meeting on a rapid turnover psychiatric ward: clinical illustration of a model for stages of group development.

This article illustrates stages of group development in a semi-structured team meeting of staff and patients in an inpatient psychiatric unit. Clinical material drawn from such a group at the Massachusetts Mental Health Center is presented in support of the view that, even in a rapid-turnover ward, group process in a mixed-level, mixed-diagnosis "ward meeting" follows some predictable lines and responds to the articulation of certain predictable concerns. Garland's (1981) model of group development is adapted to show the cyclical nature of group process in a teaching hospital, where doctors as well as patients may make only brief stays. Effective leadership strategies are suggested.     

Pharmacotherapy of schizophrenia and affective disorders: Behavioral assessment of psychiatric medications

Objectively defined, publicly observable ward behaviors (body activity, extremity activity, scanning, social interaction, proximity, participation, laughing/smiling, and idiosyncratic behavior) emitted by psychiatric inpatients with either schizophrenic or affective disorders were time sampled both before and during the administration of psychiatric medications (neuroleptics, tricyclics, and lithium). The data indicate that the primary effects of the pharmacological interventions are confined to activity measures and symptoms rather than social behaviors. The implications of these results for treatment protocols are discussed in terms of interactions between pharmacological and psychosocial interventions. In addition, rates of behavior during treatment were related to baseline rates via a log-log function of negative slope, a result that is consistent with data derived from the infrahuman laboratories. Taken together the results provide support for attempts to relate preclinical and clinical psychopharmacology and suggest that behavioral assessment can be applied profitably to drug effects in clinical situations.These investigations were supported in part by State of Illinois Department of Mental Health and Developmental Disabilities Grants RD836-13 and RD622-02 to the first author. The cooperation of the Illinois State Psychiatric Institute staff is gratefully acknowledged. Assistance in data collection was provided by S. Sussman and K. Mueser.     

An information system for measuring patient behavior and its use by staff

A behavioral measurement system was designed around a point economy for a psychiatric ward of delinquent patients. The characteristics of the system were: (1) the records of points earned for appropriate patient behavior formed the primary data. (2) After the points were recorded in a data matrix, graphs were prepared to show the behavior of individual patients, the participation of the patient group in the various ward activities, and an overall index of ward operation. (3) Several techniques were devised for reviewing the graphs so that the ward staff could evaluate the success of their procedures over substantial time periods.     

Suicide mortality of suicide attempt patients discharged from emergency room, nonsuicidal psychiatric patients discharged from emergency room, admitted suicide attempt patients, and admitted nonsuicidal psychiatric patients

The suicide mortality rate and risk factors for suicide completion of patients who presented to an emergency room (ER) for suicide attempt and were discharged without psychiatric admission, patients who presented to an ER for psychiatric problems other than suicide attempt and were discharged without psychiatric admission, psychiatric inpatients admitted for suicide attempt, and psychiatric inpatients admitted for other reasons were examined. The records of 3,897 patients who were treated at a general hospital in Seoul, Korea, from July 2003 to December 2006 were reviewed. Forty-three of the 3,897 subjects died by suicide during the 2.5-year observation period. Compared to the general Korean population, the suicide mortality rate was 82-fold higher for suicide attempt patients, admitted; 54-fold higher for suicide attempt patients, discharged; 21-fold higher for nonsuicidal patients, admitted; and 11-fold higher for nonsuicidal patients, discharged. In all four groups, diagnosis of a depressive disorder and suicide attempt at presentation were each significant independent risk factors for suicide completion. These results highlight the need for suicide prevention strategies for depressed patients who present to the ER or are admitted to a psychiatric ward after a suicide attempt.     

A community meeting protocol for assault prevention

Assaultive behavior by patients is a serious problem throughout healthcare facilities. Currently, wide variability exists in the approaches used to deal with assaultive behavior. The immediate objective of this study was to perform a consensus validation of the community meeting as a prevention and intervention measure for assault. The community meeting is a regular meeting of all staff and patients for communication, ward management, or psychiatric treatment. A delphi survey, with three iterations, was used to operationalize the collection of judgments and achieve convergence of opinion from expert respondents. A protocol for a Violence Prevention Community Meeting (VPCM) was established.