Adult oligophrenia in the large psychiatric hospital

Adult patients with mental retardation are a large group in big psychiatric hospitals. In the last years they were not enough heeded in regard of social psychiatric efforts and rehabilitation. The study shows the problems of misplacement for a big part of that group as in-patients in psychiatric hospitals, points out the necessary integration and continuous social and rehabilitative-pedagogical care. The analysis is based upon some point prevalence studies in the psychiatric hospital BFKH Rodewisch. Finally there are given statements about the future organization of process of caring for adult patients with mental retardation.     

Inpatient suicide in a Chinese psychiatric hospital

Little is known about the risk factors for suicide among psychiatric inpatients in China. In this study we identified the risk factors of suicide among psychiatric inpatients at Guangzhou Psychiatric Hospital. All psychiatric inpatients who died by suicide during the 1956-2005 period were included in this study. Using a case-control design, 64 inpatients with schizophrenia who died by suicide were compared with a matched 64 controls. The results indicate that the rate of suicide was 133.1/100,000 admissions (95%CI 103.4-162.9). There were no significant differences in the method, location, or time of suicide between male and female inpatients. The number of hospitalizations was significantly larger in the suicide group than that in the control group. In logistic regression analyses, guilty thought, depressive mood, and suicidal ideation and suicide attempt 1 month before hospital admission were identified as independent predictors of suicide among inpatients with schizophrenia. The findings of risk factors for schizophrenic inpatient suicide should be taken into account when developing interventions to prevent suicide among these patients.     

Reflections on suicide in a psychiatric hospital

Taking into consideration topical bibliography suicidal events of the psychiatric clinic of the special county hospital for neurology and psychiatry Ueckermünde are introduced and discussed from the point of view of therapeutical and organizational-structural conditions. Hereby practical procedures in the handling of suicidal patients are described.     

Assertive community treatment for frequent users of psychiatric hospitals in a large city: A controlled study

Evaluated a large-city adaptation of the assertive community treatment (ACT) model (Stein & Test, 1980). Outcomes were examined after 1 year for 82 clients, averaging over 17 lifetime psychiatric hospitalizations, randomly assigned either to ACT or to a drop-in (DI) center. After 1 year, 76% of the ACT clients and only 7% of DI clients were involved in the respective programs. The ACT team averaged 2 home and community visits per week to each client. ACT clients averaged significantly fewer state hospital admissions and state hospital days than did DI clients. ACT clients reported greater satisfaction with program services, fewer contacts with the police, and less difficulty with practical problems associated with psychiatric readmission. More ACT clients were known to have stable community housing. Annual per-client treatment costs for ACT were estimated to be $1,500 less than for DI.     

A suicide epidemic in a psychiatric hospital.

The authors report in detail on an epidemic of six inpatient suicides in a psychiatric hospital in Finland. Suggestion and identification had an effect on the timing as well as on the method of four of the suicides. The epidemic is viewed from individual, network, and organizational perspectives. The authors speculate on how such epidemics could be avoided. An increase in inpatient suicide rates has been reported from many countries, and the Werther effect may thus become a topic of considerable importance in psychiatric hospitals in the future.     

Parent-child relationships of adopted adolescents in a psychiatric hospital

This study compared the parent-child relationships of 140 adopted and non-adopted adolescents treated in a psychiatric hospital through examination of information contained in the adolescents' medical records. Specifically, comparisons were made of the mention of parental contribution to the problems precipitating hospitalization, psychiatric restriction of parental visits to hospitalized offspring, and referral of parents to an adjunct parents' group. Data were gathered by uninformed research assistants, from the hospital charts of adolescents who had already been discharged from the hospital. Statistical analysis of the data yielded the following results. Adoptive parents were significantly more frequently restricted in their visits to their children. In addition, they were also more likely to have been involved in the precipitants to hospitalization and to have been referred subsequently for adjunctive treatment. It was concluded that parent-child relations may be more problematic among hospitalized adopted, as compared with non-adopted , adolescents. It was also suggested that psychiatric bias concerning "typical" adoptive family dynamics might have contributed to the observed differences.     

A survey of groups within a psychiatric hospital

Summary

The findings of a survey of the involvement of staff in group activities within a large psychiatric hospital are presented. Over two hundred regular group meetings were being held, excluding ward-rounds and business meetings. There was a wide variation in the type and structure of the groups, the purpose and theoretical underpinning of many of which were unclear to the participants. It is suggested that this lack of clarity reflects the fact that the original therapeutic aims have been subverted in the service of institutionalised defences against anxiety. To be therapeutically effective, groups need clear leadership, good supervision and well-defined aims.     

Symptomatology of adopted and nonadopted adolescents in a psychiatric hospital

This study compared the symptomatology and diagnoses of adopted and nonadopted adolescents in a psychiatric hospital. Data were gathered from the hospital charts of adolescents who already had been discharged from the hospital. Contrary to expectations, adoptees were no more likely than nonadoptees to have received personality disorder diagnoses, nor were they more likely to be hospitalized as the result of antisocial behavior. However, in comparison with nonadopted adolescents, the adopted adolescents were younger upon admission to the hospital, significantly less often diagnosed psychotic, and significantly more often diagnosed adjustment reaction. It was suggested that adopted adolescents may be less likely than nonadopted adolescents to require severe or prolonged pathology in order to be admitted to a psychiatric hospital. It was also suggested that the antisocial symptomatology so frequently observed in adopted children in mental health settings does not account for the hospitalizations of those receiving inpatient treatment.     

The integration of family therapy in a psychiatric day hospital

The clients, who present themselves at our psychiatric day hospital in Amsterdam, often have long-standing problems. These problems are usually of a complex nature, and the age of the clients plays an imporant role in this. Their age varies from seventeen to forty, with an average of twenty-eight.
Efforts were made over a long period to facilitate solutions to the clients' family conflicts. During this time an extensive range of problems within the family were presented of which the symptoms of the client represent just a part.
Working as a family therapist in a psychiatric day hospital, where clients are admitted individually, places the family therapist in a number of dilemmas, especially when many working in the hospital see the problems only as individual ones.     

Early suicide following discharge from a psychiatric hospital

Social and clinical risk factors for completed suicide occurring shortly after discharge from a psychiatric hospital were examined in this case-control study. Seventy-seven individuals who received "suicide" or "undetermined death" verdicts at inquest, and who had been previously discharged from psychiatric hospitals in Bradford, U.K., were compared with a control group. A history of deliberate self-harm was significantly associated with early suicides compared with both late suicides and controls. A diagnosis of mood disorder, specifically depression, and longer case-notes were also significantly associated with early suicides compared to controls. This study has implications for risk management of recently discharged psychiatric patients.     

Concurrent group and individual psychotherapy in a psychiatric day hospital for depressed elderly

Concurrent psychotherapy is used in various settings for patients of different diagnoses and ages. The concurrent group and individual psychotherapy of older adults with depressive disorders in a psychiatric day hospital is described, emphasizing phases of treatment and transference and countertransference themes uniquely relevant to working with depressed elderly patients in a day hospital. Case examples are offered to illustrate these issues. The special technical considerations that need to be utilized when multiple therapists and settings are present are described. The model employs the use of an integrative, interactive group therapy, along with various other group treatments and antidepressant medication, with individual therapy serving a subordinate but organizing role.     

Effect of a total smoking ban in a maximum security psychiatric hospital

An archival study was performed in a maximum security forensic hospital to evaluate the effects of a total ban on smoking and all tobacco products. One hundred and forty patients were characterized as nonsmokers or light, moderate or heavy smokers. Patient records for the four weeks prior to the ban were compared with their records for the four weeks subsequent to the ban. Numbers of sick calls, total disruptive behaviors and verbal aggression declined markedly and significantly following the ban in those patients previously classified as moderate or heavy smokers. Weight increased significantly, but almost equally regardless of previous smoking status. Patients, and eventually staff, tolerated the smoking ban without significant negative effects. Patients relied very little on treatment modalities to alleviate nicotine withdrawal. Pre-ban apprehension by staff and patients dissipated with time after the smoking ban started.     

The status of legally committed psychiatric patients in the psychiatric hospital

101 mental patients hospitalized according to a court decision stayed on average for 9.7 years. General behaviour, social independence and chances for discharge were not related to illness but to the duration of accommodation. The chances for discharge decrease as the stay in hospital increases. The initial medical reasons for hospitalization are the less important factor in the period of in-patient treatment. The foundations for successful medical and social rehabilitation can only be laid in the early stage of accommodation.     

Suicide prevention in the psychiatric hospital

It is currently impossible to distinguish between patients with depression who will make a suicide attempt and those who will not. Prevention, therefore, must be based on the assumption that any patient with more than mild symptoms of depression is at risk of suicide, and can only be effective if it is applicable to all patients with moderate to severe depression. A treatment strategy that differentiated between regressive and progressive therapeutic measures was developed for patients admitted to a psychiatric hospital. Regressive, as opposed to progressive, treatment meant that the patient was temporarily relieved of virtually all responsibilities for self and others. Progressive measures were strictly avoided for all patients with symptoms of depression, regardless of the primary diagnosis. This strategy was tested on 5,149 inpatients and day patients over a period of 6.25 years and compared with 6,891 patients over the 15.75 years prior to this period. The suicide rate was 97 (per 100,000 admissions) compared with 319 in the previous period. The treatment method appears to be able to reduce the suicide rate. Although this result was achieved with hospital patients, it suggests that a regressive treatment method could be promising if developed for outpatient treatment as well.     

Architectural design of a secure forensic state psychiatric hospital

This article describes the architectural design of a secure forensic state psychiatric hospital. The project combined input from staff at all levels of the client organization, outside consultants, and a team of experienced architects. The design team was able to create a design that maximized patient dignity and privacy on one hand, and the ability of staff to observe all patient activity on the other. The design centers around 24-bed units, broken into smaller living wings of eight beds each. Each eight-bed living wing has its own private bathrooms (two) and showers (two), as well as a small living area solely reserved for these eight patients and their guests. An indoor-outdoor dayroom allows patients to go outside whenever they choose, while allowing staff to continue observing them. The heart of the facility is a large treatment mall, designed to foster the acquisition of social, emotional, cognitive, and behavioral skills that will help patients to safely return to their communities.