Characteristics of patients admitted to an adult PICU as compared to general adult inpatient units: a service evaluation

2021 ◽  
Author(s):  
Kirsty Ward ◽  
Suveera Prasad
Keyword(s):  
Mental Health ◽  
Risk Factors ◽  
Substance Misuse ◽  
Service Evaluation ◽  
Adult Mental Health ◽  
Icd 10 ◽  
Adult Inpatient ◽  
Increasing Demand ◽  
Mental Health Unit ◽  
Inpatient Units

Background: There is a need to ensure that mental health services adapt to the increasing demand for inpatient beds, particularly within PICUs. This study aims to identify risk factors and assess demographics of patients which may increase the risk of admission or transfer to a PICU.Method: A retrospective analysis of 85 discharges from an adult mental health unit. We collected data on demographics, admission, ICD-10 diagnosis and readmission figures. We compared two cohorts: those who required admission to a PICU and those who did not.Results: 18 (21.2%) patients were admitted to the PICU. They were younger, more likely to be male, single and unemployed. PICU admissions were more likely to have a forensic history (p = 0.009), substance misuse history (p = 0.074), to require seclusion (p<0.0001), police involvement (p = 0.443), physical health input in the form of senior medical or surgical advice (p = 0.026) and assessment at an acute hospital (p = 0.015). Schizophrenia and schizoaffective disorders were less common than substance misuse disorders within the PICU cohort (p = 0.535). They were also more likely to be discharged to another PICU and to be re-admitted.Conclusion: This population demonstrated that F10–19 diagnoses were the most frequent within the PICU cohort which contradicts the previous literature. We identified risk factors for admission to a PICU, demonstrating the demand for inpatient services to adapt to the needs and demographics of patients and allowing early identification of high risk individuals.

scholarly journals Identifying Risk Factors for Re-admission: A Service Evaluation from an Adult Inpatient Mental Health Unit

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S59-S59
Author(s):  
Kirsty Ward ◽  
Suveera Prasad
Keyword(s):  
Mental Health ◽  
Risk Factors ◽  
Personality Disorder ◽  
Substance Misuse ◽  
P Value ◽  
Health Unit ◽  
P Values ◽  
Adult Mental Health ◽  
Emotionally Unstable Personality Disorder ◽  
Mental Health Unit

AimsTo identify risk factors for re-admission to an acute inpatient general adult mental health ward. There is need to ensure that mental health services adapt to the increasing demand for inpatient bedsMethodWe conducted a single centre retrospective analysis of electronic records of 85 discharges from an adult mental health unit from 4th March 2019 – 5th August 2019. We collected information on demographics, admission details, substance use, forensic history, diagnosis as per the International Classification of Diseases 10th Edition (ICD-10), and discharge details and compared two cohorts; those re-admitted within three months of discharge and those who were not. Odds ratio (OR), 95% confidence intervals (CI) and p values were calculated where possible.ResultAmong seventeen service users who were re-admitted within the three month period there were nine women and eight men. There was no difference in ethnicity, employment or marital status. The mean length of admission for those readmitted was 48.2 days (range 1–140 days) and 47.1 days (range 1–350 days) for those who were not readmitted. Certain features were more prevalent among the readmitted group including forensic history (58.8% [10] vs 26.5% [18], OR 3.97, CI 1.31–11.9, p value 0.007), substance misuse history (70.6% [12] vs 55.9% [38], OR 1.89, CI 0.60–5.97, p value 0.138), previous contact with mental health services (100% [17] vs 76.5% [52]) and the rate of detention under the Mental Health Act at point of admission (76.5% [13] vs 66.2% [45], OR 1.66, CI 0.49, 5.67, p value 0.209).Among those readmitted, a diagnosis of emotionally unstable personality disorder (17.6% [3] vs 10.3% [7], OR 1.87, CI 0.43,-8.14, p values 0.203) and substance misuse disorder (41.2 % [7] vs 17.6 % [12], OR 3.27, CI 1.04–10.31, p value 0.218) were more prevalent. They were more likely to use illicit substances whilst they were an inpatient (23.5% [4] versus 7.6% [5], OR 3.88, CI 0.92–16.43, p value 0.033) and to be involved in police incidents (35.3% [6] versus 17.6% [12], OR 2.55, CI 0.79–8.23, p value 0.059).ConclusionOur trends demonstrate that people with substance misuse, emotionally unstable personality disorder and forensic history are more likely to be readmitted to an adult mental health inpatient unit. They were more likely to misuse illicit substances and be involved with police during admission.

scholarly journals Preliminary investigation into the identification and management of catatonia in patients admitted to adult inpatient units

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S336-S336
Author(s):  
Joanna Moore ◽  
Amy Kunicki ◽  
Georgina Latcham ◽  
Eleanor Perkins ◽  
Emma Vaccari
Keyword(s):  
Neuroleptic Malignant Syndrome ◽  
Mental State ◽  
Rating Scale ◽  
Statistical Significance ◽  
Preliminary Investigation ◽  
Psychiatric Inpatients ◽  
Service Evaluation ◽  
Improvement Project ◽  
Adult Inpatient ◽  
Inpatient Units

AimsThe prevalence of catatonia is considered to be approximately 10% in psychiatric inpatients. Clinical experience suggests a lower documented prevalence. This could cause longer admissions and complications, such as Neuroleptic Malignant Syndrome (NMS). We carried out a service evaluation to investigate the recognition and management of catatonia on inpatient units in Southern Health Foundation Trust (SHFT). We reviewed the local documented prevalence of catatonia, treatment offered and prevalence of complications.MethodWe retrospectively reviewed the electronic records of 95 consecutive admissions to four adult inpatient units in SHFT, starting on 1st August 2020. We reviewed notes for the admission to establish whether catatonia was suspected and identified. We applied the screening questions from the Bush-Francis Catatonia Rating Scale (BFCRS) to the documented mental state examinations (MSE) prior to, and shortly after, admission. We also recorded the prescriptions issued during the first 72 hours of admission, and whether patients developed neuroleptic malignant syndrome (NMS), serotonin syndrome or required admission to a general hospital during admission.ResultCatatonia was documented as a possibility for 2 patients (2.1%). One showed possible posturing and stupor, while there were no documented symptoms for the other. In both cases the possibility was discounted by the clinical team. Twelve patients (12.6%) showed one or more possible or confirmed signs of catatonia. Eleven of these were prescribed regular antipsychotic medication on admission, but only 3 were prescribed regular benzodiazepines. NMS was more likely to be suspected in patients with a BFCRS of 1 or more compared with those with a score of 0, with an odds ratio of 8.1 (95% CI [1.03-64.0], Fisher's exact test = 7.79, p = .076).ConclusionCatatonia is likely under-recognised and under-treated locally among psychiatric inpatients. Although only approaching statistical significance, the higher rate of suspected NMS in patients showing possible catatonia is noteworthy and needs further investigation. Regular benzodiazepines were not frequently prescribed in this group, while antipsychotics, prescribed in all of these patients, can precipitate NMS. Alternatively, this finding could reflect the overlap in clinical presentation between NMS and catatonia. Data collection was limited by the frequent use of “remote clerking”, in the context of the COVID-19 pandemic. Additionally, the quality of mental state examinations was often not sufficient to draw any conclusions on the possible presence or absence of catatonic symptoms. This project has highlighted practice in need of improvement, which will be further prospectively investigated and improved via a Quality Improvement Project.

Reducing Restraint and Seclusion in an Acute Aged Person's Mental Health Unit

2011 ◽  
Vol 19 (6) ◽  
pp. 498-501 ◽  
Author(s):  
Hemalatha Sivakumaran ◽  
Kuruvilla George ◽  
Ken Pfukwa
Keyword(s):  
Mental Health ◽  
Qualitative Data ◽  
Management Practice ◽  
Inpatient Setting ◽  
Health Unit ◽  
Related Factors ◽  
Behaviour Management ◽  
Major Factors ◽  
Mental Health Unit ◽  
Inpatient Units

Objective: This paper describes how a significant reduction in restraint and seclusion rates was achieved in an acute aged person's mental health unit. Method: We analysed seclusion and restraint data in 2009. This was supplemented with a random audit of patient files and qualitative data obtained from a survey of nursing staff. We also obtained management views on changes in management practice. Results: Four major factors were found to reduce rates of restraints and seclusion. These included: (i) leadership and support from management in nursing practices, (ii) increased multidisciplinary team input, (iii) renovations to the inpatient setting, and (iv) changes in treatment-related factors such as collection of behaviour management history and improving documentation in patient files. Conclusion: Experiences such as this provide insights and practical strategies that can be applied in other aged inpatient units to reduce or eliminate rates of seclusion and restraints.

scholarly journals An analysis of the views of different members of the inpatient team on the role of the physician associate on the general adult psychiatric wards

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S140-S141
Author(s):  
Declan Hyland ◽  
Mohammed Uddin
Keyword(s):  
Mental Health ◽  
Strong Argument ◽  
Staff Members ◽  
X Band ◽  
Negative Comments ◽  
Mental Health Settings ◽  
Adult Inpatient ◽  
Inpatient Units ◽  
Assistant Practitioner

AimsPhysician Associates (PAs) are healthcare professionals who have a general medical education background, having completed a two-year postgraduate degree. Whilst the number of PAs employed in healthcare trusts continues to increase, the number working in mental health settings remains small.Mersey Care NHS Foundation Trust employed two PAs two years ago. In August 2019, a third PA was recruited to work at Clock View Hospital, a general adult inpatient unit.This analysis aimed to establish the views of different members of the team across the three general adult wards and the Psychiatric Care Unit (PICU) at Clock View Hospital on the role of the PA.MethodA sample of members of staff was identified from across the three general adult inpatient wards at and the PICU, comprising: senior doctors (Consultants and Specialty Doctor), junior trainees (Core Trainee and Foundation Trainees), Ward Manager, Deputy Ward Manager, Band 5 nurse and Assistant Practitioner. Each member of staff was asked to answer the question “On a scale of 1 to 10 (with “1” being completely unhappy, “10” being completely happy), how happy are you to have a PA working on your ward?” Each staff member was then asked to provide comments on their views on the role of the PA.ResultTwenty-three members of staff participated – 3 x senior doctors, 4 x junior trainees, 4 Ward Managers, 4 Deputy Ward Managers, 4 x Band 5 nurses and 4 x Assistant Practitioners. The respondents were distributed equally across the three general adult wards and the PICU. All 23 members of staff provided a score of 10 out 10 to the question about how happy they were to have a PA working on the ward. Many of the staff members provided some very positive comments on their respective views about the role of the PA at Clock View Hospital. No negative comments were provided by any members of staff.ConclusionIt is clear from the large sample of members of staff of different grade at Clock View Hospital that were surveyed that the PA has been a warmly received and welcome addition to the inpatient team and that the PA is viewed as having become an important and valued member of the inpatient team. This provides a strong argument for both Mersey Care NHS Foundation Trust, and other mental health trusts across the U.K., to consider employing more PAs to work in their inpatient units.

Cannabis Use in Persons With Inflammatory Bowel Disease and Vulnerability to Substance Misuse

2019 ◽  
Vol 26 (9) ◽  
pp. 1401-1406 ◽  
Author(s):  
Tawnya M Hansen ◽  
Brigitte C Sabourin ◽  
Banke Oketola ◽  
Charles N Bernstein ◽  
Harminder Singh ◽  
...  
Keyword(s):  
Mental Health ◽  
Risk Factors ◽  
Inflammatory Bowel Disease ◽  
Logistic Regression ◽  
Depressive Symptoms ◽  
Bowel Disease ◽  
Substance Misuse ◽  
Cannabis Use ◽  
Factors Associated ◽  
Inflammatory Bowel

Abstract Background It is unknown whether cannabis users self-medicating their inflammatory bowel disease (IBD) symptoms are more likely to have comorbid mental health or personality risk factors associated with an increased potential for substance misuse compared with recreational cannabis users. Methods We surveyed individuals with IBD about their cannabis use, their mental health symptoms, and personality risk factors associated with substance misuse. We compared risk factors for substance misuse between individuals using cannabis to manage IBD symptoms and those using cannabis recreationally. Results Of 201 persons with IBD who completed the questionnaire, 108 reported lifetime cannabis use. Of those, a larger proportion of Crohn’s disease patients used cannabis to manage IBD symptoms (53% [34/64] vs 28% [12/43]; P = 0.010). Individuals self-medicating with cannabis were more likely to use cannabis for coping reasons (P = 0.016) and demonstrated higher levels of impulsivity (P = 0.004) and depressive symptoms (P = 0.012) when compared with individuals using cannabis recreationally. Logistic regression revealed that cannabis was 4.1 times (P = 0.05) and 3.7 times (P = 0.05) more likely to be used for IBD symptoms by smokers and individuals with moderate–severe depressive symptoms, respectively. Individuals high in impulsivity were 4.1 times more likely to use cannabis for their IBD symptoms than those low in impulsivity (P = 0.005). Conclusions Persons with IBD self-medicating with cannabis have characteristics associated with increased vulnerability to substance misuse when compared with those using cannabis recreationally. Screening for mental health comorbidities and vulnerability to substance misuse should be undertaken if cannabis is to be used to treat IBD symptoms.

scholarly journals Pandemic and student mental health: A cross-sectional and longitudinal analysis of mental health symptoms amongst university students and young adults after the first cycle of lockdown in the UK

2021 ◽  
Author(s):  
Nicole Tang ◽  
Katharine McEnery ◽  
Laura Chandler ◽  
Carla Toro ◽  
Lukasz Walasek ◽  
...  
Keyword(s):  
Mental Health ◽  
Risk Factors ◽  
Young People ◽  
University Students ◽  
Substance Misuse ◽  
Mental Health Symptoms ◽  
Health Symptoms ◽  
The Uk ◽  
Anxiety Depression ◽  
The Impact

BackgroundEarly COVID-19 research suggests a detrimental impact of the initial lockdown on youngpeople’s mental health, but it is unclear whether the impact would persist.AimsWe investigated mental health symptoms amongst university students after the firstlockdown in the UK and changes in symptoms over 6 months. We examined risk factors forthese symptoms and whether they were shared by young people not in higher education.Method895 university students and 547 young people not in higher education completed an onlinesurvey at T1 (July-September 2020). A subset of 203 university students also completeda 6-month follow-up survey at T2 (January-March 2021). Mental health symptomsmeasured were anxiety, depression, insomnia, substance misuse, and suicide risk.ResultsAt T1, nearly 40% of the participants reported moderate to severe symptoms of anxiety anddepression and risk of substance misuse; a quarter reported insomnia and clinicallysignificant suicidal risk. A reduction in anxiety, depression and insomnia was observed inparticipants reassessed at T2, but not in substance misuse and suicidality.Cross-sectionally, greater symptoms across measures were consistently associated withgender (female or other), sleep irregularity, and a worse-off financial status. Longitudinally,the most consistent risk factors for T2 symptoms were having previously diagnosed mentalhealth problems and having difficulty sleeping since the first lockdown.ConclusionsMental health symptoms were prevalent in a large proportion of young people after the firstlockdown. Risk factors identified may help characterise high-risk groups for enhancedsupport and inform interventions in both university and non-university settings.

Sign in / Sign up

Export Citation Format

Share Document