A Prehospital Emergency Psychiatric Unit in an Ambulance Care Service from the Perspective of Prehospital Emergency Nurses: A Qualitative Study

The prevalence of mental illness is steadily increasing, and ambulance teams frequently attend cases with suspected mental illness. A pilot project, Psychiatric Emergency Response Team (PAP), was carried out in which a prehospital emergency nurse (PEN) was accompanied by a psychiatric specialist nurse in the assessment of individuals with mental illness. The aim of the present study was to evaluate a prehospital emergency psychiatric unit from the perspective of PENs. A qualitative method using content analysis was applied. Seven senior PENs who had worked for 1 year in a prehospital psychiatric ambulance unit were interviewed individually. The analysis resulted in one main theme, “Transition from limited care and insufficient competence to improved and adequate care for psychiatric patients in ambulance care”. This emerged from six subcategories: inter-professional development, access to patient records, the ambulance vehicle, non-conveyed patients, cooperation with the police and meetings with patients and next of kin. In conclusion, these results suggest that in ambulance care in general, there is a lack of knowledge and skills about mental illnesses and initial care options. The PAP concept opened new avenues for the care of patients with mental illness, which the PENs described very positively as being helpful and valuable.

Factors Associated With Low Relapse Rates of Schizophrenia In Southern Thailand: A University Hospital-Based Study

Background: Schizophrenia is a chronic disease that has residual symptoms and relapse. Relapse prevention research will provide useful knowledge for the employment of an effective caring process. This study aims to explore factors associated with relapse rates in hospital where there are comparatively low relapse rates for schizophrenia. Method: Medical records of patients who had their first schizophrenia diagnosis, in the Songklanagarind hospital’s inpatient psychiatric unit, were retrospectively reviewed for the period from January 2007 to December 2019. This yielded data outlining demographic information, profiles of schizophrenia and treatment. Descriptive statistical analysis was utilized to process all data; and factors associated to relapse were investigated using bivariate and multivariate analyses. Results: Reviewed medical records identified a sample size of 156 schizophrenias. The majority were male (50.6%), Buddhist (85.9%), unmarried (80.1%), unemployed (50.6%) and living with their families (90.4%). Their mean age was 39.2 years. Relapse was defined as readmission to a psychiatric unit within 5 years after their first psychotic episode. From the 156 patients, 53.8% featured relapse whereas 46.2% were in remission. Cumulatively, the first to the fifth-year relapse rate was 22.4%, 35.3%, 44.9%, 50.0%, and 53.8% respectively. Multivariate analysis indicated that patients having stressful life events, non-adherence to medication, prescription changes and lack of insight were all factors with a statistically significant association to relapse rates.Conclusions: Stressful life events, adverse events, medical non-adherence, change prescription, and lack of insight were related to relapse. Emphasizing multimodality of treatment could be key to successful relapse prevention for schizophrenia.