Pathway to Service and Duration of Untreated Attention Deficit, Hyperactivity Disorder among Children Presented to a Governmental, Mental Health Hospital in Egypt

Background ADHD is one of the most common neurodevelopmental disorders. Despite the presence of evidence based approved diagnosing and treatment tools for ADHD, there still is an underdiagnoses and underutilization of these services. Untreated ADHD, unlike what some families may believe, doesn’t go away on its own, in fact, the condition may get worse with age, affecting more domains of the child’s life as an adolescent and later on as an adult. In addition, untreated ADHD impacts not only the patient, but also the family and the society as a whole. Objective to investigate different routes that parents take before reaching the child and adolescence psychiatric services. And to further explore various reasons for any delay in seeking psychiatric help. In addition we aimed to estimate the duration of untreated ADHD before patients receive proper psychiatric service and treatment. Patients and Methods A total of 350 cases were recruited in a cross sectional study that took place at the Child and Adolescence outpatient clinic at Abbassia mental health hospital in Cairo, Egypt. Results Results showed that the average delay in seeking Child and Adolescence psychiatric service and the duration of untreated ADHD was 3±2 years. The majority of parents, 27.1%, first consulted pediatricians as regards to their child’s symptoms. The most commonly reported source of referral was school teachers in 23.1%. The most distressing symptom stated by 28.1% of parents was impulsivity. Stigma of mental illness was the most frequently reported reason for delay in reaching out for psychiatric service. Conclusion we concluded that parents tend to take other routes through different professions before reaching Child and Adolescence Mental Health Services, this causes subsequent delay in receiving diagnosis and treatment for ADHD. In Addition, it was concluded that sociocultural beliefs affected parent’s pattern of help seeking.

Incidence of Orthostatic Hypotension in Schizophrenic Patients Using Antipsychotics at Sambang Lihum Mental Health Hospital, South Kalimantan

Schizophrenia is a psychiatric disorder that requires antipsychotics therapy. Antipsychotics cause many side effects, including orthostatic hypotension. The study aimed to describe the incidence of orthostatic hypotensive side effects experiences by schizophrenia patients at the Sambang Lihum Mental Health Hospital, South Kalimantan. This research was observational description research with data sampling by medical records. This research was conducted to 300 medical records of patients period January-December 2018 which received antipsychotics medication and data analyzed by univariate analysis. The results showed the number of patients who experienced orthostatic hypotension was 98 patients (32.67%) and no experienced were 202 patients (67.33%). Incidence of orthostatic hypotension in haloperidol 54.35% (N=46); trifluoperazine 100% (N=1); clozapine 84.62% (N=13); olanzapine 100% (N=1); haloperidol-chlorpromazine 27.27% (N=11); haloperidol-haloperidol 42.86% (N=7); clozapine-risperidone 16.67% (N=6); haloperidol-clozapine 15.05% (N=93); haloperidol-olanzapine 50% (N=2); haloperidol-risperidone 31.82% (N=22); trifluoperazine-olanzapine 100% (N=1); trifluoperazine-clozapine 22.22% (N=9); trifluoperazine-risperidone 5.56% (N=18); chlorpromazine-haloperidol-haloperidol 33.3% (N=3); chlorpromazine-haloperidol-trifluoperazine 100% (N=3); haloperidol-trifluoperazine-chlorpromazine 100% (N=1); chlorpromazine-haloperidol-clozapine 42.86% (N=7); chlorpromazine-trifluoperazine-clozapine 100% (N=1); chlorpromazine-trifluoperazine-olanzapine 100% (N=1); chlorpromazine-trifluoperazine-risperidone 50% (N=2); trifluoperazine-haloperidol-risperidone 100% (N=4); haloperidol-trifluoperazine-risperidone 100% (N=1); trifluoperazine-haloperidol-clozapine 40% (N=5); haloperidol-haloperidol-clozapine 80% (N=5); clozapine-risperidone-trifluoperazine 100% (N=4); risperidone-clozapine-haloperidol 20% (N=10). The conclusion from this study was the percentage of orthostatic hypotension on schizophrenia patients at the Sambang Lihum Mental Health Hospital was 32.67% (N=98).

Effect of COVID-19 pandemic on mental health hospital admissions: comparative population-based study

Background The coronavirus disease 2019 (COVID-19) global pandemic caused mental health services to be downscaled to abide by the public health restrictions issued. Aims The aim of this study was to investigate whether the pandemic and resultant restrictions had an impact on Malta's admissions to hospital for mental health issues by assessing the number and nature of psychiatric admissions to our only national mental health hospital. Method Data collection was carried out retrospectively for the 13-week period between 7 March 2020 and 4 June 2020, compared with the equivalent in 2019. Demographic data was obtained and descriptive statistical analysis through the use of the χ²-test, z-test and logistic regression model were used to compare both data-sets, using a P-value of 0.05. Results An overall reduction in admissions to hospital was noted in 2020 when compared with 2019, recorded to be lowest in March 2020 with a steady acceleration of admissions up until May 2020 (χ2(3) = 22.573, P < 0.001). This coincided with a decelerated rate of positive COVID-19 cases locally. In 2020, there were significantly higher female admissions (χ2(1) = 10.197, P < 0.001), increased presentations of self-harm/suicidal ideation (P < 0.001) and higher involuntary admissions using the Mental Health Act (χ2(1) = 4.904, P = 0.027). The logistic regression model identified total length of stay in hospital, primary mental health diagnosis, gender and month of admission as variables significantly associated with an admission. Conclusions Our first population-wide study confirms that the COVID-19 pandemic and subsequent public health restrictions had an impact on the population's hospital admissions for mental health issues.

Clinical experience of a nurse working in the intensive care unit in times of pandemic: When the groundbreaking system is needed

COVID-19 impacted the life and health of people worldwide including the healthcare team in Hospitals. As a consequence, this situation disturbs the healthcare systems along with the care provider such as nurses fighting as the frontlines to save the patient’s lives. Exploring the issues during their work time will support them and lead an innovative strategy on how to improve the outcome and reduce the morbidity among nurses. This paper explored the nurses’ experience when taking care of patients with COVID-19 infection in the Intensive Care Unit of Mental Health Hospital “Prof. Soerojo” Magelang, City. It is hoped that this article will encourage the nurses to keep helping the patient, endlessly.