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 Acute psychiatric units are found to be stressful working environments because of the nature of illness patients present with.  This study aimed to determine self-reported incidents of physical and verbal violence towards nurses working in acute psychiatric units in Western Cape, South Africa.  A questionnaire was used to collect data. Chi-square test was performed to determine association between gender, category and experience of violence. Mann-Whitney U test was carried out to determine associations between years of employment and the likelihood of experiencing physical violence and verbal abuse.  Overall physical violence 35 (34.3%) and verbal abuse 83 (83%) incidents. Most female respondents reported both physical violence (74.2%, n = 26) and verbal abuse (72.2%, n = 60), with (56.2%, n = 18) professional nurses reporting physical violence. Years of employment was statistically significantly associated with the likelihood of nurses experiencing physical violence (p = 0.007).  Most respondents (74.2%, n = 26) were females and they mostly experienced physical violence and verbal abuse while 28.2% (n = 29) were males. Years of service were associated with the likelihood of experiencing physical violence.Contribution: The knowledge gained will add on existing knowledge about the challenge of violence experienced by nurses in the workplace and might have an influence on policymakers.

The COVID-19 pandemic has put the UK's National Health Service under extreme pressure, and acute psychiatric services have had to rapidly adapt to a new way of working. This editorial describes the experience of a London psychiatric intensive care unit (PICU) where all nine in-patients ultimately tested COVID-19 positive.

Short-term structured risk assessment is presumed to reduce incidents of aggression and seclusion on acute psychiatric wards. Controlled studies of this approach are scarce. To evaluate the effect of risk assessment on the number of aggression incidents and time in seclusion for patients admitted to acute psychiatric wards. A cluster randomised controlled trial was conducted in four wards over a 40-week period (n = 597 patients). Structured risk assessment scales were used on two experimental wards, and the numbers of incidents of aggression and seclusion were compared with two control wards where assessment was based purely on clinical judgement. The numbers of aggressive incidents (relative risk reduction -68%, P<0.001) and of patients engaging in aggression (relative risk reduction RRR = -50%, P<0.05) and the time spent in seclusion (RRR = -45%, P<0.05) were significantly lower in the experimental wards than in the control wards. Neither the number of seclusions nor the number of patients exposed to seclusion decreased. Routine application of structured risk assessment measures might help reduce incidents of aggression and use of restraint and seclusion in psychiatric wards.

Research related to absconding and its associated risks is limited in relation to inpatients from private psychiatric units. This study aimed to compare patients who abscond from public and private psychiatric inpatient settings. Demographic data was collated on the subjects (n = 214) who all had a history of absconding. Public absconders (n = 159) were more likely to have a psychotic illness, increased number of psychiatric diagnoses, history of aggression, substance use and homelessness, when compared to private absconders. Predictors identified for private absconders (n = 55) were female gender and fewer drugs used. This study has implications for the different profiles of absconders between the public and private settings.

Although clozapine is often discontinued, there is a paucity of guidelines and evidence on treatment options after clozapine discontinuation. Moreover, it is currently unknown whether reinstating clozapine in patients formerly using clozapine should be avoided. To compare the real-world effectiveness of antipsychotics after clozapine cessation. From Finnish registry data (1995-2017), we identified 2250 patients with schizophrenia who had been using clozapine for ≥1 year before treatment cessation. The primary analysis consisted of adjusted within-individual analyses of psychiatric ward readmission owing to psychosis and treatment failure. Secondary analyses concerned between-individual mortality differences. Compared with no use of antipsychotics, risk of psychiatric ward readmission was lowest for reinitiation of clozapine (adjusted hazard ratio (aHR) 0.49; 95% CI 0.40-0.61; P < 0.0001), oral olanzapine (aHR 0.58; 95% CI 0.48-0.71; P < 0.0001) and antipsychotic polypharmacy (aHR 0.62; 95% CI 0.53-0.72; P < 0.0001). Risk of treatment failure was lowest for aripiprazole long acting injectable (aHR 0.42; 95% CI 0.27-0.65; P < 0.0001), reinitiation of clozapine (aHR 0.49; 95% CI 0.43-0.57; P < 0.0001) and oral olanzapine (aHR 0.69; 95% CI 0.61-0.77; P < 0.0001). Mortality risk was lowest for reinitiation of clozapine (aHR 0.18; 95% CI 0.09-0.36; P < 0.0001) and oral olanzapine (aHR 0.26; 95% CI 0.17-0.40; P < 0.0001). Clozapine and olanzapine are the most effective and safest treatment options in those discontinuing clozapine for undefined reasons. Clozapine should therefore be reconsidered in patients with schizophrenia who previously discontinued this compound.

Protected engagement time in mental health inpatient units is a fixed period each day during which administrative activities and visiting are suspended so that nurses can focus on individual patient contact. However, there are a number of barriers to implementing this strategy effectively, which include high workloads, staff shortages and lack of supervision to support therapeutic interventions. This article discusses some of these barriers and suggests that managers of acute psychiatric units should ensure that patients have appropriate emotional support, and that skilled mental health nurses should be supported to devote time to therapeutic interventions.

Although psychiatrists working with adolescents know that sometimes they need to be hospitalised in emergency, few studies have described the hospitalisation of adolescents in adult psychiatric wards. We aimed to estimate the prevalence of adolescents hospitalised in adult psychiatric wards (characteristics, gender comparison, subtypes). We conducted a monocentric retrospective study in the largest psychiatric hospital in France. All patients aged 15 to <18 years hospitalised in adult psychiatric wards were included, with different variables: socio-demographic and family information, history of inpatient / outpatient treatment, clinical data (like ICD-10 diagnoses, care pathway before / after hospitalisation…). We included 332 hospitalisations (70 % girls), representing 2.8 % of all psychiatric hospitalisations. For 37 hospitalisations (11.1 %), this was the first psychiatric contact; for 54.2 %, patients had no previous psychiatric hospitalisation, for 87.3 %, patients had previous outpatient treatment. Mood disorders was the diagnosis for 47 % of the admissions, suicide attempts and suicidal ideation accounted for 69 % of the clinical situations leading to hospitalisation. Boys and girls differed significantly on many variables. Cluster analyses revealed two subgroups: cluster 1 patients (62 %) more frequently were girls, had previous hospitalisations in child psychiatry, came from home, had suicide attempts / suicidal ideation, had personality disorders, whereas cluster 2 patients (38 %) more frequently had substance use disorders, psychotic episodes, clastic crisis / hetero-aggression, longer hospital stays. Emergency admission of an adolescent with psychiatric issues to an adult psychiatric ward is not uncommon, especially in the context of a suicidal crisis or psychotic episode. Our results suggest the need for establishing unscheduled hospital beds for such adolescents. •Very few studies described hospitalisations of adolescents in adult psychiatric wards.•Emergency hospitalisation of an adolescent with adults is frequent (2.8 % in the largest French hospital).•The context of these hospitalisations is mainly a suicidal crisis or a psychotic episode.•There are significant gender differences, and two clusters of patients are identified.•Specific and unscheduled hospital beds are needed for such adolescents.

A previous study by Nock et al. (2010) suggested that people’s implicit identification with “death” or “suicide” can accurately predict whether they will attempt suicide several months in advance. We report the first direct and independent replication of this promising finding. Participants were 165 patients seeking treatment at a psychiatric unit in France. At baseline, patients completed the Suicide–Implicit Association Test (S–IAT), a semistructured interview, and a self-report measure of suicide ideation. Six months later, we contacted participants by phone and examined their hospital medical records to determine whether they had made a new suicide attempt. Results showed that the S–IAT did not distinguish between patients who were admitted to the hospital following suicide attempts and those who were admitted for other reasons. As in the original study, however, the S–IAT predicted suicide attempts within the 6-month follow-up period beyond well-known predictors. The test correctly classified 85% of patients (95% confidence interval = [76.91, 91.53]), supporting its diagnostic value for identifying who will make a suicide attempt.

Background Studies conducted in high‐income countries show that a significant proportion of people admitted to psychiatric wards have an underlying neurodegenerative disease (NDD) associated with psychiatric (PSY) disorders. In fact, neuropsychiatric symptoms are associated with neuroinflammation in the context of an NDD can often mimic psychiatric disorders, leading to misdiagnosis. This study aims to investigate features and patterns in cognitive performance associated with PSY and NDD conditions in individuals admitted to a psychiatric unit real‐world clinical setting. Method This is a prospective observational cohort study of patients admitted to a psychiatric ward. We assess functional status and determine whether individuals meet clinical diagnostic criteria for NDD during hospitalization. The target population includes patients over 45 years of age. Statistical analysis were performed by welch t‐test and chi‐squared test to estimate demographic differences between groups, and Analysis of Variance (ANOVA) for investigating cognitive domains within MoCA (Montreal Cognitive Assessment) test. Result PSY group exhibits a higher proportion of women, a younger mean age, and a higher level of education compared to the NDD. Regarding cognitive performance, the PSY group demonstrates a higher mean MoCA total score (mean difference 4.8, 95% CI 1.45 to 8.06, p < 0.01). PSY group shows a lower mean score in the CDR assessment compared to the NDD group (mean difference ‐0.3, 95% CI ‐0.49 to ‐0.15, p < 0.01) (Table 1). Our results further demonstrate a significant difference in memory (mean difference 1.1, 95% CI 0.14 to 2.0, p < 0.05), language (mean difference 0,7, 95% CI 0.01 to 1.52, p < 0.05), and orientation (mean difference 0.8, 95% CI 0.30 to 1.27, p < 0.01) within MoCA domains between the groups (Figure 2). Conclusion As expected, our study revealed that NDD group presents worse cognitive and functional performance compared to individuals with PSY illness. Regarding cognitive domains, we found a significant difference in memory, language, and orientation domains in the degeneration process. These results highlight the importance of specific assessments to characterize individuals admitted to psychiatric ward that will be better detailed in further analysis.

While youth with autism spectrum disorder (ASD) are psychiatrically hospitalized at high rates, general psychiatric settings are not designed to meet their unique needs. Previous evaluations of an ASD-Care Pathway (ASD-CP) on a general psychiatric unit revealed sustained reductions in crisis interventions (intramuscular medication use, holds/restraints; Cervantes et al. in J Autism Dev Disord 49(8):3173–3180, https://doi.org/10.1007/s10803-019-04029-6 , 2019; Kuriakose et al. in J Autism Dev Disord 48(12):4082–4089, https://doi.org/10.1007/s10803-018-3666-y , 2018). The current study investigated staff perceptions of the ASD-CP ( N  = 30), and examined rates of ASD-CP implementation fidelity in relation to patient outcomes ( N  = 28). Staff identified visual communication aids and reward strategies as most helpful. The number of days of reward identification early in the inpatient stay was associated with fewer crisis interventions later in a patient’s stay.