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Association between continuity of care and treatment outcomes in psychiatric patients in Germany: a prospective cohort study
Background
Continuity of care is considered an important treatment aspect of psychiatric disorders, as it often involves long-lasting or recurrent episodes with psychosocial treatment aspects. We investigated in two psychiatric hospitals in Germany whether the positive effects of relational continuity of care on symptom severity, social functioning, and quality of life, which have been demonstrated in different countries, can also be achieved in German psychiatric care.
Methods
Prospective cohort study with a 20-months observation period comparing 158 patients with higher and 165 Patients with lower degree of continuity of care of two psychiatric hospitals. Patients were surveyed at three points in time (10 and 20 months after baseline) using validated questionnaires (CGI Clinical Global Impression rating scales, GAF Global Assessment of Functioning scale, EQ-VAS Euro Quality of Life) and patient clinical record data. Statistical analyses with analyses of variance with repeated measurements of 162 patients for the association between the patient- (EQ-VAS) or observer-rated (CGI, GAF) outcome measures and continuity of care as between-subject factor controlling for age, sex, migration background, main psychiatric diagnosis group, duration of disease, and hospital as independent variables.
Results
Higher continuity of care reduced significantly the symptom severity with a medium effect size (
p
0.036, eta 0.064) and increased significantly social functioning with a medium effect size (
p
0.023, eta 0.076) and quality of life but not significantly and with only a small effect size (
p
0.092, eta 0.022). The analyses of variance suggest a time-independent effect of continuity of care. The duration of psychiatric disease, a migration background, and the hospital affected the outcome measures independent of continuity of care.
Conclusion
Our results support continuity of care as a favorable clinical aspect in psychiatric patient treatment and encourage mental health care services to consider health service delivery structures that increase continuity of care in the psychiatric patient treatment course. In psychiatric health care services research patients’ motives as well as methodological reasons for non-participation remain considerable potential sources for bias.
Trial registration
This prospective cohort study was not registered as a clinical intervention study because no intervention was part of the study, neither on the patient level nor the system level.
Journal Article
Norte : a novel
Three unconnected people travel north, each passing in isolation over one of the most troubled and controversial dividing lines in the world: the Mexico/US border. But in a melee of language and blood, their stories and the stories of those they meet--of a young serial killer, a waitress and graphic novelist and her lover (and former professor), and an outsider artist in a mental institution--gradually begin to coalesce.
Book
Correlates of Social Isolation in Forensic Psychiatric Patients with Schizophrenia Spectrum Disorders: An Explorative Analysis Using Machine Learning
The detrimental effects of social isolation on physical and mental health are well known. Social isolation is also known to be associated with criminal behavior, thus burdening not only the affected individual but society in general. Forensic psychiatric patients with schizophrenia spectrum disorders (SSD) are at a particularly high risk for lacking social integration and support due to their involvement with the criminal justice system and their severe mental illness. The present study aims to exploratively evaluate factors associated with social isolation in a unique sample of forensic psychiatric patients with SSD using supervised machine learning (ML) in a sample of 370 inpatients. Out of >500 possible predictor variables, 5 emerged as most influential in the ML model: attention disorder, alogia, crime motivated by ego disturbances, total PANSS score, and a history of negative symptoms. With a balanced accuracy of 69% and an AUC of 0.74, the model showed a substantial performance in differentiating between patients with and without social isolation. The findings show that social isolation in forensic psychiatric patients with SSD is mainly influenced by factors related to illness and psychopathology instead of factors related to the committed offences, e.g., the severity of the crime.
Journal Article
Boogeyman 2
\"The script centers on a young woman with a long-term phobia of the boogeyman, who voluntarily checks herself into a mental health facility with the hope of conquering her overwhelming fears. However, much to her horror, she discovers that some things are terrifying on purpose, and confronting her demons was not the best course of action\"--Internet movie database.
DVD
Characteristics of International Assaultive Psychiatric Patients: Review of Published Findings, 2017–2022
Since the 1960s, empirical research has focused on a better understanding of the characteristics of assaultive psychiatric patients. International research from 1960 to 2017 indicated that male and female patients with schizophrenia and substance use disorder presented the greatest risk for assault with nursing personnel being at higher risk. This present review of studies sought to assess the latest research findings on assaultive patients for the most recent five-year period, 2017–2022. It was hypothesized that patients with schizophrenia and substance use disorders would present the greatest assault risk for nursing personnel. The studies in this review supported this hypothesis. Assaults by patients with schizophrenia and substance abuse has been a consistent finding worldwide for 62 years of published research. Explanations for these findings, the possible role of posttraumatic stress disorder (PTSD) in assaultive patients, and an updated methodological review are presented.
Journal Article
Prevalence and correlates of fatigue and its association with quality of life among clinically stable older psychiatric patients during the COVID-19 outbreak: a cross-sectional study
Background
The pattern of fatigue in older psychiatric patients during the COVID-19 outbreak was unknown. This study examined the prevalence of fatigue and its association with overall quality of life (overall QOL) in clinically stable older patients with psychiatric disorders during the COVID-19 outbreak.
Methods
This was a multicenter, cross-sectional study. Fatigue, depressive symptoms, pain, insomnia symptoms, and overall QOL were assessed with standardized instruments.
Results
A total of 1063 patients were recruited. The prevalence of fatigue was 47.1% (95%CI: 44.1–50.1%). An analysis of covariance revealed that overall QOL was significantly lower in patients with fatigue compared to those without (
P
= 0.011). A multiple logistic regression analysis revealed that more severe depressive symptoms (OR = 1.15,
P
< 0.001), insomnia symptoms (OR = 1.08,
P
< 0.001) and pain (OR = 1.43,
P
< 0.001) were significantly associated with fatigue.
Conclusions
Fatigue is common among clinically stable older patients with psychiatric disorders during the COVID-19 outbreak. Considering its negative impact on overall QOL, regular assessment of fatigue and appropriate treatment warrant attention in this subpopulation.
Journal Article
One flew over the cuckoo's nest
\"Boisterous, ribald, and ultimately shattering, Ken Kesey's One Flew Over the Cuckoo's Nest is a seminal novel of the 1960s. Here is the unforgettable story of a mental ward and its inhabitants--a counterculture classic that inspired the 1975 film adaptation, widely considered one of the greatest movies ever made\"-- Provided by publisher.
Book
Employment-Related Factors of Forensic Psychiatric Outpatients with Psychotic Disorders
Employment is important for forensic psychiatric patients with psychotic disorders, in terms of reduction in symptoms, improving the quality of life, and preventing re-offenses. However, few detailed studies on employment status in such patients exist. We aimed to determine the employment rate among forensic psychiatric outpatients with psychotic disorders and identify the factors associated with employment.
The study population comprised 406 patients with psychotic disorders who completed a forensic outpatient treatment order, were aged <65 years at discharge from a forensic psychiatric ward and provided written informed consent. Psychotic disorders were defined as psychiatric disorders classified into F2 in the International Statistical Classification of Diseases and Related Health Problems, 10th edition. Demographic data were collected from the medical records of the inpatient treatment period. Prognostic data during the outpatient treatment order period was provided by the reintegration coordinators responsible for coordinating the patients' social environment during this period. Exploratory univariate and multivariable logistic regression analyses identified the factors associated with employment.
The mean age at discharge was 44.4±10.8 years. The mean follow-up period was 2.69±1.01 years. There were 4.6 times more men (n=334) than women (n=72). During the outpatient treatment order period, 56 of 406 participants achieved employment (13.8%). Participants who committed serious crime, including homicide, arson, robbery, and sexual assault, had a lower employment rate compared to participants who committed bodily injury crimes (multivariable odds ratio, 0.421; 95% confidence interval, 0.220-0.807). History of substance use and living with family after discharge from a forensic psychiatric ward positively contributed to employment.
The employment rate among forensic psychiatric outpatients with psychotic disorders was low and was similar to that reported in previous studies on general psychiatric patients with schizophrenia. Furthermore, serious criminal behavior negatively impacted employment.
Journal Article