Prescription Pattern of Atypical Antipsychotics in a University Psychiatric Ward : 11-Year Observational Study / 대한정신분열병학회지

OBJECTIVES: This study investigated the prescribing patterns of atypical antipsychotics for the various psychiatric disorders in the psychiatric ward of a University hospital. METHODS: We reviewed the medical records of patients who were discharged from an open psychiatric ward from May, 2003 through April, 2014. The association between psychiatric disorders and prescription pattern of atypical antipsychotics was analyzed. RESULTS: The study included 3091 patients' prescription of psychiatric medication. 60% of prescription included antipsychotics; quetiapine was the most frequently prescribed antipsychotics, but the average dosage was the lowest among all the atypical antipsychotics. According to the diagnoses, prescription rates and dosage of antipsychotics were different. Prescription rates of antipsychotics were the lowest in patients with anxiety disorders, and the mean dosage were the lowest in those with delirium, dementia, and amnestic and other cognitive disorders. CONCLUSION: This observational study shows prescription patterns of atypical antipsychotics for the treatment of psychiatric disorders in a University hospital; atypical antipsychotics were widely used for the treatment of the various disorders, and there were differences in prescription patterns for each disorders. The results of this study may be used to identify the proper atypical antipsychotics effective on certain psychiatric disorders and to propose expanding the indications of each atypical antipsychotics in the future.

Changes in Psychotropic Prescription Patterns in Patients Admitted to an Open Psychiatric Ward : Eleven-Year Comparison in a University Hospital in Gyeonggi-Do

OBJECTIVES: This study investigated the patterns of psychotropic medications prescribed to patients admitted to an open psychiatric ward. METHODS: We reviewed 4282 medical records of patients who were discharged from an open psychiatric ward from May 2003 through April 2014. Data were collected on each patient's age, sex, length of hospital stay, number of past admissions, discharge diagnosis, and kinds and dosages of psychotropic medications at discharge. RESULTS: Among the 1384 male and 2898 female patients, 3.56 psychotropic medications were prescribed on average, with the number increasing across years, from 3.30 in 2003-2008 to 3.76 in 2009-2014. Prescription rates of antipsychotics, anxiolytics, and hypnotics significantly increased in patients with depressive disorders, bipolar disorders, anxiety disorders, delirium, dementia, and amnestic and other cognitive disorders. Only lithium prescription rates decreased significantly. Prescriptions for two or more anxiolytics and antipsychotics increased during the survey years, while antidepressant polypharmacy rates decreased. CONCLUSIONS: Recently, there has been a significant increase in the number of psychotropic medications prescribed, including antipsychotics, anxiolytics, and hypnotics. Caution should be exercised when prescribing medications to avoid cost increases and the risk of side effects, with uncertain gains in the quality of care.

Psychoactive substance use by psychiatric patients in the National Referral Hospital, Bhutan: a retrospective analysis.

Background: The costs to the individual and to society of psychoactive substance use is of growing concern in Bhutan. This study aimed to assess the relation between the demographic variables of patients admitted to the National Referral Hospital for first-time detoxification and the psychoactive substances used. Methods: The demographic variables and types of psychoactive substance used by 284 substance users were reviewed. Data were collected through patients’ history sheets and admission registers, and analysed through descriptive statistics, one-way analysis of variance and independent t test. Results: The commonest psychoactive substance used was alcohol, followed by cannabis, nitrazepam, dextropropoxyphene, glue (inhaled) and chlorphenamine/ pseudoephedrine/codeine-containing cough syrup. Only 14% of participants were aged 45 years or older. Most patients used more than one substance; the mean number of psychoactive substances used was highest among males, individuals aged 15–24 years and those who were unemployed. Conclusion: Among patients admitted for first-time detoxification, harmful use of alcohol is the most common, followed by cannabis and illicit prescription drugs. Preventive measures should be prioritized on a need-based strategy. The findings of this study indicate that some of these preventive measures should be focused on males, unemployed groups and youth, and should involve raising awareness of harmful use of substances and the services available to treat substance use disorders.

Factors associated with violence among male psychiatric patients admitted at the forensic psychiatry ward (pavilion 4) of the National Center for Mental Health factors

OBJECTIVE:This study seeks to describe the clinical profile of the male patients admitted to the Forensic Psychiatric Ward of the National Center for Mental Health as well as determine what demographic and clinical factors are associated with violence of the patients. METHODOLOGY: This cross sectional study was conducted in the Pavilion 4 of the NCMH with 158 subjects whose records were reviewed. Crimes were categorized as either violent or non-violent and patient's symptoms were clustered into 8 categories. To test for association, chi-square test and relative risk was computed to determine the degree of association. RESULTS: Most patients were between 30-39 years old (46.2%), single (78.5%), Catholic (84.2%) and had undergone at least an elementary education (51.9%). Majority (55.7%) came from the Luzon Provinces outside Metro Manila and 77.8% had psychiatric disorders prior to being admitted to Pavilion 4. Most (68.4%) of the violent crimes committed were committed against persons and 52.5% were committed against non-relatives. The more frequent symptoms noted were hallucinations in 56.3% and speech disturbances in 53.2%. of the psychiatric patients. The only significant factor associated with violence among the male psychiatric patients in Pavilion 4 of NCMH were depressive symptoms e.g. blank stares, crying spells, being quiet and withdrawn with a relative risk of 0.67 at a confidence interval of 0.43-1.06, which means that being depressed can prevent one from committing a crime. Majority (65.8%) had a relapse of their psychiatric illness, with Schizophrenia being the most common diagnosis (51.9%). CONCLUSION: Depressive symptoms can be considered as a protective factor against committing violent crimes.

Factors Influencing on Length of Stay in a Psychiatric Open Ward of a General Hospital / 신경정신의학

OBJECTIVES: The cost of psychiatric service is increasing every year in Korea. The length of inpatient stay (LOS) is an important factor determining in-patient service cost. This study was aimed to find the factors that influence LOS in a psychiatric open ward of a general hospital. METHODS: The study includes 134 inpatients who were consecutively admitted to a psychiatric open ward in a general hospital from January 1st to June 30th in 2001. Demographic data, clinical characteristics on admission and discharge, global functioning, social support levels and life stressors were collected. RESULTS: The mean LOS for the 134 patients was 15.5 days (S.D 9.2). The occupation of housekeeper and those secred high in phobic anxiety subscale on SCL-90-R were statistically significant predictor for longer LOS in the univariate analysis. No significant differences in LOS were found by diagnostic groups and social support. In multiple regression analysis, the scores of phobic anxiety subscale, occupation and presence of physical illness were statistically significant predictor for LOS. CONCLUSION: This study failed to find the significant variables to account for substantial proportion of variance for LOS.

Absence of Humanities in the Closed Management of Psychiatric Ward and Countermeasures / 中国医学伦理学

This paper analyzes the absence of humanities in the closed management of psychiatric ward,and proposes relevant countermeasures: strengthening absorbing knowledge in humanities,applying humanistic nursing care,promoting the cultural construction of humanities in psychiatric ward,and strengthening the mental health support for nurses in psychiatric ward.

Legal and Ethical Reflection on the Management of Open-loop Psychiatric Ward / 中国医学伦理学

The establishment of open-loop psychiatric ward is an innovation for mental disease treatment,while new legal and ethical issues become evident.For instance,psychiatric patients with no guardians or agents can not normally sign the informed consent form at hospitalization.It is extremely difficult to make a definite diagnosis in some cases.Informed consent form is refused by certain guardians due to the misunderstanding of psychiatric diseases.This paper explores those legal and ethical issues arising in the medical treatment in open-loop psychiatric ward,and comes up with relevant countermeasures.