Patient Satisfaction and Willingness to Continue with Telemental Health Care During and After the Early Period of SARS-CoV-2 Pandemic: A User Survey.

Objective: The SARS-CoV-2 pandemic and related lockdown periods generated an increase in the use of virtual care for mental health (MH). This study aimed to assess patient satisfaction with Telemental Health services (TMH) during first lockdown and factors related to their willingness to continue using this service. Methods: We conducted a cross-sectional survey of 364 MH outpatients from 9 centers in the Barcelona region (Spain), who received TMH between April 20 and May 22, 2020. We assessed sociodemographic and clinical characteristics, prior experience, and familiarity with technologies and satisfaction with TMH. Willingness to receive TMH after the lockdown was measured separately for telephone and videoconferencing. We performed descriptive statistics and bivariate and multivariate regression models to predict TMH willingness. Results: From 450 patients contacted, 364 were interviewed. Satisfaction with TMH was high (mean 9.24, standard deviation 0.07); 2.47% preferred only TMH visits after lockdown, 23.08% preferred mostly TMH visits, 50.82% accepted some TMH visits, and 23.63% would prefer in-person consultations. Female patients and those having received TMH during lockdown showed higher odds of willingness to receive TMH in the future, while patients unfamiliar with technologies showed lower odds. Concerning TMH through telephone, willingness was more likely in patients living with more persons. Videoconferencing willingness was more likely for people living with depression. Conclusions: TMH was well accepted during the first lockdown and patients were willing to maintain it after lockdown. Low familiarity with new technologies is an important barrier to TMH willingness, which needs to be addressed for appropriate implementation going forward.

Evaluation of adherence to antipsychotics: A real-world data study using four different dosing assumptions.

AIMS: This study aimed to assess the frequency of dosing inconsistencies in prescription data and the effect of four dosing assumption strategies on adherence estimates for antipsychotic treatment. METHODS: A retrospective cohort, which linked prescription and dispensing data of adult patients with ≥1 antipsychotic prescription between 2015-2016 and followed up until 2019, in Catalonia (Spain). Four strategies were proposed for selecting the recommended dosing in overlapping prescription periods for the same patient and antipsychotic drug: (i) the minimum dosing prescribed; (ii) the dose corresponding to the latest prescription issued; (iii) the highest dosing prescribed; and (iv) all doses included in the overlapped period. For each strategy, one treatment episode per patient was selected, and the Continuous Medication Availability measure was used to assess adherence. Descriptive statistics were used to describe results by strategy. RESULTS: Of the 277 324 prescriptions included, 76% overlapped with other prescriptions (40% with different recommended dosing instructions). The number and characteristics of patients and treatment episodes (18 292, 18 303, 18 339 and 18 536, respectively per strategy) were similar across strategies. Mean adherence was similar between strategies, ranging from 57 to 60%. However, the proportion of patients with adherence ≥90% was lower when selecting all doses (28%) compared with the other strategies (35%). CONCLUSION: Despite the high prevalence of overlapping prescriptions, the strategies proposed did not show a major effect on the adherence estimates for antipsychotic treatment. Taking into consideration the particularities of antipsychotic prescription practices, selecting the highest dose in the overlapped period seemed to provide a more accurate adherence estimate.

Factor analysis and validation of the Bush Francis catatonia rating scale-Spain version

Background and objectives The aim of this study was to assess the reliability and validity of the Bush Francis Catatonia Screening Instrument and Bush Francis Catatonia Rating Scale Spain Version (BFCSI-SV and BFCRS-SV) using the ICD-11 and DSM-5 diagnostic criteria as well as other catatonia scales. Methods One hundred patients were admitted to the inpatient psychiatry unit at Hospital Universitari Germans Trias I Pujol and two psychiatrists administered the BFCRS-SV to the first 10 patients to assess inter-rater reliability. The BFCRS-SV, BFCSI-SV, Modified Rogers Scale (MRS), Abnormal Involuntary Movement Scales, Barnes Akathisia Rating Scale, and Modified Simpson-Angus Scale were then employed. Results The results showed that 27% of patients had catatonia using the DSM-5 diagnostic criteria. Additionally, 51% of patients had 2 or more BFCRSI-SV items (Sensitivity: 100%; Specificity: 67.12%). The alpha coefficient values were 0.80 and 0.84 for the BFCSI-SV and BFCRS-SV, respectively, and the intraclass correlation coefficient values were 0.902 and 0.903. The area under the ROC curve was 0.971 and 0.96, and the instruments had a strong positive correlation with the DSM-5 score, ICD-11 score, and MRS. The study identified a three-factor model comprising the inhibition, excitement, and parakinetic dimensions. Conclusions Overall, the results suggest that the BFCSI-SV and BFCRS-SV are valid and reliable tools for the diagnosis of catatonia, especially when using a cut-off score of 5 or higher for the BFCSI-SV and 7 or higher for the BFCRS-SV. (AU)

Assessment of the efficacy of a Crisis Intervention Team (CIT): experience in the Esplugues Mental Health Center (Barcelona).

AIM: Crisis Resolution Teams (CRT) have shown positive clinical and service-use results in various countries but evidence in the south of Europe is scarce. The aim is to assess the impact of the Crisis Intervention Team (CIT) in Spain with respect to the course of symptomatology and mental health services use in patients served. METHODS: Prospective observational cohort study. Assessment of the psychopathological severity (HoNOS scale) of the clinical course (CGI scale) and use of medical services. RESULTS: A positive clinical course was observed following the intervention. The mean difference in HoNOS (Health of the Nation Outcome Scales) scores between baseline and discharge was 7 points (p < 0.05). On discharge, more than 60% of patients had improved their symptomatology according to the CGI scale (Clinical Global Impression) and most were discharged due to improvement or goal achievement. A tendency to reduction in the number of admissions to acute units and day hospital was observed, along with fewer emergency room visits. In contrast, an increase in the number of admissions to subacute units was seen. During the intervention, the median number of visits to the center was 15 and the median duration of care provision by the CIT was 39 days. CONCLUSIONS: The CIT intervention promotes patients' clinical improvement and has a positive impact in terms of reducing acute hospitalizations and emergency room visits.

Catatonia in elderly psychiatric inpatients is not always associated with intense anxiety: Factor analysis and correlation with psychopathology.

OBJECTIVE: Catatonic stupor has been linked to extreme fear. Whether the underlying phenomenology of every catatonic dimension is intense anxiety or fear remains unknown. METHODS: One hundred and six patients aged ≥64 years were assessed for catatonia and clinical variables during the first 24 hours of admission. Two-sample t test were used to test for group differences. A principal component analysis was developed. Analysis of variance was performed to assess for differences in the diagnostic groups. Correlation coefficients were used to examine the association between catatonic dimensions and psychopathological variables. RESULTS: There were statistically significant differences between catatonic and non-catatonic patients in the Hamilton and NPI scores. The three factor-model accounted for 52.23% of the variance. Factor 1 loaded on items concerned with "excitement," factor 2 on "inhibition" items, and factor 3 on "parakinetic" items. There was a significant effect for factor 1 (F [5.36] = 2.83, P = .02), and not significant for factor 2 and factor 3. Compared with patients with depression, patients with mania scored significantly higher on factor "excitement" (P < .05). Factor 2 showed a moderate correlation with Hamilton total score (r = .346, P = .031) and Hamilton psychic score (r = .380, P = .017). CONCLUSIONS: Catatonic patients experienced more anxiety and hyperactivity. A three-factor solution provided best fit for catatonic symptoms. Patients with mania scored highest on Excitement, patients with depression on Inhibition, and patients with schizophrenia on Parakinetic. The main finding in this study was a positive moderate correlation between the Hamilton psychic score and the Inhibition factor score, meaning that not every catatonic dimension is associated to intense anxiety.

Multidimensional determinants of the caregiving burden among Chinese male caregivers of older family members in Hong Kong.

OBJECTIVES: The objective of this study was to examine multidimensional determinants of the caregiving burden among Chinese male caregivers of older family members in Hong Kong. Based on a modified stress process model, this study explored how background and contextual factors (demographic characteristics and mental health status of caregivers, caregiving-related factors, and support and services), primary stressors (degree of care dependency and special care needs), and secondary stressors (self-efficacy and gender role conflict) might affect the caregiving burden among male caregivers. METHOD: A questionnaire survey was completed by 204 male caregivers who considered themselves as primary caregivers for older family members with care needs aged 60 and over. Descriptive, bivariate, and multivariate analyses were conducted. RESULTS: Being the son of the care receiver, the presence of depressive symptoms, a higher degree of gender role conflict, a lower degree of caregiving self-efficacy, and the use of support and services all predicted greater caregiving burden among male caregivers. CONCLUSION: This study established a modified stress process model specifically for male caregivers. Gender role conflict and caregiving self-efficacy were introduced into the model as secondary stressors and found to be significantly associated with the degree of caregiving burden. The findings of this study could inform the development of services and interventions to reduce the caregiving burden among male caregivers.

Prevalence and characteristics of catatonia on admission to an acute geriatric psychiatry ward.

BACKGROUND: This study aims to describe the prevalence of catatonia in a population of older acute psychiatric inpatients according to different diagnostic criteria. Secondary objectives are: to compare the catatonic symptom profile, prevalence, and severity, in respect to the underlying aetiology, and to evaluate the association between catatonic and somatic comorbidity. METHODS: The study included 106 patients admitted to an acute geriatric psychiatry ward. Catatonia was assessed using the Bush Francis Catatonia Rating Scale (BFCRS). RESULTS: Catatonia was highly prevalent (n=42; 39.6%), even when using restrictive diagnostic criteria: Fink and Taylor (n=19; 17.9%) and DSM 5 (n=22; 20.8%). Depression was the most frequent psychiatric syndrome among catatonic patients (n=18; 42.8%). Catatonia was more frequent in depression (48.6%) and delirium (66.7%). Affective disorders showed a higher risk than psychotic disorders to develop catatonia (OR=2.68; 95% CI 1.09-6.61). This association was not statistically significant when controlling for dementia and geriatric syndromes. The most prevalent catatonic signs were excitement (64.3%), verbigeration (61.9%), negativism (59.5%), immobility/stupor (57.1%), and staring (52.4%). CONCLUSIONS: Catatonia in older psychiatric inpatients was highly prevalent. Depression was the most common psychiatric syndrome among catatonic patients, and catatonia was more frequent in depression and mania, as well as in delirium. Affective disorders were associated with a higher risk of developing catatonia compared to psychotic disorders. Somatic and cognitive comorbidity played a crucial aetiological role in catatonia in this series.

A model for continuous monitoring of patients with major depression in short and long term periods.

BACKGROUND AND OBJECTIVE: Major depressive disorder causes more human suffering than any other disease affecting humankind. It has a high prevalence and it is predicted that it will be among the three leading causes of disease burden by 2030. The prevalence of depression, all of its social and personal costs, and its recurrent characteristics, put heavy constraints on the ability of the public healthcare system to provide sufficient support for patients with depression. In this research, a model for continuous monitoring and tracking of depression in both short-term and long-term periods is presented. This model is based on a new qualitative reasoning approach. METHOD: This paper describes the patient assessment unit of a major depression monitoring system that has three modules: a patient progress module, based on a qualitative reasoning model; an analysis module, based on expert knowledge and a rules-based system; and the communication module. These modules base their reasoning mainly on data of the patient's mood and life events that are obtained from the patient's responses to specific questionnaires (PHQ-9, M.I.N.I. and Brugha). The patient assessment unit provides synthetic and useful information for both patients and physicians, keeps them informed of the progress of patients, and alerts them in the case of necessity. RESULTS: A set of hypothetical patients has been defined based on clinically possible cases in order to perform a complete scenario evaluation. The results that have been verified by psychiatrists suggest the utility of the platform. CONCLUSION: The proposed major depression monitoring system takes advantage of current technologies and facilitates more frequent follow-up of the progress of patients during their home stay after being diagnosed with depression by a psychiatrist.

Estudio cualitativo sobre los estados de agitación y su caracterización, y los procedimientos de atención utilizados en su contención / Qualitative study of the agitation states and their characterization, and the interventions used to attend them

Introducción. La agitación es un problema común en la atención psiquiátrica con graves consecuencias clínicas y económicas. Metodología. El objetivo del estudio fue definir y caracterizar los estados de agitación en la práctica habitual en una unidad de Psiquiatría de Agudos y urgencias psiquiátricas, y describir los paquetes de atención típicos. Se establecieron dos grupos nominales, uno con 7 profesionales de enfermería y otro con 10 de psiquiatría (urgencias y psiquiatría de agudos del Parc Sanitari Sant Joan de Déu). Resultados. El equipo de enfermería describió dos estados principales que formaban los extremos de un espectro que iba de leve (pre-agitación) a grave (agitación). Se describió un tercer estado que se caracterizaba por un comportamiento desorganizado. Diversos paquetes de atención fueron descritos para cada estado de agitación que se dividían en paquetes de primera, segunda y tercera línea. La primera línea (contención verbal) se aplicaba en todos los estados de agitación. Si no fuese eficaz, se implementaban los de segunda y tercera línea, llegando hasta la contención mecánica. El equipo de psiquiatras describió tres estados de agitación: un estado inicial leve (ansiedad e irritabilidad), un estado moderado (pre-agitación sin agresividad) y un estado severo de agitación con agresividad y/o violencia. Conclusiones. Para evitar la progresión a un estado de agitación severa, ambos grupos coincidieron en la importancia de la contención verbal, apropiada para todos los estados. Esto iría seguido de las medidas ambientales y farmacológicas hasta llegar a la contención mecánica dependiendo de la gravedad de la situación

Introduction. Agitation is a common problem in psychiatric care with serious clinical and economic consequences. Methodology. The aim of the study was to define and characterize the agitation states present in usual medical practice in the acute and emergency units of a psychiatric hospital. Two nominal groups, one with 7 nurses and the other with 10 psychiatrists from the Parc Sanitari Sant Joan de Déu, were established. Results. The nurses described two main states forming the endpoints of a spectrum: from mild (pre-agitation) to severe (agitation). A third state was outlined in which agitation was characterized by disorganized behavior problems. Various care packages were described for each agitation state. The care packages were divided into first, second and third line approaches. The first line approaches (i.e., verbal containment) were used on every (pre)agitated patient. If the first line approach was not effective, the second and third line approaches were implemented, culminating with physical restraint. The psychiatrists described 3 states: a mild initial state (anxiety and irritability), moderate (pre-agitation without aggressiveness) and a severe state of agitation with aggressiveness and/or violence. Conclusions. In order to avoid progression to a severely agitated state, both groups agreed on the importance of appropriate verbal containment for all states. This would be followed by environmental measures, medication and mechanical restrain depending on the severity of the state

Qualitative study of the agitation states and their characterization, and the interventions used to attend them.

INTRODUCTION: Agitation is a common problem in psychiatric care with serious clinical and economic consequences. METHODOLOGY: The aim of the study was to define and characterize the agitation states present in usual medical practice in the acute and emergency units of a psychiatric hospital. Two nominal groups, one with 7 nurses and the other with 10 psychiatrists from the Parc Sanitari Sant Joan de Déu, were established. RESULTS: The nurses described two main states forming the endpoints of a spectrum: from mild (pre-agitation) to severe (agitation). A third state was outlined in which agitation was characterized by disorganized behavior problems. Various care packages were described for each agitation state. The care packages were divided into first, second and third line approaches. The first line approaches (i.e., verbal containment) were used on every (pre)agitated patient. If the first line approach was not effective, the second and third line approaches were implemented, culminating with physical restraint. The psychiatrists described 3 states: a mild initial state (anxiety and irritability), moderate (pre-agitation without aggressiveness) and a severe state of agitation with aggressiveness and/or violence. CONCLUSIONS: In order to avoid progression to a severely agitated state, both groups agreed on the importance of appropriate verbal containment for all states. This would be followed by environmental measures, medication and mechanical restrain depending on the severity of the state.

Gender differences in the impact of mental disorders and chronic physical conditions on health-related quality of life among non-demented primary care elderly patients.

PURPOSE: This paper aims to estimate the comorbidity of mental disorders and chronic physical conditions and to describe the impact of these conditions on health-related quality of life (HRQoL) in a sample of older primary care (PC) attendees by gender. METHODS: Cross-sectional survey, conducted in 77 PC centres in Catalonia (Spain) on 1192 patients over 65 years old. Using face-to-face interviews, we assessed HRQoL (SF-12), mental disorders (SCID and MINI structured clinical interviews), chronic physical conditions (checklist), and disability (Sheehan disability scale). We used multivariate quantile regressions to model which factors were associated with the physical component summary-short form 12 and mental component summary-short form 12. RESULT: The most frequent comorbidity in both men and women was mood disorder with chronic pain and arthrosis. Mental disorders mainly affected 'mental' QoL, while physical disorders affected 'physical' QoL. Mental disorders had a greater impact on HRQoL than chronic physical conditions, with mood and adjustment disorders being the most disabling conditions. There were some gender differences in the impact of mental and chronic physical conditions on HRQoL. Anxiety disorders and pain had an impact on HRQoL but only in women. Respiratory diseases had an effect on the MCS in women, but only affected the PCS in men. CONCLUSIONS: Mood and adjustment disorders had the greatest impact on HRQoL. The impact profile of mental and chronic physical conditions differs between genders. Our results reinforce the need for screening for mental disorders (mainly depression) in older patients in PC.

Prevalence of mental disorders in non-demented elderly people in primary care [corrected].

BACKGROUND: Mental disorders in the elderly are common, with a 12-month prevalence in the community ranging from 8.54% to 26.4%. Unfortunately, many mental disorders are unrecognized, untreated, and associated with poor health outcomes. The aim of this paper is to describe the prevalence of mental disorders in the elderly primary care (PC) population and its associated factors by age groups. METHODS: Cross-sectional survey, conducted in 77 PC centers in Catalonia (Spain), 1,192 patients over 65 years old. The prevalence of mental disorders was assessed through face-to-face evaluations using the Structured Clinical Interview for DSM-IV Axis I Disorders, Research Version (SCID-I-RV) and the Mini International Neuropsychiatric Interview (MINI); chronic physical conditions were noted using a checklist; and disability through the Sheehan Disability Scales (SDS). RESULTS: Nearly 20% of participants had a mental disorder in the previous 12 months. Anxiety disorders were the most frequent, (10.9%) (95% CI = 8.2-14.4), followed by mood disorders (7.4%) (95% CI = 5.7-9.5). Being female, greater perceived stress and having mental health/emotional problems as the main reason for consultation were associated with the presence of any mental disorder. There were no differences in prevalence across age groups. Somatic comorbidity was not associated with the presence of mental disorders. CONCLUSIONS: Mental disorders are highly prevalent among the elderly in PC in Spain. Efforts are needed to develop strategies to reduce this prevalence and improve the well-being of the elderly. Based on our results, we thought it might be useful to assess perceived stress regularly in PC, focusing on people who consult for emotional distress, or that have greater perceived stress.