Examining readmission factors in psychiatric emergency care for individuals with personality disorders: A 6-year retrospective study.

People with personality disorders (PDs) are often admitted to psychiatric emergency services due to the frequent repetition of acute crises. This study drew on the ICD diagnostic records of 2,634 individuals with PDs who were admitted to a specialized inpatient psychiatric crisis unit over a 6-year period. Multiple logistic regressions and survival regressions were performed to examine whether PD categories, gender, and other individual, interpersonal, and precipitating factors were associated with readmission and time-to-readmission. The results showed a 16.1% readmission rate. Of these, 99.5% of readmissions occurred within 4 years following the first admission. Gender was the main factor associated with both readmission and time-to-readmission: while men were readmitted faster, more women in total were readmitted for a second psychiatric emergency hospitalization. Findings also indicated that readmission rate and time-to-readmission differed following the category of PD: readmission rate in a ratio of 1-2 (from 8% to 10% for dissocial and paranoid PD up to 19%-21% for impulsive and borderline PD), and time-to-readmission in a ratio of 1-5 (from 1 month for anankastic and dependent, to 5 months for impulsive, histrionic and anxious-avoidant PD). Limitations of this naturalistic study include a lack of self-reported measures and generalizability to less specialized emergency settings. Future research should include a prospective longitudinal design using standardized scalable measurement tools to improve the completeness and accuracy of the data concerning the psychological processes involved in risk and time-to-readmission after brief hospitalizations in emergency psychiatry. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

[Crisis-MBT: Mentalization-based brief hospitalization intervention]. / TBM-Crise : intervention hospitalière brève basée sur la mentalisation.

Context Our team works in a psychiatric hospital unit at the University Hospitals of Geneva (Switzerland). We welcome there for 7 days people in crisis situations who have either suicidal thoughts or suicidal behavior. As factors precipitating the suicidal crisis, these people go through life events that are accompanied by intense interpersonal difficulties or that threaten the image they have of themselves. In our clinical population, approximately 35% of patients suffer from borderline personality disorder (BPD). In these patients, repeated crises and suicidal behavior lead to frequent and damaging relational and therapeutic ruptures. Our objective is to develop a specific approach to this clinical problem. Intervention We have developed a brief psychological intervention informed by mentalization-based treatment (MBT) in 4 stages: welcoming of the patient, affective mentalization of the crisis elements, formulation of the problem, work on discharge and the continuation of outpatient care. This intervention is suitable for a medical-nursing team. From a MBT point of view, the welcoming phase is mainly devoted to mirroring and affective regulation in order to reduce the intensity of psychic disorganization. It is then a question of activating the capacity to mentalize, namely curiosity about mental states, through work on the crisis narrative with an affective focus. We then work with people to construct a formulation of their problem in which they can assume a role. It is about making them "agents" of their crises. Then we can end the intervention by working on both the separation and a projection into the immediate future. The goal is then to extend the psychological work started in our unit at the level of an ambulatory network. The termination phase sees the attachment system reactivated and the reappearance of the difficulties hitherto outside the therapeutic space. Clinical implications MBT is effective for BPD, particularly in reducing suicidal gestures and the number of hospitalizations. We have adjusted its theoretical and clinical device for individuals hospitalized due to a suicidal crisis and who present various and comorbid psychopathological profiles. MBT allows the adaptation and evaluation of empirically based psychotherapeutic tools to different clinical settings but also to different clinical populations.

The use of attention to maintain information in working memory: A developmental investigation of spontaneous refreshing in school-aged children.

The capacity of working memory is limited and undergoes important developmental changes during childhood. One proposed reason for the expansion of working memory capacity during childhood is the emergence and increased efficiency of active maintenance mechanisms, such as that of refreshing. Refreshing is a proposed mechanism to keep information active in working memory by bringing memory items back into the focus of attention. One prevalent view is that the spontaneous use of refreshing emerges around the age of 7 and becomes more efficient during middle childhood and beyond. Using a novel approach to examine refreshing in children in Experiment 1, we show, against common conceptions, that simply giving free time in a basic working memory task does not lead to spontaneous refreshing in 9-12-year-old children. Instead, their focus of attention appears to linger on the last-presented memory item, even when ample time for refreshing is provided. Experimentally imposing the use of refreshing in Experiment 2, however, showed that children in this age range are able to switch their focus of attention away from the last-presented item in switch to another memory item. Thus, the current study uncovers that children in middle childhood do not always spontaneously switch attention away from the last-presented memory item to refresh the entire list, even though they are able to switch attention away from the last-presented memory item when instructed to do so. The theoretical implications of these findings are discussed.

Clinical Characteristics of Suicidal Youths and Adults: A One-Year Retrospective Study.

Suicide is a major mental health problem, particularly during youth, when it is the second leading cause of death. Since young people at risk of suicide are often cared for by the adult health system, we sought to identify the specificities and similarities between suicidal youths and adults in order to further inform the potential need for adaptations in taking care of suicidal youths. For this study, we used the following data: mental disorders, treatments, previous hospitalization, and reasons for current hospitalization, that were collected from November 2016 to October 2017 among people hospitalized for a suicidal crisis in a specialized psychiatric unit. First, we compared the data from the youth group with those from the adult group, and then we tried to determine if there were any associations between variables. Analyses showed that youths were more similar to adults than expected. In particular, we found comparable rates of personality disorders (especially borderline) and relapse, and similar profiles of reasons for hospitalization in suicidal crisis. Remarkably, among youth, neuroleptics appeared to be associated with fewer hospitalizations for behavioral than ideational reasons, but with more relapses. Results of this study suggest that young people could benefit from brief psychotherapeutic interventions implemented for adults.