The relationship between psychological characteristics of patients and their utilization of psychiatric inpatient treatment: A cross-sectional study, using machine learning.

High utilizers (HU) are patients with an above-average use of psychiatric inpatient treatment. A precise characterization of this patient group is important when tailoring specific treatment approaches for them. While the current literature reports evidence of sociodemographic, and socio-clinical characteristics of HU, knowledge regarding their psychological characteristics is sparse. This study aimed to investigate the association between patients' psychological characteristics and their utilization of psychiatric inpatient treatment. Patients from the University Psychiatric Clinics (UPK) Basel diagnosed with schizophrenia spectrum or bipolar affective disorders participated in a survey at the end of their inpatient treatment stay. The survey included assessments of psychological characteristics such as quality of life, self-esteem, self-stigma, subjective experience and meaning of psychoses, insight into the disease, and patients' utilization of psychiatric inpatient treatment in the last 30 months. The outcome variables were two indicators of utilization of psychiatric inpatient treatment, viz. "utilization pattern" (defined as HU vs. Non-HU [NHU]) and "length of stay" (number of inpatient treatment days in the last 30 months). Statistical analyses included multiple regression models, the least absolute shrinkage and selection operator (lasso) method, and the random forest model. We included 112 inpatients, of which 50 were classified as HU and 62 as NHU. The low performance of all statistical models used after cross-validation suggests that none of the estimated psychological variables showed predictive accuracy and hence clinical relevance regarding these two outcomes. Results indicate no link between psychological characteristics and inpatient treatment utilization in patients diagnosed with schizophrenia spectrum or bipolar affective disorders. Thus, in this study, the examined psychological variables do not seem to play an important role in patients' use of psychiatric inpatient treatment; this highlights the need for additional research to further examine underlying mechanisms of high utilization of psychiatric inpatient treatment.

[Influence of an "Open Door Policy" on Ward Climate: Impact on Treatment Quality]. / Einfluss einer "Offenen-Tür-Politik" auf die Stationsatmosphäre: Auswirkungen auf die Behandlungsqualität.

OBJECTIVE: To compare the ward atmosphere, safety, therapeutic hold, and patients' coherence on recently opened (1 year), opened (4 years) and open (> 20 years) psychiatric wards in a longitudinal naturalistic study design. The question was if a patient shift from formerly locked to open wards might deteriorate the ward atmosphere on the open and opened wards. METHODS: Ward atmosphere on two recently opened (n = 2), opened (n = 2) and open (n = 2) wards was examined using the Essen Climate Evaluation Schema (EssenCES) in a follow-up study after 4 years. Structural as well as clinical data were extracted. RESULTS: Global ward atmosphere, safety, and patients' coherence on the recently opened wards was significantly increased; on always opened wards and long-term opened wards it remained unchanged. Coercive measures and discharges against medical advice decreased during the open door process. CONCLUSION: Opening locked psychiatric wards can help to establish a positive therapeutic atmosphere without changing the therapeutic climate on the other already open wards. A better ward atmosphere might be connected with a better therapeutic quality.