Experiences of Caring for Cohort-Isolated Patients among Nurses in Locked Psychiatric Units.

The aim of this study was to gain an understanding of the experiences of caring for cohorts of patients isolated due to coronavirus disease (COVID-19) among nurses in locked psychiatric units. A phenomenological approach was used to analyze data collected from 10 nurses with a minimum of one year of experience as a mental health nurse working in locked psychiatric units that were cohort-isolated due to COVID-19. Data collected using semi-structured one-to-one in-depth interviews were analyzed based on steps outlined by Colaizzi. Five themes and thirteen subthemes emerged. The five themes were as follows: "Challenges intensified by the nature of mental disorders", "Concerns regarding limited mental health care", "Escalating stress", "Bolstered identity as a mental health nurse", "Witnessing changes that have begun". Environmental and institutional measures need to be implemented to identify the potential phenomena that may affect locked psychiatric units during an infectious disease epidemic and ensure the safety of health care professionals and patients from the infectious disease.

Relationship Between Care Burden and Religious Beliefs Among Family Caregivers of Mentally Ill Patients.

Families are considered as primary sources of care for individuals suffering from mental disorders. However, one of the major stresses in families is the infliction of a family member with mental illnesses causing dysfunction in health dimensions or generally their quality of life. Currently, most experts believe that religion can affect physical health and other aspects of human life. So, the aim of this study was to investigate "the relationship between care burden and religious beliefs among family caregivers of mentally ill patients." This cross-sectional study was carried out in Iran on 152 families with mentally ill patients who were hospitalized in psychiatric wards. The sampling method was nonprobability and consecutive sampling method. The data collection instruments included a demographic characteristic questionnaire, Religious Beliefs, and Zarit Care Burden Questionnaires. The mean score for care burden was 30.99 (SD = 16.45). 5.9% of the participants reported a low level, and 39.5% experienced a moderate level of care burden. Moreover, the mean score for religious beliefs was 115.5 (SD = 13.49), and majority of the participants (70.4%) were endowed with strong religious beliefs. There were no significant associations between care burden and intensity of religious beliefs among the study samples (P = 0.483). Considering the results of this study indicating experience of moderate-to-high levels of care burden in families with mentally ill patients, it is recommended to consider such families and their religious beliefs as contributing factors in coping with challenges of mental disorders.

Attitudes Toward Patient-Centered Care in the Mental Care Services in Isfahan, Iran.

Understanding patient-physician relationships in mental care services is an indispensable element to improve the quality of mental care, yet little is known about it in Iran. This study measured the attitudes of the patients' family and personal caregivers (FPCs) and psychiatrists toward patient-centered care. A sample of 88 FPCs of mental patients and 29 psychiatrists in four teaching hospitals of Isfahan city, Iran, providing mental care, were asked to complete the patient-practitioner orientation scale (PPOS). Results showed mean scores of PPOS, sharing and caring for the psychiatrists were 3.4, 3.8, and 3.1, compared to 3.9, 4.2, and 3.7 for the mental patients' FPCs. There was a significant difference between the PPOS mean scores of the FPC and psychiatrist groups (p < 0.05) indicating that psychiatrists' attitudes were less patient-centered. Developing medical training interventions, establishing communication skills workshops, and increasing patients' awareness are some approaches to address the low level of patient-centered care.

Características personales, clínicas y sociales en pacientes con estancia hospitalaria prolongada en los pabellones de pacientes agudos del Hospital Víctor Larco Herrera / Personal, clinical and social characteristics of inpatients with long hospital stay in the acute wards of the Hospital Víctor Larco Herrera

Objetivo: Identificar las características generales que influyen en la estancia hospitalaria prolongada en los pabellones de pacientes agudos y su comparación sobre el motivo de ingreso en una institución de Salud Mental. Materiales y métodos: Estudio descriptivo, retrospectivo, y transversal, realizado en el Hospital Víctor Larco Herrera. Con una población entre 18 a 65 años con una estancia mayor a 60 días en los pabellones de pacientes agudos. Se realizó revisión de historias clínicas, recolección de datos en ficha estructurada y análisis estadístico mediante SPSS 22.0. Principales medidas de resultados: frecuencias, media y valor de p mediante chi cuadrado en las variables características personales, clínicas y sociales. Resultados: Fueron 52 % de pacientes internados que cumplían estancia mayor a 60 días, cuyas edades fueron: jóvenes y jóvenes adultos 45 %, mediana 35,89, DE=10,45. Mujeres, un 60 %; instrucción secundaria, 61 %; solteros, 81 %; desocupación laboral, 74 %. Ingresados por Emergencia, 74 %, reingresos,55 %, de Lima, 53 %. El diagnóstico más frecuente fue esquizofrenia en 62 %; comorbilidad, 61 %; presentación con agresividad, 64 %; evolución estacionaria, 63 %; ingreso por motivo judicial,47 % y clínico en 47 %. El tratamiento brindado a los pacientes fue principalmente de combinación de fármacos en 74,2 %. Sin abandono sociofamiliar, el 52 %; acompañados por familiares, 66 %; acompañados por policía, 71,4 %; familia disfuncional, 72,6 %; soporte por padres, 51,6 % y pertenencia al SIS el 92 %. Existe mayor significancia estadística en el sexo, estado civil, procedencia, vía de ingreso, tipo o condición de paciente (nuevo o reingreso), acompañamiento de familiares y de otras personas al ingreso. Conclusiones: La estancia hospitalaria está afectada por factores personales como el sexo y estado civil en pacientes judicializados. La procedencia, factores clínicos como la vía y la condición de ingreso; y también sociales como el acompañamiento de familiar y de otros no emparentados, influyen en pacientes ingresados por motivo clínico.

Objective: To identify the general characteristics that influence a long hospital stay in the acute wards of a mental health institution and to compare them with the reason for admission. Materials and methods: A descriptive, retrospective and cross-sectional study was conducted at the Hospital Víctor Larco Herrera in patients between 18 and 65 years of age staying longer than 60 days in the acute wards. Medical records review, data collection in structured files, and statistical analysis through IBM SPSS Statistics Base 22.0 were performed. Main outcome measures were the frequencies, mean and p value (obtained by chi square test) in the variables of personal, clinical and social characteristics.Results: Out of the total number of inpatients, 52 % were staying longer than 60 days, 45 % were youths and young adults (median = 35.89, SD = 10.45), 60 % were women, 61 % had secondary education, 81 % were single, 74 % were unemployed, 74 % were admitted through the emergency department, 55 % were readmitted, 53 % were from Lima, 62 % had schizophrenia which was the most frequent diagnosis, 61 % showed comorbidities, 64 % presented an aggressive behavior on admission, 63 % showed a stable progression, 47 % were admitted due to legal reasons, 47 % were admitted due to clinical reasons, 74.2 % mainly received combination therapies, 52 % did not experience social or family abandonment, 66 % were accompanied by their relatives, 71.4 % were accompanied by the police, 72.6 % had a dysfunctional family, 51.6 % were supported by their parents, and 92 % were covered by the Comprehensive Health Service (SIS). There is greater statistical significance in gender, marital status, origin, admission route, patient type or condition (new or readmitted), and company of relatives and other persons at admission. Conclusions: Hospital stay is affected by personal factors such as gender and marital status in patients admitted due to legal reasons. The origin, clinical factors such as the admission route and condition, and social factors such as the company of relatives and other persons, have influence on patients admitted due to clinical reasons.

Factors Affecting Mental Patients' Behaviors and Attitudes Regarding Smoking

Background: Patients with mental health problems are in high risk to develop addiction, since smoking incidence is three times higher than that of the general population. The aim of the study was to investigate the factors affecting mental health patients' smoking habits. Methods: The sample of study were 356 patients out of 403 initially approached, with 142 hospitalized in hospital facilities and 214 in community settings. The «Smoking in psychiatric hospitals" and General Health Questionnaire (GHQ-28) questionnaires were used. A principal component analysis was performed using the correlation coefficients of the various variables and an orthogonal varimax rotation, in order to interpret the seven factors emerging. Among the variables the most important factors appeared to be the type of healthcare facility, legal status, depression and age. Results: The type of healthcare facility was correlated to demographic characteristics, clinical features, psychopathology and functionality, but also to the attitudes and behaviors related to smoking. More specifically, the in-hospital patients were heavier smokers, about 90% of the patients said they would consider quitting smoking. The various variables had only a small effect on the intention to quit smoking. The comparison of the coefficients of determination of each variable, showed that age had the strongest effect (R2=0.152), while the GHQ D subscale (severe depression) had the least significant effect (R2=0.023). From all (7) factors, it appears that hospitalization was positively correlated with factor 5 and negatively with the factors 2, 3 and 6, legal status (commitment order) negatively with factors 1 and 4, while depression (or consuming antidepressants) positively factor 4 and negatively to factors 1 and 3. Finally, age was the only variable that is associated with the agent 7. Conclusions: Patients are permissive to staff's smoking in the healthcare facility and may resist attempts to restrict it. It is important that these conclusions are taken into account in any systematic attempt to limit smoking within mental health settings.

Ethical Dilemma and Countermeasure of the Vagrant Mental Patients / 中国医学伦理学

Through investigating the hospital admission and hospital discharge of vagrant mental patients in Xi-aoshan Hospital from January 2011 to December 2015 , the present study found that there existed some ethical di-lemmas including the risk ofdiagnosing mental disorder but actually not, lack of the guarantee of patients' rights and interests and supervision mechanism without guardian, long-term retention in the wards, and so on. It is sug-gested to establish right protection and supervision committee for vagrant mental patients, reduce the misdiagnosis ofdiagnosing mental disorder but actually not through the error correction mechanism, ensure proper treatment and care, create retention way, protect the basic rights of the vagrant mental patients, reduce mental disability, avoid to stray again, so as to perfect the social management system.

Medidas generales de evacuación de enfermos mentales hospitalizados en situaciones de desastres. Revisión de la bibliografía y sugerencias / General evacuation measures in disaster situations for hospitalized mental patients. Literature review and suggestions

Alrededor del mundo, los desastres naturales y los provocados por el hombre causan la migración de grandes grupos humanos, trastornos mentales como el estrés postraumático y pérdidas económicas. Así, se ha calculado que cada año ocurren 1 30 desastres de diferente naturaleza en las Américas y que el 67% de los hospitales o clínicas están en zonas de alto riesgo. Por tal motivo, la Organización Mundial de la Salud considera que la prevención de los desastres, la reducción del riesgo, los preparativos y la recuperación son actividades que forman parte de un ciclo continuo por lo que ha desarrollado el programa de "Hospital Seguro" y el "Índice de Seguridad Hospitalaria" que son herramientas para evaluar la funcionalidad hospitalaria y la probabilidad de continuar en funcionamiento en casos de desastre. El presente artículo hace una revisión breve y práctica de la bibliografía sobre las medidas generales para la evacuación de los enfermos mentales de un hospital psiquiátrico ya que es una población altamente vulnerable por causas intrínsecas y extrínsecas a la enfermedad mental. Estas medidas incluyen: el momento adecuado para tomar la decisión de evacuarlo, la forma de hacerlo, seleccionar a los pacientes que requieren una evacuación inmediata, evaluar el tratamiento antes y durante el siniestro así como el abastecimiento de los medicamentos, quiénes serán los responsables de la evacuación y el lugar donde serán trasladados tomando en cuenta el tiempo que durará la catástrofe; la identificación de los pacientes y la información que se deberá dar a sus familiares, así como la supervisión de la vida en los albergues y su retorno cuando culmine el evento catastrófico. Finalmente sugiere algunos elementos a tomar en cuenta para la prevención y acciones para evacuar un hospital psiquiátrico ante dichas situaciones las cuales no son exclusivas para esta población sino que también pueden aplicarse a otras poblaciones vulnerables como niños y ancianos.

Around the world, natural and man-provoked disasters cause the migration of big human groups, mental disorders -such as post-traumatic stress disorder-, and economic losses. It has been estimated that each year 130 disasters of different nature occur in the Americas and that 67% of the hospitals and clinics are located in high risk areas. For this reason, the World Health Organization considers that disaster prevention, risk reduction, preparations, and recovery are activities which form a continuous cycle. In the light of this, it has developed the "Safe Hospital" program and the "Hospital Safety Index", two tools to evaluate the functionality of hospitals and the probability that they continue working in the case of disaster. This paper makes a brief practical review of the general evacuation measures for the mental patients of a psychiatric hospital as this is a highly vulnerable population given to causes which are intrinsic and extrinsic to mental illness. These measures include: the right moment to make the decision to evacuate a psychiatric hospital, the way to carry this out, evaluating patients requiring an immediate evacuation, evaluating pre- and post-sinister treatment, medical drugs supply, who will be responsible for the evacuation, the place where patients will be transferred taking into account the duration of the catastrophe, patients identification, the information which will be provided to relatives, the supervision of life in the shelters, and patients return at the end of the catastrophe. Finally, the paper suggests some elements to be considered for prevention, as well as some actions to evacuate a psychiatric hospital in the face of disaster situations. These are not exclusive for this population for they can be applied to other vulnerable groups, such as children and the elderly.

Effects of a suicide prevention programme for hospitalised patients with mental illness in South Korea.

AIMS AND OBJECTIVES: To investigate the effects of a suicide prevention programme on the levels of depression, self-esteem, suicidal ideation and spirituality in patients with mental illness. BACKGROUND: Instances of suicide have significant correlations with depression, low self-esteem, suicidal ideation and a low level of spirituality in the victims. Therefore, addressing depression, low self-esteem and suicidal ideation as suicide risk factors and increasing levels of spirituality can constitute an effective programme to prevent suicide among patients with mental illness. DESIGN: The study was a quasi-experimental study with a nonequivalent control group, nonsynchronised design. PARTICIPANTS: The study sample consisted of 45 patients with mental illness who had been admitted to the psychiatric unit in a university hospital in South Korea. The patients were assigned to control and experimental groups of 23 and 22 members, respectively. METHODS: The suicide prevention programme was conducted with the experimental group over four weeks and included eight sessions (two per week). The control group received only routine treatments in the hospital. RESULTS: The experimental group that participated in the programme had significantly decreased mean scores for depression and suicidal ideation compared with the control group. However, there were no significant differences in the mean scores for self-esteem and spirituality between the groups. CONCLUSION: The suicide prevention programme might be usefully applied as a nursing intervention for patients hospitalised in psychiatric wards or clinics where the goals are to decrease depression and suicidal ideation. RELEVANCE TO CLINICAL PRACTICE: Typical treatments for hospitalised patients with mental illness are not enough to prevent suicide. Intervention for suicide prevention needs to apply an integrated approach. The suicide prevention programme using an integrated approach is more effective in reducing depression and suicidal ideation in patients with mental illness than applying routine treatments in the hospital.

Caring Mental Patients Sharing the Same Rooms with Somatic Patients in General and Referral Hospitals in Rwanda: Analysis of Disadvantages and Advantages.

Hospitalizing mental patients in the same rooms with somatic patients is one of the consequences of the decentralization of mental health units in all hospitals of Rwanda. There is a necessity to discover and to analyze advantages and disadvantages of this practice. Mental health staffs of 31 general and referral hospitals have been interviewed on questions about disadvantages and advantages to hospitalize mental patients together with somatic patients. Results show these disadvantages: a therapeutic environment not appropriate or a lack of harmony in the rooms (58.1% of respondents); a lack of bodily safety for somatic patients (51.6%); a lack of safety on the properties of somatic patients (45.2%); a lack of psychological wellbeing of somatic patients (29%); a lack of safety for mental patients (29%). About the main advantages, 100% of respondents pointed out the treatment of mental patients followed even during the week-end and the break time by the guard nurses doing the ward round visit or the guard; 72.2% said it prevents discrimination, because mental patient feel that he is a patient like others; 50% said it prevents stigmatization (to avoid for example, the expression "he is mad"); 16.7% said that mental patients receive help from somatic patients.

Modern Approach to Treating Mental Patients in Colonial Chosun / 의사학

Literature produced by the government and the private sector in the colonial era was reviewed to determine the knowledge of the people of colonial Chosun of mental illness and mental patients and the mental patient management system that they implemented or intended to implement. The results of this study show that the people of Chosun realized the need to sterilize mental patients because they considered mental patients very violent, dangerous and eugenically inferior and they believed that mental patients would eventually impede the prosperity of Chosun. The people of colonial Chosun had learned about the lifelong mental hygiene movement, which had knowledge of mental illness prevention. However, they also recognized that people who developed mental illness despite efforts to prevent such condition needed help from the modern system, especially from modern Western psychiatry. The primary responsibility to attend to mental patients was imposed on their family. The family had to understand the symptoms of mental illness according to the modern medical classification and how to deal with them. When the family could not afford to take care of its mentally ill family member due to the increase in the member's risk behavior such as frenzied-convulsive excitement, paranoia and delusion of jealousy, the family was also responsible for isolating him and connecting him with a mental hospital. The police and social workers were also responsible for observing and monitoring mental patients in their community and for connecting them with a mental hospital. The police made a list of mental patients within their area of jurisdiction and prohibited them from wandering based on the law. It was also considered desirable for mental patients who could not identify their family members to be sent to a mental hospital. Social workers were responsible for managing mental patient sanatoriums, and district commissioners sent to the police mental patients who had no family to look after them or who posed a threat to others, or else commissioned them to the government hospital. Thus, the final responsibility for mental patients was imposed on the modern Western medical team, because the district commissioners sent them to the police and the police sent them to the government mental hospital. Most educated people and government personnel in the colonial era thought modern Western psychiatry circles were responsible for mental patient management, and the Japanese empire enacted mental-health-related laws and made efforts to secure funds for the establishment of mental hospitals. As the literature at that time also show the position of the modern Western medical circle, their ambivalent attitude to mental patients must also be clarified to interpret the modern approach to treating mental patients in colonial Chosun. In this context, a research on historical figures in Japanese psychiatry, a study on the specific treatment methods used by the modern Western psychiatric team in the colonial era and their effects, and the extension of the subject period for such researches are suggested.

The Relationship between Family Burden and Mental Health Service Needs of Family for Home-based Chronic Mental Patients in Community / 農村醫學 地域保健

OBJECTIVES: This study was carried out to identify the relationships of family burden and mental health service needs of chronic mental patients in community. METHODS: Objects of the study were 153 chronic mental patients in community of P. city in korea. Data were collected from December, 2007 to February, 2008 using structured questionnaire. Research tools of this study were family burden tool developed by Pai & Kapur (1981) and mental health service needs tool developed by Kim (2003). RESULTS: The average grades for family burden was 1.62 points. And the biggest part of family burden was economic burden(1.74), followed by interrupt of daily life(1.67), interrupt of family relationship(1.64), interrupt of family leisure (1.57), effects of mental health(1.50), and effects of physical health(1.43). The average grades for mental health service needs was 2.72 points. And the biggest part of mental health service needs was rehabilitation service(3.09), followed by social service(2.87), and Psychiatric medical service(2.21). Positive correlation showed between all parts of family burden. And, positive correlation showed between psychiatric medical service and interrupt of daily life(r=.281, p<.01), psychiatric medical service and effects of physical health(r=.355, p<.01), social service and effects of mental health(r=.213, p<.01). CONCLUSION: The family burden for care giver of mental patients was related with all parts of family burden and mental health service needs of family. Thus, these results should be considered to reduce family burden for care giver of mental patients in community.

The Quality of Life of Chronic Mental Patients according to Therapeutic Environment / 신경정신의학

OBJECTIVES: This study aimed to figure out the characteristics and differences of therapeutic environment by classifying into closed-ward inpatient, open-ward inpatient and community residence outpatient environment and comparing objective and subjective quality of life of each group. METHODS: The subjects consisted of 67 open-ward chronic inpatients, 58 closed -ward inpatients in the National Naju Mental Hospital and 85 outpatients living in Naju. We measured objective and subjective quality of life using semi-structural interview by Leman's quality of life scale and compared the 3 groups. We used one-way ANOVA and chi-square test to analyze the differences of the 3 groups. RESULTS: Open-ward inpatients who have autonomy and various community service program were more satisfied with their general life than the others. Community residence outpatients spent more money and less assaults experience but their leisure activities and social contact frequencies were lower than in the inpatients. Outpatients were less satisfied with their health, finances and leasure activities. Inpatients had more leisure activities and higher social contact frequency than outpatients. They were more satisfied with their finances despite of spending less the money monthly than the outpatients. They experienced violence and damage more often for the past one year and were more satisfied with their health. CONCLUSION: The quality of life reported by chronic mental patients differed according to the characteristics of therapeutic environment. The life-quality of open-ward inpatients were the highest among the 3 groups. It is necessary to serve various community service program so that we can improve the life-quality of community residence outpatients.

Frequência de anticorpos anti-Cysticercus cellulosae em população de risco para cisticercose e em segmento de população considerado supostamente normal, em regiões do Estado de São Paulo, Brasil / Frequency of anti-cysticercus cellulosae antibodies in high risk population for cysticercosis and in a segment considered as normal population, in areas of Säo Paulo state, Brazil

Examinaram-se, através de reação de fixação de complemento, os soros de 234 pacientes internados em hospital psiquiátrico localizado no município de Presidente Prudente, considerados de risco para infecção cisticercótica, além de 454 soros de gestantes procedentes da Região Administrativa de Santos e 397 soros de indivíduos considerados supostamente normais, procedentes da Região Administrativa de Presidente Prudente. O antígeno utilizado na reação de fixação de complemento foi obtido através de extração metílica, à temperatura ambiente, dos císticercos tratados com acetona. Consideraram-se positivas as reações em que ocorreu fixação de complemento a partir da diluição 1 :2. Dos 1.085 soros testados, 27 apresentaram atividade anticomplementar e 17 (1,6%) mostraram-se reagentes. Todavia, quando se consideraram, separadamente, os grupos procedentes de Santos, Presidente Prudente e os doentes mentais, percebe-se diferença significativa nos resultados: assim, os índices de freqüência foram, respectivamente, 0,88% e 1,00% para os indivíduos procedentes de Santos e Presidente Prudente e considerados supostamente normais e 3,8% para os doentes mentais. Os resultados indicam que não é desprezível a ocorrência de anticorpos anti-Cysticercus cellulosae em nosso meio, especialmente entre pacientes de hospitais psiquiátricos (AU).