Barriers to Positively Impact Weight Gain in a Psychiatric Inpatient Unit.

Weight gain is a problematic issue for patients with serious mental illness. A previously published study found that hospitalized psychiatric patients gained over 6 lb in stays ≥ 30 days. Furthermore, hospital-wide changes to promote healthy eating were unsuccessful in stemming weight gain. A second study was initiated to institute further interventions to decrease the amount of weight gained by inpatients. Sadly, these interventions were unsuccessful. As inpatient weight gain is a chronic and significant medical problem faced by mental health providers, this report outlines the hurdles faced in this project so that others can glean important insights into tackling this issue.

Weight Gain in Psychiatric Inpatients: Are Interventions Making a Positive Impact?

OBJECTIVE: The negative impact of weight gain is a common problem facing all patients, but it is especially concerning in the seriously mentally ill population. The literature is replete with interventions to mitigate weight gain in this population; however, most focus on outpatient settings. This study was undertaken to quantify weight gain in an inpatient setting and to assess whether instituted interventions to reduce weight gain were effective. METHODS: This retrospective study analyzed weight changes in adult psychiatric inpatients with length of stay of 30 days or more. Data regarding weight changes were collected from records before (July 2005 to June 2006) a hospital-wide policy change to combat weight gain and after (July 2013 to June 2014) the changes were instituted. A total of 537 charts were reviewed. RESULTS: Male inpatients gained a mean of 7.61 lb and females gained 6.02 lb. The mean weight change increased for the pre and post policy change periods: 6.08 lb and 7.85 lb, respectively, a 29% increase in mean weight. CONCLUSION: This study demonstrates that weight in psychiatric inpatients hospitalized for 30 days or longer increased despite widespread changes in the hospital setting implemented to limit weight gain.

A guide to treating military personnel in a civilian mental health facility.

As the number of troops returning home from the Middle East continues to rise, so does the need for psychiatric treatment. More and more often, civilian mental health facilities will be faced with treating active duty service members. Because the patients are active duty status, civilian providers need to become familiar with the unique intricacies and challenges of interacting with military command and mental health clinics. Concepts such as confidentiality and consent have a slightly different meaning in the military that affects care in the civilian realm. Diagnoses, medication choices, and treatment planning can also have an impact on a service member's career in the military that civilian providers may not recognize. This guide serves as a "beginner's" manual for working with active duty service members.

Infection control for MRSA in a psychiatric hospital.

OBJECTIVE: This article examines the challenges in treating methicillin resistant Staphlococcus Aureus (MRSA) in an acute psychiatric inpatient unit. METHOD: The article outlines a case study of one particularly difficult patient who presented to an acute psychiatric hospital with a large wound that was MRSA positive and reviews the dilemmas facing mental health providers. RESULTS: The outcome of the case presented suggests that hospital policies interfered with the psychiatric treatment and recovery of an acutely ill patient as well as create possibly unnecessary costs. CONCLUSIONS: Hospitals should review their infection control policies to curb the spread of infection among patients and staff in an acute psychiatric setting.

Civil commitment outcomes of incompetent defendants.

In Maricopa County, Arizona, most defendants who are found not competent and not restorable (NCNR) are admitted involuntarily to an acute-care inpatient hospital. Many of these patients would most likely not have met the State's usual admission criteria for acute inpatient care had they not been evaluated in relation to a criminal offense. Is this group treated differently from their peers who are not involved in the criminal justice system? We examined records for 293 NCNR admissions, retrospectively, to assess their admission status and the outcomes of their commitment. We compared them to 280 matched cases of patients admitted involuntarily from the community (non-NCNR). The NCNR group met fewer admission criteria and received court-ordered treatment (COT) 22 percent more often than did the non-NCNR patients. The NCNR patients had longer hospital stays despite being found less dangerous to themselves or others than the community sample. Results suggest that NCNR individuals are treated differently from non-NCNR patients.