sentenced for statutory rape—sex with an underage girl. It is a sign of changing social attitudes that this has been largely downplayed or ignored in discussions of the novel. McMurphy represents individualism and freedom in a battle with Nurse Ratched who embodies social conformity. The theme of the psychiatric patient as a nonconformist or rebel against societal values was a feature of the work of writers such as Laing. The struggle between McMurphy and Nurse Ratched is at the heart of the drama. McMurphy challenges her authority at every opportunity—for example, by ensuring that the group watches the World Series or by running card schools. McMurphy is particularly shocked when he realizes that the other patients have admitted themselves voluntarily to the hospital. He has been transferred from prison—thus making the initial distance between himself and the other patients even greater. The novel also emphasizes the social isolation of psychiatric patients and the ways that this feeds stigma and the wider society’s fear of them as a group. These attitudes are also internalized. McMurphy acts as a catalyst to challenge these views. Set pieces in the novel such as the fishing trip or the party McMurphy organizes on the ward emphasize this theme. Nurse Ratched is a dominant authority figure on the ward. The work of Goffman (1968a) and Rosenhahn’s (1975) famous pseudo patient experiment revealed, that on many occasions,
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non-psychotic disorder but who later manifest psy- chotic symptoms (Hogerzeil et al., 2014). Elec- tronic health records can help alleviate these prob- lems, whereby clinical information is screened us- ing a diagnostic instrument to identify symptoms of psychosis within a defined period and conse- quently classify new FEP cases. An example of such an endeavour is work being carried out at the Institute of Psychiatry and South London & Maudsley (SLaM) NHS Trust using the Biomed- ical Research Centre Clinical Records Interactive Search (CRIS) to identify FEP cases in the CRIS- First Episode Psychosis study (Bourque, 2015). To summarize this work, psychiatric experts man- ually coded data in the free-text of clinical records between 1st May 2010 and 30th April 2012 for patients presenting to SLaM with compliance for psychotic disorder using a psychiatric diagnos- tic tool. Whilst the screening of clinical records sampling method comprehensively identifies cases and reduces risk of underestimation, this approach raises resource and efficiency challenges. For ex- ample, review of clinical records requires expert level resource (such as a psychiatrist or psychi- atric nurse) for annotation, which can be very ex- pensive. On average approximately 80-100 indi- vidual clinical records were screened per week by each annotator. It is clear that manual screening of electronic records is resource-intensive and time- consuming.
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Recently natural language processing (NLP) tools have been developed to identify and ex- tract salient risk indicators in electronic health records (EHRs). Sentiment analysis, although widely used in non-medical areas for improv- ing decision making, has been studied mini- mally in the clinical setting. In this study, we undertook, to our knowledge, the first domain adaptation of sentiment analysis to psychiatric EHRs by defining psychiatric clinical senti- ment, performing an annotation project, and evaluating multiple sentence-level sentiment machine learning (ML) models. Results indi- cate that off-the-shelf sentiment analysis tools fail in identifying clinically positive or nega- tive polarity, and that the definition of clinical sentiment that we provide is learnable with rel- atively small amounts of training data. This project is an initial step towards further re- fining sentiment analysis methods for clinical use. Our long-term objective is to incorporate the results of this project as part of a machine learning model that predicts inpatient readmis- sion risk. We hope that this work will initiate a discussion concerning domain adaptation of sentiment analysis to the clinical setting.
The reported increasing hospital readmission of children and adolescents with psychiatric illness (pediatric psychiatric patients) continues to present as a public health concern. One question of particular importance is whether hospital length of stay during the initial treatment impacts readmission and use of resources. In this paper, the objective was to investigate the association between hospital length of stay in days and readmission for children with psychiatric illness who have received inpatient care. The focus extends to examining how length of stay changed for the different diagnoses, and how such change affected patient readmissions between 1999 and 2010. For the methods, descriptive statistics were calculated, and Receiver Operating Characteristic (ROC) curves were obtained to calculate area under the curve with length of stay as the analysis time. Length of stay was divided into 7-day increments for the first 35 days, thus providing the following length of stay categories: 1-7, 8-14, 15-21, 22-28, and 29-35 days. Generally, fewer days of hospital stay were not a direct predictor of readmission for many diagnoses. For some diagnoses, however, like the group of eating disorders few days of hospital stay may predict readmission as shown by the observed large area under the curve while using the ROC. Prospective research examining length of stay may be necessary to determine how length of stay interacts with other factors in predicting readmission.
Abstract: This paper attempts to see whether proportion of male and female patients is equal or not and to study the survival pattern of psychiatric patients. Simple random sampling without replacement (SRSWOR) has been used to collect information on Psychiatric patients and other related variables using a pre-tested questionnaire from the Assam medical college and hospital, Assam, India. At first, the testing equality of proportion between male and female patient with respect to discharge, we seen that the proportion of female patient released on request from the hospital is significantly higher than male patient. The highest numbers of patients are in the age group (20-30) years with. In this context, the Kaplan-Meier method has been applied to estimate the median duration of stay in the hospital for the patient. The Kaplan Meier curve for male and female shows that there is not much difference in recovery time for male and female patients. Again, the Cox proportional hazard model has been used to shows that risk of staying in the hospital. These shows, that is almost identical for both the male and female patients. Thus, it can be concluded that prevalence of Schizophrenia is highest in this population alarmingly it is highest among the youth aged (20-30) years.
The present study is the first to quantitatively analyse the complete set of data for the entire population in a country, to investigate factors affecting psychiatric inpa- tient MEs and to differentiate those factors across differ- ent types of public health insurance programmes. Moreover, instead of standard linear regression analyses, multilevel analyses taking account of clustering within a medical institution were employed. Despite this obvious methodological advantage, several limitations should be mentioned. First, this claim-based study limits my ability to utilize such characteristics as pre-admission history and the severity of psychiatric illness. Second, because the data used in this study were collected during a parti- cular period of time, my analyses do not consider psy- chiatric patient MEs for periods between the beginning of admission to an institution and inpatient discharge. However, psychiatric patient MEs during a particular period of time could be of importance, particularly from the perspective of mental health policy. Finally, the pro- portion of involuntary admissions or of readmission at a medical institution might affect patient ME, although this has not been identified in my datasets.
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This article applies the Rasch model , as a supple- ment to CTT in order to assess the psychometric prop- erties of one of the measures derived from the Psychiatric Out-Patient Experiences Questionnaire (POPEQ). The questionnaire has been used in two con- secutive national patient experience surveys in Norway [19,20]. The development of the questionnaire followed a literature review including widely used questionnaires within psychiatry that was designed to identify domains and items of potential relevance to psychiatric outpati- ents [21-27]. The review showed that Norway lacked a standardized, validated questionnaire for the measure- ment of outpatients ’ experiences with mental health care in Norway. Therefore development work was undertaken which included reviews of items by an expert group, cognitive interviews with patients and piloting . Following qualitative interviews with patients and consultation with an expert group, the items and domains identified by the review were assessed for relevance and supplemented by additional items and domains. This process was designed to ensure the content validity of the POPEQ. The core 11-item POPEQ includes a range of patient experiences ques- tions relating to the three domains of perceived out- come of the treatment (3 items), the quality of interaction with the clinician (5 items), and the quality of information provision (3 items) in addition to a num- ber of single items and background questions. The three domains are often included in other psychiatric patient
In the psychiatric health care environment of Japan, the average hospital stay is much longer than those of other countries. Long-term hospitalization is a problem in psychiatric hospitals in Japan . Today, the Japanese gov- ernment is promoting outreach services , and patient transitions from hospital to community as social rehabil- itation strategy . This situation is essential to prevent re-admissions and early discharge of patients, and to provide appropriate treatments and interdisciplinary care to patients with psychiatric disorders. However, there is no patient database for nursing that specializes in nursing in the psychiatric hospital in Japan. Therefore, psy- chiatric nursing care assessment is inefficient. The Japanese Psychiatric Nursing Assessment Classification Sys- tem (PsyNACS)© was developed to improve psychiatric nursing care services . The PsyNACS© has nine Pa- tient Assessment Data (PAD) with 2 to 5 Cluster Assessment Data (CAD). Thirty one CADs comprised the Pa- tient Assessment Data: (PAD1) Psychological symptom and stress, (PAD2) Information about treatment, (PAD3) Function of eating and balance of water, (PAD4) Life and value, (PAD5) Vital signs and health assessment, (PAD6) Self-care, (PAD7) Social Support, (PAD8) Activity, sleeping and mobility capability, and (PAD9) Sexual function and sexual behavior. The PsyNACS© is a classification of items assessing health care needs within the Japanese psychiatric nursing care environment. It can also be used in various psychiatric patient care situations in psychiatric units.
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The value of these assessments is described by  who emphasised that there may be a dramatic deterioration of the neurocognitive ability, but through sys- tematic assessment early during the illness, the risks are discovered, and ade- quate efforts can be put in place if coordination between psychiatric and somatic care is carried out . The assessment itself is also believed to have a therapeu- tic effect. A previous study  showed that multiple self-assessments increase individuals’ ability positively and when they conducted repeated self-assessments, their ability to make adequate self-ratings also increased. Our conclusion was that it might be due to training effects from the repeated assessments; specifical- ly, individuals’ talents to communicate about their illness and quality of life were promoted. Our assumption is that these results reflect a factor that contributed to remission, but that there are more reasons that are highlighted in this study that are worth exploring further.
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Severe agitation in patients with delirium may be difficult for clinicians’ management because of problems of differential diagnosis and treatment. Regrettably, theory and guidelines concerning this issue may fail to cover the incredible complexity of clinical practice. Our aim is to describe three cases of delirium from our real-life clinical experience, with a specific focus on their com- plexity as far as differential diagnosis and psychopharmacological treatment are concerned. In clinical practice, as shown by the three cases we describe, the etiology of delirium is various and mixed, lab analysis are not specific and it is not possible to exactly assess which kind of substances were used by patients. New drugs and smart drugs are not yet detectable by our urine analysis, and their effects, interaction with prescription drugs and pharmacokinetics are not well known. With the aim to obtain a successful sedation and to calm the patient, in our cases, we needed to use a pharmacological combined approach (benzodiazepines, first and second generation antipsy- chotics) with different routes of administration and, when inevitable, physical restraint.
The association between patient characteristics, psychiatrist gender, duration of decision (from when the topic is initially raised to when a decision is taken or deferred), length of visit and OPTION scores were explored using linear mixed- effects models using SPSS version 19  taking into account psychiatrist clustering. Kruskall-Wallis one-way ANOVA’s examined the association between decision topics and individual psychiatrist on OPTION scores. Variables associated with OPTION scores at the 10% significance level were further explored in multivariate analyses using mixed-effects regression.
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Strategies to improve the FD patient outcome involve a series of procedures, including (Figure 1) the following: 1) proper diagnosis to exclude neurological and psychiatric disorders that can have similar physical presentation and can require the use of vocal probes for differential diagno- sis; 2) careful recording of the voice signal with quantita- tive measurement and qualitative description of the vocal deviation for comparison after treatment; 3) acoustic evalu- ation including both extraction of selected parameters and description of the spectrographic trace, to gather data on the mechanism involved in voice production; 4) self-assessment questionnaires to map the impact of the voice problem and to comprehend the dimensions involved; 5) referral to a psychological evaluation in cases of suspected anxiety and/or depression; 6) identification of coping strategies to face dysfunctional approaches; 7) self-regulation data to assist the patient regarding vocal load; and finally 8) direct and intensive vocal rehabilitation to reduce psychological resistance and to reassure patients recovery.
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this finding also confirms that psychiatric patients’ points of view concerning the quality of care are relevant and linked to the evolution of their health and treatment gains. How- ever, the strength of this association was lower than it was for care characteristics (ie, the therapeutic relationship and seclusion). Although symptomatic improvement is important for patients, it is not the most important feature for them, confirming the need for clinicians to increase their attention to other aspects, rather than just focusing on symptoms. Unlike previous studies, 22,57,58 our results showed that satisfaction
proposed MPU are admitted to an internal medicine, neurology, or traumatology ward. Together with general surgery and gastroenterology wards, these wards will refer 75% of patients with an MPU indication in the future. Sup- port from these departments and their specialists will be crucial to establish a well-functioning MPU. Since the Erasmus MC is a tertiary referral center the MPU should be able to deliver the most complex physical and psychi- atric care in order to provide added value and be accept- able for medical specialists. When both specialists agreed that there was no MPU-admission indication, they com- monly stated that medical acuity was too high or specialist nursing care or equipment was needed. A Psychiatric Con- sultative Service should stay easily accessible for these pa- tients to provide psychiatric assessment and treatment. Kishi et al. described the patient population of their type IV integrated medicine and psychiatry treatment program. The psychiatric conditions of their patients are similar to those of our MPU-eligible patient group, most common be- ing substance-related disorders, delirium, mood disorders and dementia . Molnar et al. explored differences be- tween patients using a Liaison-Consultative Service (LCS) and patients on an MPU . In our study organic mental disorder, including delirium, was a common diagnosis, while in Molnar’ s study delirium occurred in only small number of patients. In our study substance related disor- ders were frequently found in the need for MPU patient group, hence the proposed MPU might need collaboration and agreements with addiction treatment centers .
Evidence suggests that problem behaviours such as physical aggression and temper tantrums are predictors of use of psychiatric and behavioural services in adults with ID (Aman, Sarphare & Burrows, 1995; Singh, Ellis & Wechsler, 1997). Anti-psychotic medication is also frequently prescribed in adults with ID to control problem behaviours in the absence of mental illness (Bouras, 1999; Gray & Hastings, 2005). Relatively little is known about the use of mental health services by adults with PDD and ID. Given the general trend for large institutions to close, more research is needed on people with PDD and ID living in community settings E. Tsakanikos ( & ) Æ H. Costello Æ G. Holt Æ N. Bouras
The adult inpatient psychiatry unit is housed in the first floor and is independent and a closed ward. The total bed strength is 40 for both sexes and in separate wings. There is also an addi- tional 15 beds within the same ward but separate wing for sub- stance use disorders. In addition, psychiatric patients who are not disturbed and harmful to self or others are admitted to other open medical wards. The bed occupancy is usually full and the average length of stay is 12 days. Most of the patients on an av- erage 95% are discharged into the community and a small num- ber are transferred to long-term facility. The treatment and care of patients are by a multidisciplinary team. The admission pro- cess occurs in a comfortable and in a non-threatening atmo- sphere where the significant others are encouraged to stay with the patients most of the time during their stay. Though there are particular visiting hours, it has been flexible for maximal fam- ily involvement. Family psycho education or therapeutic family interactions occur at least twice during their hospitalizations as part of the treatment programmes. It is a closed ward; however there is minimal use of seclusion and restraint.
Methods: This retrospective, qualitative multiple-case study was based on the patient records of patients with severe mental illness, mainly schizophrenia and other psychotic disorders. Twenty two patient records were analyzed. Patients ’ demographic and clinical characteristics were heterogeneous. All were treated by Flexible Assertive Community Treatment teams (FACT teams) at two mental health institutions in the greater Rotterdam area in the Netherlands and had a compulsory admission in a predefined inclusion period. The data were analyzed according to the Prevention and Recovery System for Monitoring and Analysis (PRISMA) method, assessing acts, events, conditions, and circumstances, failing protective barriers and protective recovery factors.
sectional analysis of all psychiatric consultations at the University Hospital Ulm (Ulm, Germany) was carried out observing a 1-year period. Therefore, an in-house inventory was developed to gain data (see methods) from the documentation schedules for further analysis. Based on shortcomings in documentation, that should be identi- fied in our analysis, we first intended to create a standard form with particular items according to detected idiosyn- cracies that should replace the former blank documenta- tion schedules. In addition, composing a pocket-booklet with useful information for the consulting psychiatrist was proposed. This pocket-booklet should contain in- formation regarding diagnostic criteria, differential di- agnosis and treatment guidelines of the most frequent diseases within our PCR to render an improved and more homogenous outcome possible.
Results: Inpatient staff feel sustained in their potentially stressful roles by mutual loyalty and trust within cohesive ward teams. Clear roles, supportive ward managers and well designed organisational procedures and structures maintain good morale. Perceived threats to good morale include staffing levels that are insufficient for staff to feel safe and able to spend time with patients, the high risk of violence, and lack of voice in the wider organisation. Conclusions: Increasing employee voice, designing jobs so as to maximise autonomy within clear and well- structured operational protocols, promoting greater staff-patient contact and improving responses to violence may contribute more to inpatient staff morale than formal support mechanisms.
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Results: In total, 189 errors were detected in 1,082 opportunities for error (17%) of which 84/998 (8%) were assessed as potentially harmful. The frequency of errors was: prescribing, 10/189 (5%); dispensing, 18/189 (10%); administration, 142/189 (75%); and discharge summaries, 19/189 (10%). The most common errors were omission of pro re nata dosing regime in computerized physician order entry, omission of dose, lack of identity control, and omission of drug. Conclusion: Errors throughout the medication process are common in psychiatric wards to an extent which resembles error rates in somatic care. Despite a substantial proportion of errors with potential to harm patients, very few errors were considered potentially fatal. Medical staff needs greater awareness of medication safety and guidelines related to the medication process. Many errors in this study might potentially be prevented by nursing staff when handling medication and observing patients for effect and side effects of medication. The nurses’ role in psychiatric medication safety should be further explored as nurses appear to be in the unique position to intercept errors before they reach the patient.