Daily light exposure among psychiatric inpatients.

1. The light environment is a key element in the restoration and maintenance of health. 2. People need exposure to bright light (greater than 2,000 lux) to synchronize their circadian rhythms. 3. The affective state of people is related to their light exposure. 4. Bright light among psychiatric inpatients is low. Interventions to increase light exposure in therapeutic environments and individual care plans are recommended.     

The relationships among childhood abuse, borderline personality, and self-harm behavior in psychiatric inpatients

The current study was undertaken to explore the relationships among childhood abuse subtypes (sexual, physical, and emotional abuse; witnessing violence), three diagnostic screenings for borderline personality disorder (BPD), and self-harm behavior. Psychiatric inpatients (N = 77) were evaluated for childhood abuse histories through a survey. Participants also underwent assessment for BPD using a self-report measure, clinical diagnosis, and a DSM-IV checklist. Finally, each was assessed for self-harm behavior using the 22-item Self-Harm Inventory (SHI). Compared with non-abused participants, those with abuse histories (with the exception of witnessing violence) had a significantly greater number of BPD confirmations (i.e., self-report, clinical diagnosis, DSM-IV checklist) as well as self-harm behaviors. When examining the total number of endorsed abuse subtypes, there was a significant correlation with the number of self-harm behaviors, but not the number of BPD diagnoses. Among psychiatric inpatients, childhood abuse demonstrates a complex relationship to BPD diagnoses and self-harm behavior.     

Male victims of sexual abuse: An analysis of adolescent psychiatric inpatients

All too often it has been assumed that male victims of sexual abuse are simply similar to their female counterparts. The present study compares the psychological and substance use statuses of sexually abused adolescent male psychiatric inpatients with nonsexually abused adolescent male psychiatric inpatients. Data were collected from 166 male patients consecutively admitted to a 24-bed adolescent psychiatric unit. Abused adolescent males showed significant differences in several domains: they used drugs more frequently, were more depressed, had lower self-esteem, were more hopeless about the future, had more difficulty controlling sexual feelings, and were more concerned about their appearance than their nonabused counterparts. Implications for investigation, treatment, and training are discussed.     

Contributions of a poetry writing group to the treatment of severely disturbed psychiatric inpatients

A poetry writing group in a Veterans Administration Hospital had unexpected advantages for the treatment of patients. As an elective group that de-emphasized the discussion of emotions and concentrated instead on technique and writing of poems, it attracted a variety of patients. Some were initially too disorganized to participate effectively in other treatment groups on the ward, but were able to behave in a more organized way in this group. Their writing allowed staff to see treatment possibilities that were otherwise obscured by the patient's withdrawn or confused presentation on the unit.Red violet in the neighbor house. Poster paints climbing the chromatic scale. G. H.     

The development and construct validation of a consumer satisfaction questionnaire for psychiatric inpatients.

A consumer satisfaction scale was developed for psychiatric inpatients. The scale was administered to a state-wide sample of (n = 366) patients discharged from acute psychiatric units throughout Missouri. The scale was factor analyzed and given to another sample of (n = 390) discharges. Three out of five factors that were found in the first sample were replicated in a factor analysis of data from the second sample. Acceptable coefficient alphas were obtained on all three factors, demonstrating internal reliability. The three factors were labeled Treatment Effectiveness, Trust of Staff, and Hospital Environment. Comparable levels of satisfaction with prior studies were found on the first general satisfaction factor of Treatment Effectiveness. Subjects discriminated areas of satisfaction by expressing higher levels of dissatisfaction on the factors of Trust of Staff and Hospital Environment.     

Marital status and psychiatric disorders among blacks and whites.

This paper examines the association between marital status and psychiatric disorder for Blacks and explores the extent to which these patterns differ from those for Whites. Widowed and separated/divorced Black males and females have higher rates of disorder than the married; never-married Blacks do not have an elevated risk of psychiatric illness. The association between marital status and disorder for White males is similar and stronger than that observed for Blacks. For White women, the separated/divorced have a higher risk of disorder than the married, and unmarried White females have higher rates of the substance abuse disorders, but lower rates of the anxiety disorder than the married. Across all marital status groups, Black males and White males have higher rates of disorder (except for depression), than females. A complex pattern emerges when gender differences in the relative rates of disorder for unmarried Blacks compared to married Blacks are considered. Separated/divorced Black men, widowed Black women, and never-married Black men are worse off than their respective peers. Except for the separated/divorced, opposite patterns are evident for Whites. Directions for further research are outlined.     

Anomaly,impulsivity, and addiction

There are two behavioral approaches to addiction: rational and irrational. The rational approach assumes that addicts have higher time preference rates and lower risk-aversion coefficients—parameters that are interpreted as impulsive preferences. On the other hand, the irrational approach argues that addiction is a consequence of anomalies such as non-expected utility and hyperbolically discounted utility. This paper integrates these two approaches and concludes that anomaly and impulsivity complementarily account for addiction.     

Early assessment of implementing evidence-based brief therapy interventions among secondary service psychiatric therapists

This implementation study was part of the Ostrobothnia Depression Study, in Finland, which covered implementation of motivational interviewing (MI) and behavioral activation (BA) within regional public psychiatric secondary care. It aimed to evaluate the mid-term progress of implementation and related factors. Altogether, 80 therapists had been educated through the implementation program by the point of the mid-term evaluation. Eligible information for evaluation was gathered using two questionnaires (q1, q2) with a one-year interval.A total of 45 of the 80 therapists completed q1, 30 completed q2, and 24 completed both questionnaires. Professional education was the only background factor associated with adopting the interventions (q1: p = 0.059, q2: p = 0.023), with higher education indicating greater activity. On the basis of trends such as changes in overall usefulness score from q1 to q2, the most involved therapists were slightly more likely to adopt MI/BA. Our experience so far suggests that encouraging staff to begin using new interventions during education is very important. The Consolidated Framework for Implementation Research was found to be a useful tool for constructing the evaluation.     

Neurodevelopment,impulsivity, and adolescent gambling

The prevalence of problem and pathological gambling in adolescence and young adulthood has been found to be two- to fourfold higher than in adulthood. Given that these high rates might predict future increases across all age groups, it is important to explore the causes of the elevated rates of problem and pathological gambling among youths. This article reviews evidence for a neurobiological basis for adolescent vulnerability to problem and pathological gambling behaviors. We propose that a common trait motif of impulsivity might underlie phenomenology of pathological gambling, commonly comorbid psychiatric disorders, and related aspects of adolescent behavior. Recent advances in understanding the brain mechanisms involved in motivation, reward, and decision-making allow a discussion of neural circuitry underlying impulsivity. Emerging data indicate that important neurodevelopmental events during adolescence occur in brain regions associated with motivation and impulsive behavior. We hypothesize that immaturity of frontal cortical and subcortical monoaminergic systems during normal neurodevelopment underlies adolescent impulsivity as a transitional trait-behavior. While these neurodevelopmental processes may confer advantage by promoting a learning drive for optimal adaptation to adult roles, they may also confer an increased vulnerability to addictive behaviors such as problem and pathological gambling. An exploration of the developmental changes in neural circuitry involved in impulse control has significant implications for understanding adolescent behaviors and treating problem and pathological gambling among youths.     

Evaluation of an experience-based program to understand the concept of recovery among hospital-based psychiatric nurses

This study aimed to implement an experience-based program to promote the understanding of the concept of recovery, which is defined as a meaningful life and valued sense of integrity based on subjective and individual viewpoints, among psychiatric nurses working in hospitals in Japan and to evaluate this program. Methods: We conducted a preliminary survey of nurses at six facilities with psychiatric wards. The experience-based program was conducted for 12 nurses who expressed a wish to participate. The program spanned three days and consisted of lectures, assertive community treatment (ACT) staff visits for recovery orientation, and group work. Results: The mean Recovery Knowledge Inventory of nine participants ultimately included was 3.41 points (SD, 0.28) before the program and 3.69 points (SD, 0.24) after the program, indicating a significant difference (p = .004). Categories obtained from ACT support experiences included the following: “Continuing to attend to the need to live in one’s community/home regardless of how bad psychiatric symptoms become without the use of medicines,” “Viewing the person living their life in a place where they belong and in their own individual style,” “Valuing the patient’s wishes is the slow but sure way to a fruitful relationship,” and “Become familiar to the patient and their family’s lifestyle by carefully listening to the family’s feelings”. Discussion: We believe that this program can help establish the concept of recovery in hospital, which tend to rely on the medical model, and enable daily nursing practice to be implemented from a strength-based viewpoint.     

The effects of psychiatric symptoms on quality of life assessments among the chronic mentally ill

This study of chronically mentally disabled persons in community residences examined the discriminant validity of subjective quality of life indicators and self-report mental health indices to determine the potential confounding effects of psychopathology on the assessment of quality of life (QOL). Factor analyses and difference-score reliabilities identified a general QOL construct and a general mental health construct with 27% common variance. However, psychiatric symptoms did not significantly (p less than .05) alter the bivariate and multivariate relationships among the QOL ratings, except in the health domain in which the correlations of health-related QOL indicators with global QOL were significantly (p less than .05) attenuated after removing the effects of psychopathology. The results suggest that psychopathology does not introduce bias into the overall structure of QOL data, but they also indicate the importance of controlling for mental health effects in the assessment of patients' self-rated health and satisfaction with health care.     

Rates and correlates of recurrent psychiatric crisis episodes among children and adolescents in state custody

The purpose of this study was to determine the extent of and factors associated with recurrent psychiatric crisis episodes among children and adolescents in state custody. A total of 1362 children ages 3 to 16 years who were in custody of the child welfare agency and underwent a psychiatric crisis screening and services for the first time between 2001 and 2003 were followed for the same observation period of 24 months. Logistic regression was used to determine the clinical and non-clinical factors associated with a return to psychiatric crisis screening and services. Overall, 44.6% of the sample had another psychiatric crisis episode in the following two years. Nearly two thirds of those who returned did so within 6 months of their first crisis episode. A greater likelihood of recidivism was associated with severity of psychiatric illness, being female, white, in residential care placement, and having placement instability. Recurrent psychiatric crises appear to be predictable using readily available variables, which can inform interventions designed to reduce repeat episodes.     

Workplace stress among psychiatric nurses. Prevalence,distribution, correlates, & predictors

Vicarious trauma and burnout are serious manifestations of workplace stress. Both can have substantial consequences for health care professionals, health services, and consumers. This article reports results of a study examining the prevalence, distribution, correlates, and predictors of vicarious trauma and burnout among registered psychiatric nurses (RPNs). A survey was distributed to all practicing RPNs in Manitoba, Canada (N = 1,015). The survey contained the Maslach Burnout Inventory, the Traumatic Stress Institute Belief Scale (i.e., a measure of vicarious trauma), and a section on symptoms of posttraumatic stress disorder (PTSD). The RPNs were found to be experiencing high levels of emotional exhaustion (i.e., high burnout) and even higher levels of personal accomplishment (i.e., low burnout). No significant differences were found between respondents' total scores on the Traumatic Stress Institute Belief Scale and instrument norms for mental health care professionals. Predictors of burnout and vicarious trauma also are presented in this article. Stress experienced by RPNs, as well as strengths on which to build, clearly are evident in the study results. Strategies for reduction in workplace stress may benefit psychiatric nurses, clients, and health services.