RESUMEN
OBJECTIVE: The aim of this study was to determine whether implementation of a collaborative problem-solving approach would be associated with a decrease in seclusion and restraint in a child and adolescent inpatient unit. METHOD: A collaborative problem-solving (CPS) approach was implemented. Seclusion and restraint, length of treatment, clinician- and patient/parent-rated outcomes and staff utility and acceptability were surveyed pre and post implementation. RESULTS: The number of restrictive events significantly decreased, including full restraint, partial restraint and seclusion. Length of treatment and routine clinician-rated outcome measures remained consistent. Patient or parent-rated outcomes showed greater reduction post implementation. Despite some initial scepticism, the staff found this approach useful. CONCLUSIONS: A CPS approach was successfully implemented, and in this naturalistic study was associated with a significant decrease in seclusions and restraints.
Asunto(s)
Conducta Cooperativa , Pacientes Internos , Aislamiento de Pacientes/estadística & datos numéricos , Solución de Problemas , Restricción Física/estadística & datos numéricos , Adolescente , Niño , Hospitales Psiquiátricos/organización & administración , Humanos , Nueva Zelanda , Medición de Resultados Informados por el PacienteRESUMEN
OBJECTIVE: To determine the rate, indications and process for using seclusion for patients undergoing treatment at an older adolescent inpatient unit. METHOD: Data were gathered prospectively and retrospectively as part of a quality assurance initiative at the Christchurch Youth Inpatient Unit (YIU); paper, electronic and legal documentation were examined. RESULTS: During the time period of the investigation, approximately 13% of individuals admitted to the unit were secluded. Psychosis, involuntary admission and Maori ethnicity were significantly associated with the use of seclusion with aggression being the most documented indication. The vast majority of seclusions occurred within the first seven days of admission and over half utilized pro re nata medication prior to seclusion. CONCLUSIONS: Opportunities exist for intensifying and focusing efforts to minimize the use of seclusion and restraint, particularly during the first week of hospitalization.
Asunto(s)
Hospitales Psiquiátricos/estadística & datos numéricos , Pacientes Internos/psicología , Aislamiento de Pacientes/estadística & datos numéricos , Adolescente , Agresión/psicología , Internamiento Obligatorio del Enfermo Mental/estadística & datos numéricos , Femenino , Humanos , Masculino , Nativos de Hawái y Otras Islas del Pacífico/estadística & datos numéricos , Nueva Zelanda , Aislamiento de Pacientes/psicología , Estudios Prospectivos , Trastornos Psicóticos/etnología , Trastornos Psicóticos/terapia , Estudios Retrospectivos , Factores de RiesgoRESUMEN
The objective of this study was to evaluate the efficacy and tolerability of quetiapine in the treatment of first onset psychosis in older adolescents using risperidone as a comparator. Twenty-two patients with first onset psychosis were randomized to receive quetiapine (up to 800 mg/day) or risperidone (up to 6 mg/day) for 6 weeks. Raters blind to treatment assignment performed outcome symptom ratings. No statistical differences emerged in terms of efficacy or tolerability between the two drugs. However, there were some clinically notable differences that seem to favour the efficacy of risperidone over quetiapine. Patients taking quetiapine, although improved, showed less clinical improvement on scores for total positive and negative symptoms, clinical global severity and depression at 6 weeks than patients taking risperidone. Although both treatments were associated with weight gain and sedation, more patients on quetiapine experienced over 10% weight gain. However, fewer patients who were taking quetiapine required anticholinergic medication or experienced extrapyramidal side effects than patients taking risperidone. Risperidone was significantly more likely to be associated with elevation in serum prolactin levels in this population. In conclusion, the results in this small trial show that adolescent patients may benefit more from treatment with risperidone than quetiapine. However, those susceptible to side effects, particularly hyperprolactinaemia, may be more suitable for treatment with quetiapine.
Asunto(s)
Conducta del Adolescente/efectos de los fármacos , Antipsicóticos/uso terapéutico , Dibenzotiazepinas/uso terapéutico , Trastornos Psicóticos/tratamiento farmacológico , Risperidona/uso terapéutico , Adolescente , Conducta del Adolescente/psicología , Antipsicóticos/efectos adversos , Dibenzotiazepinas/efectos adversos , Femenino , Humanos , Hiperprolactinemia/inducido químicamente , Masculino , Prolactina/sangre , Trastornos Psicóticos/sangre , Trastornos Psicóticos/diagnóstico , Fumarato de Quetiapina , Risperidona/efectos adversos , Resultado del Tratamiento , Aumento de Peso/efectos de los fármacosRESUMEN
OBJECTIVES: The aim of this paper was to determine if patients undergoing treatment at an older adolescent inpatient unit receive psychoeducation according to the unit philosophy of providing timely and pertinent information regarding illness/diagnosis, medication, diet, outpatient follow-up, and alcohol/ drug use. METHODS: Data were gathered prospectively as part of a quality assurance initiative at the Christchurch Youth Inpatient Unit. Patients were interviewed by a registered nurse using a structured audit tool. RESULTS: Participants reported receiving adequate information on medication and illness, and most received information on outpatient follow-up and alcohol and drug use. However, the majority reported a lack of information/ advice about diet. Patients' reported awareness of relapse prevention and the relationship of alcohol and other drugs use to medication and treatment was lower than expected. CONCLUSIONS: The audit highlighted areas of discrepancy between information staff believed they had delivered and information youth perceived as received. Psychiatric staff working with young people need be aware of the timing, language and mode of delivery of psychoeducation to enable their patients to 'take in' the information provided.
Asunto(s)
Conocimientos, Actitudes y Práctica en Salud , Servicios de Salud Mental/estadística & datos numéricos , Educación del Paciente como Asunto/estadística & datos numéricos , Adolescente , Actitud del Personal de Salud , Femenino , Humanos , Masculino , Evaluación de Programas y Proyectos de SaludRESUMEN
PROBLEM: Little has been written on the value of composing narrative letters to adolescent psychiatric inpatients as rated by those who receive them. METHODS: Survey of youth, family members, and professionals given copies of a narrative discharge letter written as an alternative to a copy of an initial discharge letter written to the referrer. FINDINGS: Narrative letters conceptualized and validated youth experience, progress, and future directions in a language easily understood by the youth and family members, enabling reflection and empowerment. CONCLUSION: Narrative letter writing is a valuable therapeutic tool to facilitate reflective, empowering partnerships among professionals, youth, and family members.
Asunto(s)
Correspondencia como Asunto , Alta del Paciente , Adolescente , Actitud del Personal de Salud , Actitud Frente a la Salud , Familia/psicología , Encuestas Epidemiológicas , Enfermería Holística , Humanos , Pacientes Internos/psicología , Narración , Enfermería Psiquiátrica , Procesos PsicoterapéuticosRESUMEN
Little is known about which nursing interventions used in adolescent psychiatric inpatient treatment demonstrate improvements in outcome in the 'real world' setting, despite an increase in external outcomes reporting requirements.This paper examines nursing and other multidisciplinary interventions commonly used at the Youth Inpatient Unit, Christchurch, New Zealand, in relation to improvements in outcomes as measured by the Health of the Nation Outcome Scales for Children and Adolescents, utilizing data gathered prospectively as part of an ongoing quality assurance and outcomes project. We found the majority of interventions investigated were utilized equally across diagnostic groups, although stress management and problem-solving education was used more for patients with mixed affective disorders. Further, the results contribute to growing evidence toward the value of providing medication and problem-solving education to this population. Mental health nurses working with children and adolescents should be supported to utilize and develop their unique skill set to offer targeted interventions and to examine their practice to identify the most valuable interventions for their patients within this developmental context.
Asunto(s)
Trastornos Mentales/enfermería , Rol de la Enfermera , Evaluación de Resultado en la Atención de Salud/organización & administración , Enfermería Psiquiátrica/organización & administración , Índice de Severidad de la Enfermedad , Adolescente , Psiquiatría del Adolescente/organización & administración , Trastornos Psicóticos Afectivos/enfermería , Análisis de Varianza , Terapia Cognitivo-Conductual/organización & administración , Enfermería Basada en la Evidencia , Femenino , Unidades Hospitalarias/organización & administración , Humanos , Tiempo de Internación/estadística & datos numéricos , Masculino , Trastornos Mentales/diagnóstico , Nueva Zelanda , Investigación en Evaluación de Enfermería , Educación del Paciente como Asunto/organización & administración , Estudios Prospectivos , Trastornos Psicóticos/enfermería , Trastornos por Estrés Postraumático/enfermería , Gestión de la Calidad TotalRESUMEN
OBJECTIVE: To determine the level of compliance with official guidelines for prescribing mood stabilizers among adolescents in Christchurch, New Zealand. METHODS: A retrospective audit of clinical files of patients aged 13-19 years attending inpatient and outpatient services in the Child, Adolescent and Family Service in the Canterbury District catchment area was carried out against set criteria derived from the Ministry of Health Guidelines regarding the use of mood stabilizers (lithium and sodium valproate). A guideline compliance index was also created to measure overall compliance. RESULTS: Over a period of 3 years beginning from January 2000, we identified 68 episodes of initiation among 58 adolescents. Of those, 91.2% were for indications set in the guidelines. More than half appeared to have been given no information about the medication, and only 61.8% had documented consent. Two-thirds had a full laboratory work-up before initiation. More than one-third had no evidence of communication with general practitioners about being initiated on a mood stabilizer. Overall, only 13.2% were 100% compliant and only 50% were 80% compliant. CONCLUSION: In general, mood stabilizers were prescribed as indicated, but adherence to the guidelines beyond that appears to fall short of standards set by the guidelines.
Asunto(s)
Servicios de Salud del Adolescente/normas , Antidepresivos/uso terapéutico , Antimaníacos/uso terapéutico , Prescripciones de Medicamentos/normas , Adhesión a Directriz/estadística & datos numéricos , Carbonato de Litio/uso terapéutico , Auditoría Médica , Servicios de Salud Mental/normas , Trastornos del Humor/tratamiento farmacológico , Guías de Práctica Clínica como Asunto , Ácido Valproico/uso terapéutico , Adolescente , Adulto , Femenino , Humanos , Masculino , Trastornos del Humor/diagnóstico , Nueva Zelanda , Educación del Paciente como Asunto , Estudios Retrospectivos , Índice de Severidad de la EnfermedadRESUMEN
OBJECTIVE: The aim of this study is to identify factors associated with readmission to adolescent psychiatric inpatient care, in the context of a relapsing major mental illness. METHOD: Data were obtained from 71 patients admitted to an adolescent psychiatric inpatient unit over a 2-year period. Patients who were rehospitalized within 12 months of discharge were compared with patients who had only one admission during the study period with respect to diagnosis, age of first admission, history of child sexual abuse (CSA) and the events precipitating admission. RESULTS: Medication non-adherence and a history of CSA were positively and independently associated with relapse readmission, while a trend emerged among readmitted patients toward younger age at first psychiatric hospitalization. A negative association was found between readmission and the experience of personal loss. Readmission was not related to DSM-IV axis I or axis II diagnosis, including substance abuse. CONCLUSIONS: The association, in an adolescent sample, of medication non-adherence and relapse readmission is consistent with findings from numerous adult studies, as is the trend toward younger age of first admission. The relationship of a history of CSA to readmission has attracted little previous research and the finding of a positive association suggests that further investigation of a history of CSA in this context is warranted. The implications of these findings and suggestions for further research are discussed.
Asunto(s)
Trastornos Mentales/rehabilitación , Servicios de Salud Mental/estadística & datos numéricos , Readmisión del Paciente/estadística & datos numéricos , Adolescente , Australia/epidemiología , Áreas de Influencia de Salud , Recolección de Datos/métodos , Manual Diagnóstico y Estadístico de los Trastornos Mentales , Femenino , Hospitalización , Humanos , Masculino , Trastornos Mentales/diagnóstico , Estudios RetrospectivosRESUMEN
OBJECTIVE: To determine the length of stay in hospital for youth with acute psychiatric illness, and the treatment outcome. METHODS: Diagnostic and Statistical Manual of Mental Disorders (4th edn; DSM-IV) psychiatric diagnosis, clinical outcome and the length of stay were systematically gathered for admissions over an 18 month period at the Christchurch Youth Inpatient Unit (YIU). Clinical outcome data were collected at admission, 3 weeks after admission and at discharge, using the Health of the Nation Outcome Scale for Children and Adolescents (HoNOSCA). The length of stay was determined retrospectively. Discharge was decided on clinical grounds. RESULTS: During the 18 months of the investigation, 72 subjects were admitted for the treatment of acute mental illness. The most common diagnostic category was mood disorder (n=39, 54%), followed by anxiety or adjustment disorder (n=18, 25%), and major psychosis (n=15, 21%). The mean length of admission for the whole population was 27.3 days, 23.7 days for mood disorders, 18.9 days for anxiety disorders and 46.9 days for the major psychosis diagnostic groups. According to HoNOSCA clinician ratings, the major portion of the improvement occurred during the first 3 weeks of admission. CONCLUSIONS: For the majority of youth with acute psychiatric illness, a relatively short stay in hospital is feasible, because most health gains tend to occur early during an admission.
Asunto(s)
Hospitalización/estadística & datos numéricos , Tiempo de Internación/estadística & datos numéricos , Trastornos Mentales/terapia , Enfermedad Aguda , Adolescente , Australia , Servicios Comunitarios de Salud Mental/organización & administración , Cuidados Críticos , Manual Diagnóstico y Estadístico de los Trastornos Mentales , Estudios de Factibilidad , Estudios de Seguimiento , Humanos , Trastornos Mentales/diagnóstico , Evaluación de Resultado en la Atención de Salud , Escalas de Valoración Psiquiátrica , Estudios Retrospectivos , Índice de Severidad de la Enfermedad , Resultado del TratamientoRESUMEN
OBJECTIVE: Substance abuse/dependence has been reported to show significant association with psychopathology, and is likely to influence the course and outcome of psychiatric illness. The aim of this study was to determine the rate of substance use disorders (other than alcohol) comorbidity among inpatient adolescents with severe Axis 1 psychiatric disorder. METHOD: A retrospective analysis of systematically collected data was carried out. The subjects were 16-18-year-old youths, admitted to an inpatient unit for severe psychiatric disorder. The data collection process utilized the DSM-IV criteria for diagnostic categorization of psychiatric disorder and substance use disorder. Demographic data, and data on suicide attempts were also collected. RESULTS: Over a period of one year (March 2001-March 2002), 62 patients were admitted to the Christchurch Youth Inpatient Unit; 40 (64.5%) had a comorbid Substance Abuse Disorder (SAD) according to DSM-IV criteria and none had a Substance Dependence Disorder. The vast majority involved cannabis and stimulants. Sixty per cent of those with mood disorder, 63% of those with anxiety disorder and 80% of those with schizophrenia spectrum disorder had a comorbid SAD. Internalizing problems, especially mood disorders, pre-dominated among those with SAD reflecting the Unit's admission criteria. There were no differences in attempted suicide rates between those with SAD and those without SAD, but those with SAD were more likely to have unstable accommodation/living arrangements than those without SAD. CONCLUSIONS: Our findings confirm previous reports suggestive of high rates of SAD comorbidity among youth with severe psychiatric illness. There are clinical and process implications for these findings particularly identification of substance use disorders and their treatment as well as resource availability and staff training.