The objective of the study was to investigate associations between patients ratings of their treatment milieu and personal characteristics such as gender, age, educational level, personality disorders, symptom distress, interpersonal problems, global level of functioning, as well as treatment outcome. Data was taken from 908 patients (with mainly personality, mood and anxiety disorders) consecutively admitted to eight day-treatment units. Treatment milieu was measured by Ward Atmosphere Scale for Therapeutic Programs (WAS-TP). Overall level of psychosocial functioning was measured by Global Assessment of Functioning (GAF). Diagnoses and personality traits was measured by the Structured Clinical Interview for DSM-III-R Personality Disorders (SCID-II), according to DSM-IV. Symptom distress and interpersonal problems was measured by Symptom Checklist 90-R and the Circumplex of Interpersonal Problems, respectively. No substantial associations were found between individual personal characteristics and ratings of the treatment milieu, and no substantial associations were found between ratings of the treatment milieu and treatment outcome or the likelihood of treatment completion. There seems to be no support as to making general inferences about or from individual ratings of the treatment milieu. Possible uses of individual evaluations of treatment milieu are discussed.
To provide an overview of the results of the Canadian Psychiatric Association (CPA) practice profile survey (PPS), a national survey of psychiatrists and psychiatric practice.
Mail-in interviews were sent to all Canadian psychiatrists listed in their provincial registers and to all active CPA members (total = 3628). Respondents provided general information about their professional activities for one 24-hour day and detailed information for 1 randomly selected hour. Patient information--including sociodemographics, diagnostic profiles, functioning levels, risk of harm to self or others, and disposition--was elicited for 1 patient seen during the random hour as well as for the most seriously ill patient receiving clinical services that day.
Psychiatrists work 10 hours daily on average and take calls for 5 hours. Sixty percent of the overall work time is in the provision of direct patient care, and fee-for-service payments account for 55% of hours worked. Forty percent of the clinical work is provided in a hospital setting, and 34% is in a private office. Agency work accounted for only 6% of clinical hours worked. Relatively few practitioners provide services to children, older, or forensic patients. The average patient seen is female, aged 40 years, unmarried or with a marital disruption, significantly impaired in multiple areas of functioning, and likely to suffer from depression (21%), schizophrenia (14%), an anxiety disorder (13%), or bipolar disorder (12%). Comorbid Axis I and Axis II disorders are common (each over 30%) and fairly high rates of suicidal (15% to 30%) and homicidal (10% to 20%) risk are present.
This paper suggests a wide diversity of practice in psychiatry in Canada, with services being provided to a wide range of individuals with many different conditions.
Community treatment orders (CTOs) were legally implemented in psychiatry in Sweden in 2008, both in general psychiatry and in forensic psychiatric care. A main aim with the reform was to replace long leaves from compulsory psychiatric inpatient care with CTOs. The aims of the present study were to examine the use of compulsory psychiatric care before and after the reform and if this intention of the law reform was fulfilled.
The study was based on register data from the computerized patient administrative system of Örebro County Council. Two periods of time, two years before (I) and two years after (II) the legal change, were compared. The Swedish civic registration number was used to connect unique individuals to continuous treatment episodes comprising different forms of legal status and to identify individuals treated during both time periods.
The number of involuntarily admitted patients was 524 in period I and 514 in period II. CTOs were in period II used on relatively more patients in forensic psychiatric care than in general psychiatry. In all, there was a 9% decrease from period I to period II in hospital days of compulsory psychiatric care, while days on leave decreased with 60%. The number of days on leave plus days under CTOs was 26% higher in period II than the number of days on leave in period I. Among patients treated in both periods, this increase was 43%. The total number of days under any form of compulsory care (in hospital, on leave, and under CTOs) increased with five percent. Patients with the longest leaves before the reform had more days on CTOs after the reform than other patients.
The results indicate that the main intention of the legislator with introducing CTOs was fulfilled in the first two years after the reform in the studied county. At the same time the use of coercive psychiatric care outside hospital, and to some extent the total use of coercive in- and outpatient psychiatric care, increased. Adding an additional legal coercive instrument in psychiatry may increase the total use of coercion.
Cites: BMJ. 2011;343:d834622209821
Cites: Med J Aust. 2012 May 21;196(9):591-322621153
Retrospective personal accounts of 48 people concerning their admission to, treatment in, and discharge from a psychiatric unit were examined. Analysis reveals that the research participants were poorly informed about their legal rights. One in eight participants did not know whether they were voluntarily or involuntarily admitted. Few participants were ever consulted about their treatment programs or discharge plans. In general, the research participants reported being powerless and having little control over their lives during psychiatric hospitalization.
Using 38 focussed accounts the author reports on the hospitalization experiences of patients 18 to 38 years old in the psychiatric ward. The sample comes from the psychiatric wards of two general hospitals in the Montréal area (Canada). The data were analyzed using a qualitative method. Empirical categories were inferred from the respondents' discourse based on the broad themes which make up the psychiatric experience: admission; hospital environment and rules; daily life; medication; relations with the staff and leaving the hospital. The results shed light on the suffering, dissatisfaction and ambivalent feelings surrounding the patients' hospital experience. Based on the experience of psychiatric patients, the author identified five processes at work during psychiatric hospitalization.
The Western Canada Waiting List Project (WCWL) is a federally funded partnership of 19 health-related organizations that was created to develop tools to manage waiting lists for five types of health services.
The children's mental health (CMH) panel developed and tested a set of standardized clinical criteria for setting priorities among patients awaiting CMH services. The criteria were applied to 817 patients by 92 mental health professionals in three western provinces. Regression analysis was used to determine the set of criteria weights that collectively best predicted clinicians' global urgency ratings. To assess reliability, raters used the criteria to score six standardized "paper cases."
The criteria accounted for about 40% of the observed variance in overall urgency ratings (R2 = 41.7%). The panel modified the criteria on the basis of the initial empirical work. Reliability assessment of the revised tool indicated that half of the items had excellent or fair/good interrater agreement; test-retest reliability was good.
Priority criteria were able to capture clinicians' judgments of relative urgency in the CMH setting. A number of operational challenges remain with the use of priority criteria for scheduling CMH services. Further development and testing of the tool appear warranted.
A transverse survey was conducted with 772 Quebecers in September 1992. Its purpose was to evaluate the level of awareness of the general public about mental illness, the general knowledge of these illnesses and their treatments and the attitudes towards mentally ill patients. Results show that half of the interviewed subjects still feel that they are not informed enough about mental illness and even well informed people have a poor general knowledge of mental illnesses and their treatments. Finally, more than 65% of the surveyed population show positive attitudes towards psychiatric patients, which seems to be an improvement in comparison with the past years. The author believes that physicians should give more information on mental illness and particularly on the role of drugs in the treatment of mentally ill patients. It seems also important to put more emphasis on information to low and middle class people.
Over 2,200 North American psychotherapists completed a Web-based survey concerning their clinical work, including theoretical orientation, client characteristics, and use of specific psychotherapy techniques. Psychotherapeutic integration was common, with the majority of respondents identifying with more than one theoretical orientation or as having an eclectic orientation. The modal patient was a White female adult suffering from a mood or anxiety disorder and interpersonal problems. Individual psychotherapy was the preferred treatment modality. The most frequently endorsed techniques were relationship-oriented such as conveying warmth, acceptance, understanding, and empathy. The least frequently endorsed techniques were biofeedback, neurofeedback, body and energy therapies, and hypnotherapy. Efforts to disseminate empirically based therapies require understanding and accommodating clinicians' tendencies to integrate techniques.
Cites: Am J Psychiatry. 2002 Feb;159(2):201-711823259
Cites: Am J Psychiatry. 2002 Nov;159(11):1914-2012411228
Cites: Behav Res Ther. 2004 Mar;42(3):277-9214975770