The Competencies, Roles and Scope of Practice of Advanced Psychiatric Nursing in Indonesia

The graduate advanced psychiatric nursing (psychiatric nursing specialist) from master degree in Indonesia are about 70 nurses, 67 nurses were graduated from University of Indonesia. They are working at mental health services and educational setting around Indonesia and yet seem not ready to perform some specific advanced competencies in clinical area. The mastery on mental health assessment, neurochemical perspectives, medical management and psychotherapy have not yet performed by the psychiatric nurse specialist in the clinical area or community.To have those competencies and its performances, therefore the curriculum in a psychiatric nursing graduate program must include advanced courses in physiopsychology, psychopathology, advanced psychopharmacology, neurobehavioral science, advanced mental health assessment, and advanced treatment interventions such as psychotherapy and prescription and management of psychotropic medications as their core and major courses in the curriculum. Those courses should be performed in their clinical practice courses or other related learning experiences. When those qualifications are met, then they are competent to be called advanced psychiatric nurse.As advanced practice registered nurses, the advanced psychiatric nurses should be able to demonstrate their direct expertise and roles in advanced mental health assessment, diagnostic evaluation, psychopharmacology management, psychotherapy with individuals, group and families, case management, millieu management, liason and counselling from prevention, promotion until psychiatric rehabilitation. Meanwhile the skill such as psycho-education, teaching, unit management, research and staff development can be added as their indirect roles

Ridesharing as an Alternative to Ambulance Transport for Voluntary Psychiatric Patients in the Emergency Department

Introduction: Emergency department (ED) crowding is a growing problem. Psychiatric patients have long ED lengths of stay awaiting placement and transportation to a psychiatric facility after disposition.Methods: Retrospective analysis of length of ED stay after disposition for voluntary psychiatric patients before and after the use of Lyft ridesharing services for inter-facility transport.Results: Using Lyft transport to an outside crisis center shortens time to discharge both statistically and clinically from 113 minutes to 91 minutes (p = 0.028) for voluntary psychiatric patients. Discharge time also decreased for involuntary patients from 146 minutes to 127 minutes (p = 0.0053).Conclusion: Ridesharing services may be a useful alternative to medical transportation for voluntary psychiatric patients

Routinely administered questionnaires for depression and anxiety : systematic review

Objectives To examine the effect of routinely administered psychiatric questionnaires on the recognition, management, and outcome of psychiatric disorders in non-psychiatric settings. Data sources Embase, Medline, PsycLIT, Cinahl, Cochrane Controlled Trials Register,and hand searches of key journals. Methods A systematic review of randomised controlled trials of the administration and routine feedback of psychiatric screening and outcome questionnaires to clinicians in non-psychiatric settings. narrative overview of key design features and end points, together with a random effects quantitative synthesis of comparable studies. Main outcome measures Recognition of psychiatric disorders after feedback of questionnaire results; interventions for psychiatric disorders and outcome of psychiatric disorders. Results Nine randomised studies were identified that examined the use of common psychiatric instruments in primary care and general hospital settings. Studies compared the effect of the administration of these instruments followed by the feedback of the results to clinicians, with administration with no feedback. Meta-analytic pooling was possible for four of these studies (2457 participants), which measured the effect of feedback on the recognition of depressive disorders. Routine administration and feedback of scores for all patients (irrespective of score) did not increase the overall rate of recognition of mental disorders such as anxiety and depression (relative risk of detection of depression by clinician after feedback 0.95, 95% confidence interval 0.83 to 1.09). Two studies showed that routine administration followed by selective feedback for only high scores increased the rate of recognition of depression (relative risk of detection of depression after feedback 2.64, 1.62 to 4.31). This increased recognition, however, did not translate into an increased rate of intervention. Overall, studies of routine administration of psychiatric measures did not show an effect on patient outcome. Conclusions The routine measurement of outcome is a costly exercise. Little evidence shows that it is of benefit in improving psychosocial outcomes of those with psychiatric disorder managed in non-psychiatric settings

Psychiatric manifestations of multiple sclerosis and acute disseminated encephalomyelitis

It is unusual for acute disseminated encephalomyelitis and multiple sclerosis to present as purely psychiatric disorders. We report five patients with such demyelinating diseases and symptoms of psychosis, depression or anxiety. The importance of excluding demyelination as the basis for these psychiatric disturbances is emphasized, especially in the presence of unexplained neurologic findings. The possible relationship between psychiatric symptoms and demyelinating disorders is explored

Post-inpatient Attrition from Care “As Usual” in Veterans with Multiple Psychiatric Admissions

Disengagement from outpatient care following psychiatric hospitalization is common in high-utilizing psychiatric patients and contributes to intensive care utilization. To investigate variables related to treatment attrition, a range of demographic, diagnostic, cognitive, social, and behavioral variables were collected from 233 veterans receiving inpatient psychiatric services who were then monitored over the following 2 years. During the follow-up period, 88.0 % (n = 202) of patients disengaged from post-inpatient care. Attrition was associated with male gender, younger age, increased expectations of stigma, less short-term participation in group therapy, and poorer medication adherence. Of those who left care, earlier attrition was predicted by fewer prior-year inpatient psychiatric days, fewer lifetime psychiatric hospitalizations, increased perceived treatment support from family, and less short-term attendance at psychiatrist appointments. Survival analyses were used to analyze the rate of attrition of the entire sample as well as the sample split by short-term group therapy attendance. Implications are discussed

A Closer Look at the Psychiatric Effects of Deep Brain Stimulation to Further Guide Treatment of Refractory Epilepsy: A Focused Review

Introduction: Effective treatment of medically-refractory epilepsy remains a formidable challenge in many patients. The SANTE trial (2010) led to the FDA approval of deep brain stimulation (DBS) of the anterior nucleus of the thalamus (ANT) for the treatment of medically-refractory epilepsy. However, ANT DBS also raised significant mental health concerns. This review will take another look at the psychiatric effects of DBS to more definitively outline the mental health risks and identify additional targets to guide future treatment. Methods: A search of the clinical literature published between January 1, 1990 and December 31, 2019 was completed. The most relevant papers were reviewed with special focus on psychiatric effects. The references cited in select papers were utilized to obtain additional sources. Results: DBS targets associated with adverse psychiatric effects included various thalamic nuclei (ANT, STN, VIM), the globus pallidus interna, the internal capsule and the subcallosal cingulate gyrus. Those not associated with a reported decline included the centromedian nucleus of the thalamus, the nucleus accumbens, the hippocampus, the hypothalamus and the cerebellum. Possible improvement in psychiatric health was noted with stimulation of the hippocampus, the centromedian nucleus and the cerebellum. Conclusion: The results of this review note the probable risk of mental health decline with certain DBS targets. Yet, it also highlights targets with less risk of psychiatric effects, most notably, the hippocampus, the centromedian nucleus and the cerebellum. These results are limited by the number of studies not directly reporting psychiatric effects and small sample sizes. The psychiatric outcomes of DBS in targets not known to be associated with either induction of or exacerbation of psychiatric illness is an area for future research

Outpatient Management of Mood Disorders by the Family Physician

It is well-known that the demand for psychiatric care in the US is higher than the supply of psychiatric clinical providers. Vermont, in particular, has a paucity of psychiatric providers and there are minimal providers in Chittenden County and the greater Burlington area. Many patients with psychiatric conditions are inconsistently managed given the lack of available outpatient providers, particularly for patients on Medicaid. Often times, patients suffer from psychiatric episodes that require an emergency department visit or inpatient stay, and they may leave the hospital with an outpatient medication regimen that can then be carried out by a primary care provider. Patients should not have to endure a psychotic episode bringing them into the hospital in order to receive appropriate psychiatric care. A possible solution to this gap in care would be for primary care providers to be armed with the knowledge and skills to appropriately and sustainably manage psychiatric conditions on an outpatient level. Tools to summarize the evidence and current guidelines around prescribing, testing, surveillance, and other drug-related parameters may enable providers to quickly assess the recommendations during a busy clinical day, especially if such tools were consistently updated and embedded into the electronic medical record. This project focuses on management of mood disorders in the outpatient family medicine clinic; a one-pager table summarizing guidelines around commonly prescribed mood stabilizers in the setting of bipolar disorder was created and displayed in the Hinesburg Family Medicine clinic.https://scholarworks.uvm.edu/fmclerk/1485/thumbnail.jp

Treatment decision-making capacity in children and adolescents hospitalized for an acute mental disorder: The role of cognitive functioning and psychiatric symptoms

OBJECTIVE: This study was conducted to assess treatment decision-making capacity (TDMC) in a child and adolescent psychiatric sample and to verify possible associations between TDMC, psychiatric symptom severity, and cognitive functioning. METHODS: Twenty-two consecutively recruited patients hospitalized for an acute mental disorder, aged 11-18 years, underwent measurement of TDMC by the MacArthur Competence Assessment Tool for Treatment (MacCAT-T). The MacCAT-T interview focused on patients' current treatment, which comprised second-generation antipsychotics (45.5%), first-generation antipsychotics (13.6%), antiepileptic drugs used as mood stabilizers or lithium carbonate (45.5%), selective serotonin reuptake inhibitors (32%), and benzodiazepines (18%). We moreover measured cognitive functioning (Wechsler Intelligence Scale for Children III) and psychiatric symptom severity (Brief Psychiatric Rating Scale v 4.0). RESULTS: Patients' TDMC varied within the sample, but MacCAT-T scores were good in the sample overall, suggesting that children and adolescents with severe mental disorders could be competent to consent to treatment. The TDMC proved independent of psychiatric diagnosis while being positively associated with cognitive functioning and negatively with excitement. CONCLUSION: The MacCAT-T proved feasible for measuring TDMC in a child and adolescent psychiatric sample. TDMC in minors with severe mental disorders was not necessarily impaired. These results deserve reconsidering the interplay between minors and surrogate decision-makers as concerning treatment decisions

Neurocognitive phenomics: examining the genetic basis of cognitive abilities

Cognitive deficits are core to the disability associated with many psychiatric disorders. Both variation in cognition and psychiatric risk show substantial heritability, with overlapping genetic variants contributing to both. Unsurprisingly, therefore, these fields have been mutually beneficial : just as cognitive studies of psychiatric risk variants may identify genes involved in cognition, so too can genome-wide studies based on cognitive phenotypes lead to genes relevant to psychiatric aetiology. The purpose of this review is to consider the main issues involved in the phenotypic characterization of cognition, and to describe the challenges associated with the transition to genome-wide approaches. We conclude by describing the approaches currently being taken by the international consortia involving many investigators in the field internationally (e. g. Cognitive Genomics Consortium; COGENT) to overcome these challenges.</p