Multicomponent intervention for patients admitted to an emergency unit for suicide attempt: an exploratory study

Suicide is a major cause of premature deaths worldwide and belongs to the top priority public health issues. While suicide attempt is the most important risk factor for completed suicide, intervention for suicide attempters (SA) have produced mixed results. Since an important proportion of SA request medical care, emergency units (EU) are an opportune setting to implement such interventions. This exploratory study evaluated the feasibility and acceptability of a multicomponent intervention for SA admitted to an EU. The intervention consisted of coordination by a case manager of a joint crisis plan (JCP), an early meeting with relatives and the existing care network, as well as phone contacts during 3 months after suicide attempt. Among 107 SA admitted to the emergency unit during the study period, 51 could not be included for logistical reason, 22 were excluded, and intervention was offered to 34. Of these, 15 refused the intervention, which was thus piloted with 19 SA. First-time attempters most frequently declined the intervention. Feasibility and acceptability of phone contacts and case manager were good, while JCPs and meetings were difficult to implement and perceived as less acceptable. Refusal pattern questions the global acceptability and is discussed: JCPs and meetings will have to be modified in order to improve their feasibility and acceptability, especially among first-time attempters

Effect of measuring patient satisfaction during or after staying in a psychiatric hospital

BACKGROUND: Patient satisfaction surveys are commonly conducted to evaluate health care quality. However, little is known about the impact of the time point of survey administration on the level of satisfaction, questionnaire acceptability, and costs, especially for inpatient psychiatric care. AIMS: To assess whether inpatient satisfaction, questionnaire acceptability, and total costs of study differ according to the time point of questionnaire administration for inpatient psychiatric care. METHOD AND SAMPLE: Inpatients completed the ©Saphora-Psy, a French validated tool measuring satisfaction with care with 35 items assessing 7 dimensions of care, 2-3 days before leaving the ward (first phase). Four to eight weeks after discharge, patients received the same instrument at home (second phase). Time needed to fill the questionnaire and items assessing its acceptability were requested. RESULTS: Only fifty of 104 inpatients in the acute psychiatric hospital, aged &gt;18, who completed the first questionnaire, participated to the second phase, although they all agreed to complete it twice. The participation rate during the hospital stay was 47%. Acceptability did not differ significantly. The mean proportion of missing values was slightly higher after hospital stay (3.84%) than during hospital stay (3.52%), while the number of manuscript comments was identical (n=13). Global evaluation of the questionnaire was similar when administered after or before discharge (excellent/very good : 41% and 42% respectively). General satisfaction with care was rated higher when measured during (vs after) hospital stay. Satisfaction was significantly lower when measured after discharge on four items: nursing staff's empathy (p=0.02) and communication about care (p=0.03), smoking directives (p=0.01), and information regarding treatment after discharge (p=0.01). Costs were about eight times higher during the first phase. CONCLUSIONS: Satisfaction appeared to vary slightly according to the time point of questionnaire administration, with higher ratings measured during hospital stay. In terms of acceptability, the surveys offered identical rates. The costs were much higher during the first phase, due to the hot pursuit of patients about to leave the hospital. [Authors]]]> Patient Satisfaction; Quality of Health Care; Questionnaires; Hospitals, Psychiatric; Hospitalization eng oai:serval.unil.ch:BIB_8CB02C4CD096 2022-05-07T01:22:28Z openaire documents urnserval <oai_dc:dc xmlns:dc="http://purl.org/dc/elements/1.1/" xmlns:xs="http://www.w3.org/2001/XMLSchema" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xmlns:oai_dc="http://www.openarchives.org/OAI/2.0/oai_dc/" xsi:schemaLocation="http://www.openarchives.org/OAI/2.0/oai_dc/ http://www.openarchives.org/OAI/2.0/oai_dc.xsd"> https://serval.unil.ch/notice/serval:BIB_8CB02C4CD096 Change in defense mechanisms and coping patterns during the course of 2-year-long psychotherapy and psychoanalysis for recurrent depression: a pilot study of a randomized controlled trial. info:doi:10.1097/NMD.0b013e3182982982 info:eu-repo/semantics/altIdentifier/doi/10.1097/NMD.0b013e3182982982 info:eu-repo/semantics/altIdentifier/pmid/23817160 Kramer, U. de Roten, Y. Perry, J.C. Despland, J.N. info:eu-repo/semantics/article article 2013 Journal of Nervous and Mental Disease, vol. 201, no. 7, pp. 614-620 info:eu-repo/semantics/altIdentifier/eissn/1539-736X urn:issn:0022-3018 <![CDATA[Very little research has been conducted so far to study the potential mechanisms of change in long-term active psychological treatments of recurrent depression. The present pilot randomized controlled trial aimed to determine the feasibility of studying the change process occurring in patients during the course of 2-year-long dynamic psychotherapy, psychoanalysis, and cognitive therapy, as compared with clinical management. In total, eight outpatients presenting with recurrent depression, two patients per treatment arm, were included. All patients were randomly assigned to one of the four treatment conditions. Defense mechanisms and coping patterns were assessed using validated observer-rated methodology based on transcribed, semistructured follow-along independent dynamic interviews. The results indicated that, whereas some patients in the active treatments changed on the symptomatic levels, some others remained unchanged during the course of their 2-year-long treatment. However, with regard to potential mechanisms of change in these patients, changes in defense mechanisms and coping patterns were revealed to be important processes over time in successful therapies and, to a lesser extent, in less successful treatments. No change was found either on outcome or on the process measure for the control condition, that is, clinical management. These results are discussed along with previous data comparing change in defense mechanisms and coping during the course of treatments

MOST photometry and modeling of the rapidly oscillating (roAp) star gamma Equ

Aims. Despite photometry and spectroscopy of its oscillations obtained over the past 25 years, the pulsation frequency spectrum of the rapidly oscillating Ap (roAp) star gamma Equ has remained poorly understood. Better time-series photometry, combined with recent advances to incorporate interior magnetic field geometry into pulsational models, enable us to perform improved asteroseismology of this roAp star. Methods. We obtained 19 days of continuous high-precision photometry of gamma Equ with the MOST (Microvariability & Oscillations of STars) satellite. The data were reduced with two different reduction techniques and significant frequencies were identified. Those frequencies were fitted by interpolating a grid of pulsation models that include dipole magnetic fields of various polar strengths. Results. We identify 7 frequencies in gamma Equ that we associate with 5 high-overtone p-modes and 1st and 2nd harmonics of the dominant p-mode. One of the modes and both harmonics are new discoveries for this star. Our best model solution (1.8 M_sun, log T_eff ~ 3.882; polar field strength ~8.1 kG) leads to unique mode identifications for these frequencies (ell = 0, 1, 2 and 4). This is the first purely asteroseismic fit to a grid of magnetic models. We measure amplitude and phase modulation of the primary frequency due to beating with a closely spaced frequency which had never been resolved. This casts doubts on theories that such modulation - unrelated to the rotation of the star - is due to a stochastic excitation mechanism.Comment: 10 pages, 12 figures, published in Astronomy & Astrophysics typos corrected, and minor changes in appearance and wordin

A cross-sectional study of patients with and without substance use disorders in Community Mental Health Centres

<p>Abstract</p> <p>Background</p> <p>Epidemiological studies have consistently established high comorbidity between psychiatric disorders and substance use disorders (SUD). This comorbidity is even more prominent when psychiatric populations are studied. Previous studies have focused on inpatient populations dominated by psychotic disorders, whereas this paper presents findings on patients in Community Mental Health Centres (CMHCs) where affective and anxiety disorders are most prominent. The purpose of this study is to compare patients in CMHCs with and without SUD in regard to differences in socio-demographic characteristics, level of morbidity, prevalence of different diagnostic categories, health services provided and the level of improvement in psychiatric symptoms.</p> <p>Methods</p> <p>As part of the evaluation of the National Plan for Mental Health, all patients seen in eight CMHCs during a 4-week period in 2007 were studied (n = 2154). The CMHCs were located in rural and urban areas of Norway. The patients were diagnosed according to the ICD-10 diagnoses and assessed with the Health of the Nation Outcome Scales, the Alcohol Use Scale and the Drug Use Scale.</p> <p>Results</p> <p>Patients with SUD in CMHCs are more frequently male, single and living alone, have more severe morbidity, less anxiety and mood disorders, less outpatient treatment and less improvement in regard to recovery from psychological symptoms compared to patients with no SUD.</p> <p>Conclusion</p> <p>CMHCs need to implement systematic screening and diagnostic procedures in order to detect the special needs of these patients and improve their treatment.</p

Multiplicity among chemically peculiar stars II. Cool magnetic Ap stars

We present new orbits for sixteen Ap spectroscopic binaries, four of which might in fact be Am stars, and give their orbital elements. Four of them are SB2 systems: HD 5550, HD 22128, HD 56495 and HD 98088. The twelve other stars are : HD 9996, HD 12288, HD 40711, HD 54908, HD 65339, HD 73709, HD 105680, HD 138426, HD 184471, HD 188854, HD 200405 and HD 216533. Rough estimates of the individual masses of the components of HD 65339 (53 Cam) are given, combining our radial velocities with the results of speckle interferometry and with Hipparcos parallaxes. Considering the mass functions of 74 spectroscopic binaries from this work and from the literature, we conclude that the distribution of the mass ratio is the same for cool Ap stars as for normal G dwarfs. Therefore, the only differences between binaries with normal stars and those hosting an Ap star lie in the period distribution: except for the case of HD 200405, all orbital periods are longer than (or equal to) 3 days. A consequence of this peculiar distribution is a deficit of null eccentricities. There is no indication that the secondary has a special nature, like e.g. a white dwarf.Comment: 31 pages, 15 figures, A&A accepte

Benzodiazepine use among adults residing in the urban settlements of Karachi, Pakistan: A cross sectional study

<p>Abstract</p> <p>Background</p> <p>There are hardly any studies carried out in Pakistan on the usage of benzodiazepines at the level of community. This research was aimed to determine the frequency of benzodiazepine use, along with its associations with socio-demographic and clinical characteristics among community dwelling adults, residing in two urban settlements of Karachi, Pakistan.</p> <p>Methods</p> <p>We performed a cross sectional study from August 2008 to December 2009, in 2 areas of Karachi, namely Garden and Sultanabad. We followed the systematic sampling strategy to randomly select the households, with an adult of either sex and of age 18 years or more. Data collection was carried out through interview, using a pre-tested questionnaire, with items on socio-demographic position, medical history and benzodiazepine use. Student's t-test and χ²test was employed to determine the associations between socio-demographic and clinical characteristics, and their relationship with benzodiazepine use was determined using applied logistic regression.</p> <p>Results</p> <p>The overall percentage of benzodiazepine consumption was estimated to be 14%. There were significantly more benzodiazepine users in the peri-urban Sultanabad community to the urban community of Garden (p-value = 0.001). The mean age (± SD) for users was 51.3 (± 15.6) years compared to 37.1 (± 14.4) years among non-users. Bromazepam was the most widely used benzodiazepine (29%); followed by diazepam, with a median duration on primary use being 144 weeks (IQR = 48-240). The adjusted logistic regression model revealed that increasing age, location, female sex, unemployment and psychiatric consultation were associated with increased likelihood of benzodiazepine use.</p> <p>Conclusion</p> <p>We believe the unregulated over-the-counter sales of benzodiazepines and social conditions might be playing a role in this high consumption of benzodiazepines in the community.</p

Weak magnetic fields in Ap/Bp stars: evidence for a dipole field lower limit and a tentative interpretation of the magnetic dichotomy

Publisher's version/PDFAims. We investigated a sample of 28 well-known spectroscopically-identified magnetic Ap/Bp stars, with weak, poorly-determined or previously undetected magnetic fields. The aim of this study is to explore the weak part of the magnetic field distribution of Ap/Bp stars. Methods. Using the MuSiCoS and NARVAL spectropolarimeters at Télescope Bernard Lyot (Observatoire du Pic du Midi, France) and the cross-correlation technique Least Squares Deconvolution (LSD), we obtained 282 LSD Stokes V signatures of our 28 sample stars, in order to detect the magnetic field and to infer its longitudinal component with high precision (median [sigma] = 40 G). Results. For the 28 studied stars, we obtained 27 detections of Stokes V Zeeman signatures from the MuSiCoS observations. Detection of the Stokes V signature of the 28th star (HD 32650) was obtained during science demonstration time of the new NARVAL spectropolarimeter at Pic du Midi. This result clearly shows that when observed with sufficient precision, all firmly classified Ap/Bp stars show detectable surface magnetic fields. Furthermore, all detected magnetic fields correspond to longitudinal fields which are significantly greater than some tens of G. To better characterise the surface magnetic field intensities and geometries of the sample, we phased the longitudinal field measurements of each star using new and previously-published rotational periods, and modeled them to infer the dipolar field intensity (B[subscript d], measured at the magnetic pole) and the magnetic obliquity ([Beta]). The distribution of derived dipole strengths for these stars exhibits a plateau at about 1 kG, falling off to larger and smaller field strengths. Remarkably, in this sample of stars selected for their presumably weak magnetic fields, we find only 2 stars for which the derived dipole strength is weaker than 300 G.We interpret this “magnetic threshold” as a critical value necessary for the stability of large-scale magnetic fields, and develop a simple quantitative model that is able to approximately reproduce the observed threshold characteristics. This scenario leads to a natural explanation of the small fraction of intermediate-mass magnetic stars. It may also explain the near-absence of magnetic fields in more massive B and O-type stars

Un modèle de soins adapté aux hospitalisations psychiatriques brèves [A care model adapted to brief psychiatric hospitalizations]

Practice of psychiatric hospitalization has considerably changed: deinstitutionnalization, brief hospitalizations, opened units, partnership with patients and complementarity with community mental health services. These changes appear simultaneously in most of industrialized countries. They are the result of social changes, evolution of mental health care, and a sharper perception of deinsertion risks through long term hospitalizations. Values of psychiatric hospital were based on a closed and protective place, where community life prepared to life in the community; they are now founded on an opened place where care aims at resolving crisis and keeping closely in touch with the community. These modifications imply to rethink hospital psychiatric care and their connections with environment. This paper describe a model of care developed in a first admission psychiatric unit

Readiness to participate in psychiatric research.

BACKGROUND: The feasibility of clinical trials depends, among other factors, on the number of eligible patients, the recruitment process, and the readiness of patients to participate in research. Seeking patients' views about their experience in research projects may allow investigators to develop more effective recruitment and retention strategies. METHODS: A total of 100 patients consecutively admitted to a psychiatric university hospital were interviewed with respect to their willingness to participate in a study. For a different study scenario, patients were asked whether they would be ready to participate if such a study were organized in the service and to indicate their reasons for refusing or for participating. RESULTS: The general readiness to participate in a study ranged between 70% and 96%. The prospect of remuneration did not notably augment the potential consent rate. The most common and spontaneous motivation for agreeing to take part in a study was to help science progress and to allow future patients to benefit from improved diagnosis and treatment (87%). The presence or lack of a financial incentive was rarely chosen as an argument to agree (23%) or to refuse (7%) to participate. Patients relied mainly on their treating physicians when contemplating possible participation in a study (family physician [65%] and hospital physician [54%]). CONCLUSIONS: Clinicians and, in particular, treating doctors can play an important role in facilitating the recruitment process

Drogues et psychose: que faire [Drugs and psychoses: what to do?]

Substance abuse co morbidity is frequent in psychotic disorders. General practitioners are frequently involved in such treatments. In order to be able to face this complex task, it is important to be able to identify early symptoms of psychosis in a patient abusing substances, to make the difference between psychotic symptoms and intoxication or withdrawal symptoms, to know basic principles of treatment and the type of medication used in such interventions, and finally to know when specialised treatment or hospital admission are required. This paper reviews epidemiological and diagnostic elements, outlines the various treatment stages, the type of medication currently used in such situations and provides a brief description of motivational interview techniques