Muaid Ithman

Predictors of Length of Stay in an Acute Psychiatric Hospital

Length of stay (LOS) in acute psychiatric hospitals has been heightened in recent years with the current economic climate and a growing realization that health care costs need to be contained. This study was designed to identify predictors of LOS which are available at the time of admission. Charts of 391 admissions to an acute psychiatric hospital were reviewed on the basis of a pre-constructed checklist. Regression modeling with the natural logarithm of LOS as the dependent variable was used to identify a multivariate model for LOS. Age, marital status, involuntary admission and diagnosis of an affective disorder or a psychotic disorder were shown to be independent variables that predicted length of stay. These variables in a multivariate model accounted for approximately 19% of the variance in LOS.

Predictors of length of stay in a psychiatric hospital

Objective. This article reviews the available evidence for predicting length of stay in a psychiatric hospital based on several patient characteristics. Methods. An OVID Medline search was done for studies in this area with terms: length of stay, acute psychiatric hospital and predictors. Indexed articles were searched for additional references and subsequently cross referenced. The variables described in various studies were classified into demographic, diagnostic, treatment related and system-based variables (Table 1). Results. Substance abuse has been consistently shown to be associated with a shorter length of stay. Mood and psychotic disorders have shown to lengthen the stay in an acute psychiatric hospital. Women tend to stay longer in an acute psychiatric hospital. Other demographic variables like age and education have had equivocal results, while a married marital status and employment are consistently related to a shorter length of stay. Use of restraints and ECT during hospitalization has shown to lengthen the stay in the hospital. Conclusions. Many studies have explored the relationship between the demographics, diagnosis and treatment variables on length of stay in an acute psychiatric hospital. These studies have been able to account for about 10–37% of the variance in the length of stay. The relevant findings impacting the length of stay are shown in Table 2.

Rechallenging Clozapine After Neuroleptic Malignant Syndrome

Neuroleptic malignant syndrome (NMS) is a potentially fatal manifestation of antipsychotic use associated with symptoms that include mental status changes, muscle rigidity, fever and autonomic dysfunction. An occurrence of NMS with clozapine has been reported in the past but there are very few reports of successfully rechallenging the drug in individuals who have developed the syndrome. This case report discusses one of the few instances in literature where clozapine has been re-administered successfully to a patient without a reoccurrence of NMS. In conclusion, a rechallenge of clozapine after neuroleptic malignant syndrome can be done if care is taken to avoid concurrent use of lithium and other psychotropics, monitoring for NMS symptoms and titrating the dose upward slowly after a reasonable period of time.

Does indication drive use, or does use drive indication?

I this issue of The Journal of Clinical Psychiatry, Fu et al1 report on the results of a study of paliperidone palmitate once-monthly in patients diagnosed with schizoaffective disorder. In this well-designed and well-executed trial, paliperidone monthly was used either as monotherapy or as an adjunct to mood stabilizers or antidepressants. The subjects were randomized to continue paliperidone monthly or switch to placebo after a 12-week fixed-dose stabilization phase. The groups were stratified on the basis of use of mood stabilizers or antidepressants (monotherapy vs adjunctive arms). In both groups, paliperidone monthly significantly reduced relapse compared to placebo, with placebo having a 2.5 times greater risk of relapse overall. As one might expect, the relapse risk was a bit more pronounced in the monotherapy arm compared to the augmentation arm (3.3 times vs 2.0 times). The effectiveness of paliperidone monthly was not particularly surprising, as oral paliperidone has been US Food and Drug Administration (FDA)–approved for treatment of schizoaffective disorder since July 2009. The positive results of this clinical trial led to the approval of paliperidone monthly by the FDA for the treatment of schizoaffective disorder as a monotherapy or an adjunct to mood stabilizers or antidepressants on November 13, 2014. For any medication, FDA approval for additional indications has significant effects. It allows the medication to be marketed by the pharmaceutical company for that use, when prior to the indication this was expressly forbidden. In addition, it can remove potential roadblocks by insurers hesitant to approve a medication for non–FDA-approved indications. In some cases, a new indication dramatically broadens a medication’s use, an example being antipsychotics for antidepressant augmentation. In some cases, formerly generic medications are “repackaged” as proprietary medications for novel usage. Balancing the benefits of expanded use is the possibility that a larger number of patients will be exposed to the risks of these potent compounds. A concern that is not often fully appreciated by clinicians and patients is the potential for the long-term risks of antipsychotics (eg, tardive dyskinesia). Whether these risks are equal, lesser, or even greater in illnesses other than schizophrenia has not been extensively studied.2 The use of paliperidone monthly for schizoaffective disorder is an important development, but it raises the following question: Were patients with schizoaffective disorder not receiving paliperidone monthly before the

Videoconferencing for Civil Commitment: Preserving the Dignity [Leading Edge]

The paper states that teleconferencing saves time, improves productivity, enhances safety, and helps preserve patient dignity.

Pre- and Post-Clerkship Knowledge, Perceptions, and Acceptability of Electroconvulsive Therapy (ECT) in 3rd Year Medical Students

To examine the impact of the third year psychiatry clerkship on medical students’ knowledge and opinion of ECT at University of Missouri-Columbia School of Medicine. Despite overwhelming evidence of ECT’s efficacy and safety for refractory affective illnesses, (among other conditions), it remains a misunderstood and underutilized intervention. Several studies indicate that ECT stigma and misinformation, unfortunately, does not spare the medical community. Medical students are an optimal group to study, as they are forming their perspectives on different specialties. Few studies have measured the effect of education programs (e.g., clerkships, lectures, observation of ECT) on medical students’ perspectives on ECT.

Treatment-Refractory Mania with Psychosis in a Post-Transplant Patient on Tacrolimus: A Case Report

Bipolar affective disorder type I imparts significant morbidity and disease burden in the population. It is characterized by occurrence of one or more manic episodes which may be preceded or followed by a depressive or hypomanic phase. About half of these manic episodes are characterized by the presence of psychotic features. The condition is further complicated when the patient has multiple comorbid conditions. We report here the case of a Caucasian woman, aged 66 years, previously diagnosed with Bipolar disorder who developed treatment refractory mania with psychotic feature after being on the immunosuppressive agent, tacrolimus, after kidney transplantation.

Telepsychiatry: Current Outcomes and Future Directions

Telepsychiatry is an evolving field in the treatment of mental illness. Although it is used since 1950, its application is widely expanded in the past one decade. Telepsychiatry is defined as the use of technology to communicate with the people and provide psychiatry services from a distance. It requires a collaborative and supportive team consisting of patients, psychiatrists, referring physicians, nurses, families, and health care facilities. Telepsychiatry is very feasible and is applicable to a wide range of patient population having diverse cultural backgrounds. It can also be used in different clinical settings and is proven to be effective in reducing disease severity in several disorders like anxiety, attention deficit hyperactive disorder (ADHD), bipolar disorder, depression, post-traumatic stress disorder (PTSD), schizophrenia, and psychosis. Telepsychiatry is effective both clinically and academically. Clinically, it is used for diagnosing and managing the patient, conducting neuropsychological testing, and providing psychotherapy. Academically telepsychiatry can be used for education, training, and research purposes. Although it is very effective in many ways, few challenges in this field include training and recruiting physicians who can provide care using such services, access to patients, and continuously update health care facilities with the recent advancements in the information and communication technology. Telepsychiatry is mainly helpful to decrease the gap in delivering psychiatric care to people in rural and/or underserved areas. So, more insight should be provided to patients and physicians about the advantages of using telepsychiatry services. In this review, we discussed the challenges, different treatment outcomes, effectiveness, and future directions of telepsychiatry.