No abstract
Absconding by patients from acute psychiatric wards is a high risk behavior profile in mental medical centers. Being admitted to an acute ward is a stressful event for the patient, accompanied by pathological psychiatric symptomatology, separation from family and familiar environment, adjustment to the environs of ward, the treatment process itself and the loss of autonomy over everyday life. Absconding by patients presents a legal, social and treatment challenge for caregivers. Absconding means abrupt stopping of medication and therapeutic processes, need for police and legal systems interference and worry for the family. Moreover, absconding disposes major safety issues for the patient and his surroundings.This abstract summarizes prospective study in two mental health centers. Every absconding was mapped within 48 hours of occurrence. Mapping was carried out by a trained team member filling out a structured form.Study goal: Collecting data and identifying absconders' characteristics, comparing absconders' data from the two centers, pointing out significant ward or hospital variables affecting absconding and comparing patient and staff apprehension of the event.Results:The study collected data of 143 absconding patients, 33% of whom were in confined hospitalization. Most of them were young, single and of low socioeconomic status. Most escaped in the evening shift. There were no significant differences in patient variables between the 2 hospitals. Previous hospitalizations was higher in one of the hospitals (t=2.568, p= .013). There were more staff members in one of the hospitals (t=4.016, p<.0001). There were no difference between the day and the absconding shift.
This research examines the infl uence of the level of professional training of the caretaking staff in psychiatric wards, the type of wards in which a patient is treated and the patient ' s age compared with the level of limitation put on patient autonomy. Detailed questionnaires were administered to 296 nurses from fi ve mental health centers who met inclusion criteria for the study. The level of autonomy restriction was measured using six representative cases from fi eldwork of the interviewees. These cases were analyzed by the authors based on Collopy ' s theory, by categorizing the data according to the six polarities of autonomy presented in his work. Our fi ndings suggest a positive correlation between the level of professional training of the nursing staff, patient ' s age and the level of autonomy given. Our fi ndings did not show a signifi cant relationship between the type of ward and level of autonomy, although there could be a tendency for higher autonomy within closed wards.
Background:Fibromyalgia syndrome (FMS) is characterized by widespread pain and diffuse tenderness. FMS is more prevalent in females rather than males, and among patients with major depression disorder (MDD).Aim:to obtain better conception of linkage between depression, gender and FMS.Methods:42 male and 42 age matched females, and age matched male and female healthy controls were evaluated for coexisting FMS. Each patient completed a questionnaire characterizing sleep quality, Sheehan Disability Scale (SDS) and SF-36 scale, Hamilton Depression rating scales (HDRS) and the CGI-S.Results:Disease parameters were worse for men as compared to women;CGI-S: 5.4±1, vs. 4.0±1 (t=6.634, p<0.001), HDRS: 23.9±6 vs. 20.8±6 (t=2.304, p=0.024), respectively. Yet, FMS was more prevalent among depressed females. The SF-36, SDS and sleep quality scores were similar between males and females. A one way analysis of variance with gender and MDD revealed that both gender and disease were found to be significant contributing factors for the number of tender points (F=21.131, p<.0001; F=65.232, p<.0001, respectively). A one way analysis of covariance for tender points with CGI-S and HDRS as covariates revealed that gender was a significant factor regardless of depression severity. CGI-S and Hamilton scores correlated with tender points count in females but not in males.Conclusion:Female gender is a risk factor for FMS in depressed population. Depression is associated with FMS among women but not among men. Among females, depression severity is significantly correlated to FMS severity. FMS is correlated to sleep quality and to QoL among depressed patients.
Israel's mental health services in general and its psychiatric hospitals in particular have been undergoing substantial structural change.A specific instance of the changes is the merging of the Be'er Ya'akov, the Ness Tziona and the Israel Prisons Service mental health centers. This is the first such successful merger in Israel and has became a model for merging other mental health facilities. Directed by the Ministry of Health, the merger was protracted over many phases and highly complex consultations with the various service-provider bodies and the managements of the three institutions. Numerous steering committee meetings reviewed the merged center's operational model and long negotiations took place with the trades unions involved.Selected clinical disciplines benefited from an extensive retraining program and both inpatient and outpatient services were reinforced with new specialist staff and other resources.The merger was driven by structural, economic, therapeutic and ethical considerations, among them efficient resource use, increased cooperation within and between service systems, reinforcing and enriching human capital, providing a comprehensive response to consumer needs and optimal continuity of care.The merger phases included: (a) establishing a unified management, (b) creating a new organizational structure (c) creating and implementing a new staff placement and mobility mechanism.The presentation will set out the benefits of the merger to staff and clients, the structural outcomes, and the lessons learnt. The early experience of the merged center is offered for the benefit of other organizations considering a similar step.
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