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Sharon M Hall - One of the best experts on this subject based on the ideXlab platform.
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efficacy of initiating tobacco dependence treatment in Inpatient Psychiatry a randomized controlled trial
American Journal of Public Health, 2014Co-Authors: Judith J Prochaska, Stephen Hall, Kevin L Delucchi, Sharon M HallAbstract:Objectives. We evaluated the efficacy of a motivational tobacco cessation treatment combined with nicotine replacement relative to usual care initiated in Inpatient Psychiatry.Methods. We randomized participants (n = 224; 79% recruitment rate) recruited from a locked acute Psychiatry unit with a 100% smoking ban to intervention or usual care. Prior to hospitalization, participants averaged 19 (SD = 12) cigarettes per day; only 16% intended to quit smoking in the next 30 days.Results. Verified smoking 7-day point prevalence abstinence was significantly higher for intervention than usual care at month 3 (13.9% vs 3.2%), 6 (14.4% vs 6.5%), 12 (19.4% vs 10.9%), and 18 (20.0% vs 7.7%; odds ratio [OR] = 3.15; 95% confidence interval [CI] = 1.22, 8.14; P = .018; retention > 80%). Psychiatric measures did not predict abstinence; measures of motivation and tobacco dependence did. The usual care group had a significantly greater likelihood than the intervention group of psychiatric rehospitalization (adjusted OR = ...
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clinical management of tobacco dependence in Inpatient Psychiatry provider practices and patient utilization
Psychiatric Services, 2013Co-Authors: Teresa M Leyro, Sharon M Hall, Norval J Hickman, Romina Kim, Stephen E Hall, Judith J ProchaskaAbstract:ObjectiveThis investigation examined predictors of utilization of nicotine replacement therapy (NRT) during a smoke-free psychiatric hospitalization. MethodsSmokers (N=324) were recruited from smoke-free adult Inpatient psychiatric units. Exploratory analyses examined correlates of NRT provision and utilization. ResultsThe prevalence of NRT use was 51% overall and was greater among patients offered NRT on admission (58%) versus later (34%), among patients with more severe depression and nicotine withdrawal, and among those who reported perceptions that NRT decreases nicotine withdrawal, provides a nicotine substitute, and helps with quitting smoking (p<.05, all comparisons). Although the ratio of nicotine patch dose to usual cigarettes per day was 1.2±.7, the ratio was negatively correlated with time to first cigarette (Spearman’s ρ=–.30, p<.01), suggesting potential underdosing of more dependent smokers. ConclusionsDuring smoke-free psychiatric hospitalizations, clinical management of nicotine withdrawal...
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stage tailored tobacco cessation treatment in Inpatient Psychiatry
Psychiatric Services, 2009Co-Authors: M Judith P H J Prochaska, Stephen Hall, Sharon M HallAbstract:Individuals with mental illness and co-occurring addictive disorders account for 44% of the cigarettes sold in the United States (JAMA 284:2606–2610, 2000). Smokers with mental illness face serious tobacco-related consequences, including increased morbidity and mortality, isolation, stigma, and financial hardship. Tobacco use also increases the metabolism of some antipsychotic and antidepressant medications, with the potential for subtherapeutic treatment and higher rates of rehospitalization. Nearly half of U.S. state psychiatric hospitals now ban tobacco use on their premises. The American Psychiatric Association identifies psychiatric hospitalizations as an ideal opportunity to treat tobacco dependence. Yet little research has examined tobacco cessation treatments in Inpatient Psychiatry. If tobacco dependence is left unaddressed, most psychiatric patients return to smoking immediately after discharge (American Journal of Addictions 15:15–22, 2006). Multi-component interventions are needed that address the motivational, behavioral, and physiological aspects of nicotine dependence for smokers with co-occurring psychiatric disorders. We briefly describe an innovative tobacco treatment intervention initiated during psychiatric hospitalization. The intervention combines a computer-delivered expert system intervention and manual based on the transtheoretical model, an individual counseling session, and nicotine replacement therapy (NRT). The model identifies five stages of change: precontemplation (no immediate intention to stop smoking), contemplation (intending to quit in the next six months), preparation (considering quitting in the next month with a quit attempt in the past year), action (quit smoking for less than six months), and maintenance (smoke-free for at least six months). The 20-minute computer intervention generates individualized feedback at a sixth-grade reading level to guide participants through the stages of quitting smoking and to direct them to relevant sections of the manual. In a 30-minute session with the participant, study counselors review the printed feedback and manual, identify and support goals concerning tobacco use, and discuss proper use of NRT. Nine hospitalized psychiatric patients representing a range of psychiatric, demographic, and tobacco-use characteristics intensively evaluated the intervention components. Despite having fairly limited computer experience, all agreed or strongly agreed that the program was easy to understand and gave sound advice, and all recommended the computer program to others. Most participants required assistance with program navigation, suggesting the need for more user-friendly capabilities, such as a touch screen and audio. All participants read part of the manual, and most read beyond their stage-of-change chapter. Participants rated the manual highly for its organization and helpful strategies, describing it as “realistic” and “easy to understand … good for any person to read.” Participants also rated the counseling session highly, citing the openness of the dialogue, the focus on their needs and interests, and the lack of pressure to quit: “She didn’t push any points … she just presented the material. She was open, nonjudgmental. … She let me come to my own conclusions that I want to quit.” Most participants used NRT, identified several benefits, and expressed interest in continuing NRT after hospitalization. Side effects also were noted. Of concern, most participants stated that clinical staff did not instruct them in proper use of NRT. This small and intensive evaluation suggests that the intervention provides a viable and acceptable strategy for initiating tobacco treatment in the Inpatient psychiatric setting. In a randomized clinical trial, we are evaluating efficacy of the intervention relative to usual care. With a 79% recruitment rate, we enrolled 224 participants. After the brief hospital stay, intervention participants received ten weeks of NRT and two additional computer contacts, and their outpatient providers were informed of their cessation goals. Follow-up continues for 18 months. Psychiatric hospitals are making important strides in banning tobacco use. Bans, however, are only part of a much larger strategy needed to overcome the high rates of tobacco use in populations with mental illness. If cessation services are not offered, patients may misperceive smoking bans as punitive and themselves as unworthy of receiving intervention on this deadly addiction. When smoking was allowed on psychiatric units, an average of 15 minutes was spent per nursing shift managing patients’ cigarette use. Ideally, a portion of the time saved with a no-smoking policy could be shifted to delivery of cessation services. The findings present an innovative, acceptable, multicomponent intervention for initiating tobacco treatment in Inpatient Psychiatry.
Judith J Prochaska - One of the best experts on this subject based on the ideXlab platform.
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efficacy of initiating tobacco dependence treatment in Inpatient Psychiatry a randomized controlled trial
American Journal of Public Health, 2014Co-Authors: Judith J Prochaska, Stephen Hall, Kevin L Delucchi, Sharon M HallAbstract:Objectives. We evaluated the efficacy of a motivational tobacco cessation treatment combined with nicotine replacement relative to usual care initiated in Inpatient Psychiatry.Methods. We randomized participants (n = 224; 79% recruitment rate) recruited from a locked acute Psychiatry unit with a 100% smoking ban to intervention or usual care. Prior to hospitalization, participants averaged 19 (SD = 12) cigarettes per day; only 16% intended to quit smoking in the next 30 days.Results. Verified smoking 7-day point prevalence abstinence was significantly higher for intervention than usual care at month 3 (13.9% vs 3.2%), 6 (14.4% vs 6.5%), 12 (19.4% vs 10.9%), and 18 (20.0% vs 7.7%; odds ratio [OR] = 3.15; 95% confidence interval [CI] = 1.22, 8.14; P = .018; retention > 80%). Psychiatric measures did not predict abstinence; measures of motivation and tobacco dependence did. The usual care group had a significantly greater likelihood than the intervention group of psychiatric rehospitalization (adjusted OR = ...
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clinical management of tobacco dependence in Inpatient Psychiatry provider practices and patient utilization
Psychiatric Services, 2013Co-Authors: Teresa M Leyro, Sharon M Hall, Norval J Hickman, Romina Kim, Stephen E Hall, Judith J ProchaskaAbstract:ObjectiveThis investigation examined predictors of utilization of nicotine replacement therapy (NRT) during a smoke-free psychiatric hospitalization. MethodsSmokers (N=324) were recruited from smoke-free adult Inpatient psychiatric units. Exploratory analyses examined correlates of NRT provision and utilization. ResultsThe prevalence of NRT use was 51% overall and was greater among patients offered NRT on admission (58%) versus later (34%), among patients with more severe depression and nicotine withdrawal, and among those who reported perceptions that NRT decreases nicotine withdrawal, provides a nicotine substitute, and helps with quitting smoking (p<.05, all comparisons). Although the ratio of nicotine patch dose to usual cigarettes per day was 1.2±.7, the ratio was negatively correlated with time to first cigarette (Spearman’s ρ=–.30, p<.01), suggesting potential underdosing of more dependent smokers. ConclusionsDuring smoke-free psychiatric hospitalizations, clinical management of nicotine withdrawal...
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screening for understanding of research in the Inpatient Psychiatry setting
Journal of Empirical Research on Human Research Ethics, 2011Co-Authors: Norval J Hickman, Judith J Prochaska, Laura B DunnAbstract:People with mental illness constitute a substantial proportion of smokers and an important population for smoking cessation research. Obtaining informed consent in this population is a critical ethical endeavor. We examined performance on a three-item instrument (3Q) designed to screen for understanding of several key elements of research: study purpose, risks, and benefits. Patients were clinically diagnosed with primary unipolar depression (n = 40), a primary psychotic disorder (n = 32), both mood and psychotic disorders (n = 17), and primary bipolar disorder (n = 14). Among an ethnically diverse sample of 124 psychiatric Inpatients approached for a smoking cessation trial, 107 (86%) performed adequately on the 3Q (i.e., obtained a score of at least 3 out of a possible 6). Patients were better able to identify the study risks and benefits than to describe the study purpose. The 3Q appears to be a useful tool for researchers working with vulnerable psychiatric patients.
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ten critical reasons for treating tobacco dependence in Inpatient Psychiatry
Journal of the American Psychiatric Nurses Association, 2009Co-Authors: Judith J ProchaskaAbstract:Lawn and Pols reviewed 26 studies of Inpatient Psychiatry units reporting on the effectiveness of smoking bans and concluded (1) there were few problems, and (2) staff often anticipated far more problems than actually occurred (Lawn & Pols, 2005). Consistency, coordination, and full administrative support were identified as key elements to success. Units with partial, rather than complete, smoking bans were more likely to experience difficulties.
Prabha S. Chandra - One of the best experts on this subject based on the ideXlab platform.
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Catatonia among women with postpartum psychosis in a Mother-Baby Inpatient Psychiatry unit.
General hospital psychiatry, 2016Co-Authors: Abhinav Nahar, Geetha Desai, Nithin Kondapuram, Prabha S. ChandraAbstract:Abstract Objective The aims of the present study were to determine the prevalence of catatonia in women with postpartum psychosis, describe its socio demographic, clinical and obstetric correlates and identify predictors of treatment response. Methods Data was extracted from clinical charts of 200 women with postpartum psychosis admitted to an Inpatient mother baby unit (MBU) in India over a 3year period. Results Of the 200 patients, 20% (n=40) had symptoms of catatonia. Mean catatonia score on the Bush Francis Catatonia Rating Scale (BFCRS) was 14.97±3.2. The most frequent catatonic feature was mutism (n=40, 100%). Adequate response to lorazepam trial in catatonia was seen in half the women (n=18/36), with longer duration of untreated catatonia being associated with poorer response. An adequate response to Electroconvulsive therapy (ECT) was seen in 19 women who did not respond to the lorazepam trial. Women with catatonia had significantly higher rates of onset within the first four weeks of postpartum period (50% vs 31.5%, P=0.022) and a longer duration of untreated psychosis at presentation (79.46±159.88 vs 56.12±47.26, P=0.002) compared to mothers without catatonia. Conclusion Catatonic symptoms were identified in one-fifth (20%) of women with postpartum psychosis. Early identification and treatment of catatonia are essential for rapid control of symptoms in this vulnerable population.
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the establishment of a mother baby Inpatient Psychiatry unit in india adaptation of a western model to meet local cultural and resource needs
Indian Journal of Psychiatry, 2015Co-Authors: Prabha S. Chandra, Geetha Desai, Dharma Reddy, Harish Thippeswamy, Gayatri SarafAbstract:BACKGROUND: Several Western countries have established mother-baby psychiatric units for women with mental illness in the postpartum; similar facilities are however not available in most low and medium income countries owing to the high costs of such units and the need for specially trained personnel. MATERIALS AND METHODS: The first dedicated Inpatient mother-baby unit (MBU) was started in Bengaluru, India, in 2009 at the National Institute of Mental Health and Neurosciences in response to the growing needs of mothers with severe mental illness and their infants. We describe the unique challenges faced in the unit, characteristics of this patient population and clinical outcomes. RESULTS: Two hundred and thirty-seven mother-infant pairs were admitted from July 2009 to September 2013. Bipolar disorder and acute polymorphic psychosis were the most frequent primary diagnosis (36% and 34.5%). Fifteen percent of the women had catatonic symptoms. Suicide risk was present in 36 (17%) mothers and risk to the infant by mothers in 32 (16%). Mother-infant bonding problems were seen in 98 (41%) mothers and total breastfeeding disruption in 87 (36.7%) mothers. Eighty-seven infants (37%) needed an emergency pediatric referral. Ongoing domestic violence was reported by 42 (18%). The majority of the mother infant dyads stayed for CONCLUSIONS: Starting an MBU in a low resource setting is feasible and is associated with good clinical outcomes. Addressing risks, poor infant health, breastfeeding disruption, mother infant bonding and ongoing domestic violence are the challenges during the process. Language: en
Christopher M Perlman - One of the best experts on this subject based on the ideXlab platform.
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how high trends in cannabis use prior to first admission to Inpatient Psychiatry in ontario canada between 2007 and 2017 a quelle hauteur les tendances de l usage du cannabis avant la premiere hospitalisation en psychiatrie en ontario canada entre 2007 et 2017
The Canadian Journal of Psychiatry, 2020Co-Authors: Taylor Mcguckin, Mark A Ferro, David Hammond, Shannon L Stewart, Bridget Maloneyhall, Nawaf Madi, Amy Porath, Christopher M PerlmanAbstract:Objectives:To examine the trends in cannabis use within 30 days of first admission to Inpatient Psychiatry in Ontario, Canada, between 2007 and 2017, and the characteristics of persons reporting ca...
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development of mental health quality indicators mhqis for Inpatient Psychiatry based on the interrai mental health assessment
BMC Health Services Research, 2013Co-Authors: Christopher M Perlman, John P Hirdes, Howard E Barbaree, Brant E Fries, Ian Mckillop, John N Morris, Terry RabinowitzAbstract:Outcome quality indicators are rarely used to evaluate mental health services because most jurisdictions lack clinical data systems to construct indicators in a meaningful way across mental health providers. As a result, important information about the effectiveness of health services remains unknown. This study examined the feasibility of developing mental health quality indicators (MHQIs) using the Resident Assessment Instrument - Mental Health (RAI-MH), a clinical assessment system mandated for use in Ontario, Canada as well as many other jurisdictions internationally. Retrospective analyses were performed on two datasets containing RAI-MH assessments for 1,056 patients from 7 facilities and 34,788 patients from 70 facilities in Ontario, Canada. The RAI-MH was completed by clinical staff of each facility at admission and follow-up, typically at discharge. The RAI-MH includes a breadth of information on symptoms, functioning, socio-demographics, and service utilization. Potential MHQIs were derived by examining the empirical patterns of improvement and incidence in depressive symptoms and cognitive performance across facilities in both sets of data. A prevalence indicator was also constructed to compare restraint use. Logistic regression was used to evaluate risk adjustment of MHQIs using patient case-mix index scores derived from the RAI-MH System for Classification of Inpatient Psychiatry. Subscales from the RAI-MH, the Depression Severity Index (DSI) and Cognitive Performance Scale (CPS), were found to have good reliability and strong convergent validity. Unadjusted rates of five MHQIs based on the DSI, CPS, and restraints showed substantial variation among facilities in both sets of data. For instance, there was a 29.3% difference between the first and third quartile facility rates of improvement in cognitive performance. The case-mix index score was significantly related to MHQIs for cognitive performance and restraints but had a relatively small impact on adjusted rates/prevalence. The RAI-MH is a feasible assessment system for deriving MHQIs. Given the breadth of clinical content on the RAI-MH there is an opportunity to expand the number of MHQIs beyond indicators of depression, cognitive performance, and restraints. Further research is needed to improve risk adjustment of the MHQIs for their use in mental health services report card and benchmarking activities.
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development of mental health quality indicators mhqis for Inpatient Psychiatry based on the interrai mental health assessment
BMC Health Services Research, 2013Co-Authors: Christopher M Perlman, John P Hirdes, Howard E Barbaree, Brant E Fries, Ian Mckillop, John N Morris, Terry RabinowitzAbstract:Background Outcome quality indicators are rarely used to evaluate mental health services because most jurisdictions lack clinical data systems to construct indicators in a meaningful way across mental health providers. As a result, important information about the effectiveness of health services remains unknown. This study examined the feasibility of developing mental health quality indicators (MHQIs) using the Resident Assessment Instrument - Mental Health (RAI-MH), a clinical assessment system mandated for use in Ontario, Canada as well as many other jurisdictions internationally.
Christopher G Ahnallen - One of the best experts on this subject based on the ideXlab platform.
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skills based psychotherapy training for Inpatient Psychiatry residents a needs assessment and evaluation of a pilot curriculum
Academic Psychiatry, 2020Co-Authors: Brady B Lonergan, Nerissa P Duchin, John A Fromson, Christopher G AhnallenAbstract:The study’s objectives were to assess the psychotherapy interests and needs of Psychiatry residents, to develop a psychotherapy didactic curriculum for Psychiatry residents on the Inpatient service, and to evaluate residents’ self-reported understanding and confidence with skills-based interventions. Psychiatry residents within a major metro region in the Northeast were asked if they would voluntarily participate in a survey to assess their interest and skills. Based on the results of this survey, the authors devised an 8-week course for seventeen residents on the Inpatient unit. Topics included general cognitive behavioral therapy (CBT), sleep hygiene, behavioral activation, dialectical behavioral therapy (DBT), mind-body skills, and motivational interviewing. Residents completed post-course questionnaires on comprehension and confidence in providing psychotherapy skills using 5-point Likert scales. Participants (N = 39) reported a strong interest in learning psychotherapy and in education focused on Inpatient skills-based interventions. At the end of the course, 12/17 (70.6%) participants provided feedback to indicate that 9/12 (75%) respondents experienced increased confidence in therapy skills, 10/12 (83.3%) reported a basic understanding of skills-based psychotherapy, and 10/12 (83.4%) believed they could teach at least one new technique. Psychiatry residents in this study overwhelmingly requested additional training focused on skills relevant to Inpatient service, and the curriculum the authors developed led to a subjective self-reported understanding of and confidence in providing these psychotherapy skills on the Inpatient unit. These very preliminary results suggest that provision of increased skills-based psychotherapy training for Inpatient Psychiatry residents is important and beneficial within resident education.
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skills based psychotherapy training for Inpatient Psychiatry residents a needs assessment and evaluation of a pilot curriculum
Academic Psychiatry, 2020Co-Authors: Brady B Lonergan, Nerissa P Duchin, John A Fromson, Christopher G AhnallenAbstract:Objective The study’s objectives were to assess the psychotherapy interests and needs of Psychiatry residents, to develop a psychotherapy didactic curriculum for Psychiatry residents on the Inpatient service, and to evaluate residents’ self-reported understanding and confidence with skills-based interventions.