Psychiatric services最新文献

Objective: Attention-deficit hyperactivity disorder (ADHD) diagnosis rates and stimulant use have increased recently, particularly among adults, in the context of increased telehealth use and shortages in stimulant medications. To better understand changes in ADHD medication use and inform policy governing the prescribing of these medications, this study aimed to compare stimulant and nonstimulant fills for 2019 versus 2023.

Methods: This study used national all-payer prescription claims data for 2019 (before onset of the COVID-19 pandemic) and 2023 to calculate stimulant and nonstimulant ADHD medication fill rates overall and by patient age and prescriber specialty.

Results: Total ADHD medication fills increased 23.8%, from 72,849,441 in 2019 to 90,183,437 in 2023; stimulants accounted for most fills (91.4% in 2019; 88.9% in 2023). Whereas the number of stimulant fills rose 20.4% from 2019 to 2023, the number of nonstimulant fills increased at three times that rate (60.1%). Both stimulant and nonstimulant fills increased among adults, whereas stimulant fills decreased 6.5% among children (ages 0-18). Nurse practitioners and physician assistants were responsible for one in three ADHD prescription fills in 2023; nonstimulants were prescribed most commonly by these providers and by psychiatrists.

Conclusions: The number of ADHD medication fills rose substantially from 2019 to 2023. Although a majority of 2023 fills were stimulants, nonstimulant fills sharply increased, even though nonstimulants are not the first-choice ADHD medication treatment. This increase was likely due in part to stimulant shortages that continue to limit access to ADHD pharmacotherapy nationwide.

Objective: To enhance understanding of the risk for violence in inpatient psychiatric environments, the authors studied assaultive behavior in a large health care system to explore the demographic, clinical, and other factors associated with the likelihood of patients' committing a physical assault.

Methods: In this retrospective chart review study, 3 years of data were collected from a single-state health care system spanning >330 inpatient psychiatric beds across six separate hospitals. The system's risk management database was queried for all physical assaults during the study period (2021-2023), and these assaults were cross-matched with patients' electronic medical record data. Descriptive and inferential statistical analyses were conducted to investigate differences between patients who had committed an assault during the study period and those who had not.

Results: A total of 15,186 unique inpatients were evaluated, and 556 physical assaults committed by 359 (2.4%) patients during the study period were identified. Patients who committed an assault were significantly more likely to be male, be younger, identify as Black or African American, have a psychotic disorder, be subject to conservatorship, have been admitted involuntarily, and have a known history of assault. Patients with a comorbid substance use disorder were significantly less likely to engage in assault.

Conclusions: This study represents one of the largest investigations into rates of assault by patients in U.S. inpatient psychiatric hospitals. By attaining a greater understanding of risk factors for inpatient assault, this study may contribute to the development of risk assessment and management methodologies.

Objective: This study aimed to characterize the use of emergency psychiatric holding powers in Ireland, investigate predictors of their initiation, and describe clinical outcomes among patients subject to holds.

Methods: This retrospective case-control study characterized and compared all voluntarily admitted patients who were either detained under holding powers (N=167 cases involving 162 unique patients) or not subject to holding powers (N=334 control patients) during a stay in one of two psychiatric hospitals in Dublin (January 2018-December 2020). These groups were examined from admission through 1 year after discharge.

Results: The use of holding powers was rare (2% of voluntary admissions during the study). Patients in both groups were similar, with no significant sociodemographic differences. The case group was rated as having more severe illness at admission (p<0.001). Multivariable analyses demonstrated that detention was more likely in the presence of impaired insight (OR=4.14), psychotic symptoms (OR=7.56), and suicidal ideation (OR=2.58) at admission and with a diagnosis of bipolar disorder (OR=2.50). Mean length of stay was longer for case group (vs. control group) patients (81.37 vs. 45.74 days, z=-7.42, p<0.001), but illness improvement ratings at discharge did not significantly differ between the groups, nor did readmission rates for the year after discharge.

Conclusions: Voluntarily admitted patients who became subject to holding powers had more severe illness at admission than did those without holds. The likelihood of experiencing detention increased with impaired insight, psychotic symptoms, and suicidal ideation at admission. However, the results suggested that treatment outcomes for both groups were similar.

Objective: Unaddressed mental health needs of justice-involved youths increase the risk for reoffending and impede effective community integration. This study had three main objectives: to calculate the prevalence of mental disorders, to estimate the cumulative incidence of reoffending, and to examine patterns of nonmandated outpatient mental health treatment and its association with reoffending among justice-involved youths.

Methods: Offending records from January 1, 1994, to March 31, 2022, were linked with mental health records from January 1, 2001, to March 31, 2022, for justice-involved youths supervised in both custodial (N=790) and community (N=766) settings in New South Wales, Australia. The association between mental health service contact and reoffending was assessed by using Cox proportional hazards regression.

Results: Mental health issues were prevalent among 32% of girls and 29% of boys. Among custody-supervised youths, 49% reoffended within 12 months of release. Custody-supervised youths with mental health issues had a median time of 1 month until contact with mental health services after their release. Among community-supervised youths, 41% reoffended within 12 months of study entry. The median time until contact with mental health services for community-supervised youths with mental health issues was 6 months. Contact with mental health services was associated with lower hazards of reoffending among boys in custody (adjusted hazard ratio [aHR]=0.60, p=0.001) and under community supervision (aHR=0.43, p=0.045).

Conclusions: Clinical engagement with mental health services can address criminogenic mental health problems among justice-involved youths and reduce criminal behavior.

Objective: Given the growing need for novel psychiatric service delivery, this study sought to characterize the use of an outpatient electronic consultation service, Ask-A-Doc (AAD), in a rural health care system.

Methods: A qualitative codebook was developed (final interrater agreement=92%) and applied to the free text of all AAD questions (N=707) received by a psychiatry department during a 12-month period.

Results: Primary care was the principal source of AAD questions (95%), with most submitted by physicians (56%) and advanced practitioners (44%). Medication management was the most common reason for AAD submission (90%). Submissions mentioned psychiatric symptoms (85%) more than diagnoses (52%). Commonly mentioned symptoms included anxiety and depression; frequently mentioned diagnoses included bipolar disorder, attention-deficit hyperactivity disorder, and major depressive disorder.

Conclusions: Nonpsychiatrists find benefit in psychiatrist assistance in managing patients with mental health conditions; they generally want recommendations for medication management to target specific symptoms, not assistance with making or treating specific diagnoses.

Objective: The authors aimed to estimate the past-year prevalence of mental and substance use disorders, including schizophrenia spectrum disorders (schizophrenia, schizoaffective, or schizophreniform disorder), among U.S. adults ages 18-65 years from samples of households and prisons and stratified samples from selected homeless shelters and state psychiatric hospitals. Such information is vital to meet the treatment needs of individuals with these disorders.

Methods: The Mental and Substance Use Disorders Prevalence Study (MDPS) was conducted between October 2020 and October 2022. Interviewers administered a structured clinical interview for the DSM-5 (N=5,679 participants; N=4,764 in households). Weighted past-year prevalence estimates of mental and substance use disorders were calculated. Level of impairment and the likelihood that a disorder was caused by the COVID-19 pandemic were assessed.

Results: The prevalence estimates of lifetime and past-year schizophrenia spectrum disorders were 1.8% (95% CI=1.3%-2.5%) and 1.2% (95% CI=0.9%-1.8%), respectively. The most common past-year disorders were major depressive disorder (15.5%, 95% CI=13.6%-17.5%) and generalized anxiety disorder (GAD; 10.0%, 95% CI=8.3%-12.1%). About one in 10 participants had at least one substance use disorder (10.6%, 95% CI=8.7%-12.9%). Half of those with an MDPS mental disorder had moderate or serious impairment.

Conclusions: The prevalence rates of lifetime and past-year schizophrenia spectrum disorders were two to four times higher than previously reported. The prevalence rates of major depressive disorder and GAD were substantially higher than reported in past national studies. Almost 20% of these cases were likely due to the pandemic. Increased mental health treatment resources are urgently needed.

Objective: Electroconvulsive therapy (ECT) is an effective treatment for severe depression, but racial-ethnic disparities in its receipt have long been observed, and previous studies have had limited generalizability. This study aimed to determine whether racial-ethnic disparities persist in contemporary treatment environments after adjustment for various demographic factors.

Methods: A retrospective study was conducted among patients with data in the HCA Healthcare Enterprise Data Warehouse who were diagnosed as having severe unipolar depression (ICD-10 codes F32-F33) and who sought care in any of 162 inpatient and outpatient facilities between 2016 and 2021. Patients were grouped by self-reported racial-ethnic identity. The association between race-ethnicity and selected covariates was determined by using chi-square tests (α=0.05), and the relationship between race-ethnicity and ECT receipt, given selected predictor variables, was estimated by using logistic regression.

Results: Analyses were conducted for 19,011 unique patients. Significant variation by race-ethnicity was found for all covariates (p<0.001). ECT was administered to 3% of White patients and 1% of non-White patients. Compared with all other race-ethnicities, the unadjusted odds ratio for ECT receipt among White patients was 3.12 (p<0.001). Patients from each non-White racial-ethnic group had significantly lower rates of ECT receipt compared with White patients, including Asian (adjusted OR [aOR]=0.43, p<0.001), Black (aOR=0.27, p<0.001), and Hispanic (aOR=0.39, p<0.001) patients and patients identifying as other race-ethnicity (aOR=0.53, p=0.001).

Conclusions: In this nationwide study, significant disparities in ECT use, by self-identified racial-ethnic identity, were observed even after demographic covariates were controlled.