Vulnerable long-term psychiatric inpatients need screening for physicalhealth problems: An audit of regular hospital statistics and clinical files

Abstract

Objective: Maintaining physical health in the presence of severe mental illness remains a challenge. The aims of this study were to identify the most pressing physical health problems of long-term psychiatric in-patients and to identify vulnerable subgroups, as part of a multi-phased programme evaluation project to improve service delivery to and quality of care of long-term patients in Weskoppies Hospital. Method: Regular nursing statistics on vital data, infections, injuries, deaths, and adverse incidents, as well as clinical file data, infection-control statistics and dietician statistics were recorded for 268 long-term in-patients at Weskoppies Hospital over six months. Adverse incidents including aggression were recorded because of their potential for injury and nursing implications. Subgroups of patients were compared using two-way tables and Fisher's Exact Tests, or Mann-Whitney-U and KruskalWallis tests. Results: The blood pressure of hypertensive patients was well controlled. Prevalent problems were epilepsy, respiratory tract infections, and injuries (accidental and from fighting or assault). Most vulnerable are older male patients (prone to respiratory tract infections and lower body weight); patients with cognitive disorders (prone to any injury, especially accidents and falls); and younger male patients (prone to aggression and resultant injury). Conclusion: Increased screening should be conducted for older underweight male patients (for chronic respiratory or infectious diseases that might cause cachexia) and of patients with cognitive disorders or who have fallen (for treatable risk factors for falling and preventative measures). More patients should be referred for special diets. Nursing interventions should be emphasised more with aggressive and irritable patients.

Prevalence of Physical comorbidities among Long-Term Psychiatric Inpatients: A Single Centre Study from South India

“…While some studies have observed the prevalence to be higher than 70%, 9,11,14 others have reported lower estimates. 15,16,17 This difference in the estimated prevalence of physical comorbidities among long-term stay patients with psychiatric patients in various studies could be due to the differences in the age composition of the study participants, general population prevalence of physical disorders in the study region and preventative measures put in place by the facilities to reduce physical comorbidities.…”

“…For psychiatric in-patients, and in particular for long-term psychiatric in-patients, the challenge of maintaining physical health often relates to various factors, including inadequate monitoring of their physical problems, inadequate self-report by the patients themselves of physical symptoms due to severe psychopathology or cognitive impairment, preexisting genetic vulnerability and adverse effects of the antipsychotic medications. 8,9 Previous studies from the western parts of the world have examined the prevalence of physical comorbidities among long-term stay patients. In a study, the prevalence of physical morbidity in elderly psychiatric patients was observed to be nearly 75%.…”

Psikiyatri Kliniğinde Yatan Hastaların Komorbit Somatik Hastalıkları

“…Cinsiyet ile somatik tanı dağılımı arasında istatistiksel olarak anlamlı bir ilişkinin olmadığı görüldü. Yapılan çalışmalarda psikiyatri kliniğinde yatan erkek hastalarda kadın hastalara göre daha fazla travma ve solunum yolu enfeksiyonları olduğu saptanmıştır (17,26,27). Başka bir çalışmada kadınlarda fiziksel hastalık sıklığı daha yüksek bulunmuştur (25).…”

“…Geniş ölçekli bir çalışmada psikiyatri hastalarının en sık somatik tanıları arasında vasküler, endokrin ve nörolojik hastalıklar olduğu belirtilmiştir (16). Afrika'da yapılan bir çalışmada ise ruhsal rahatsızlıklara daha çok hipertansiyon, epilepsi, solunum yolu enfeksiyonları ve yaralanmalar eşlik etmektedir (17). Yapılan birçok çalışmada ruhsal rahatsızlıklara daha çok endokrin, kardiyovasküler ve nörolojik hastalıkların eşlik ettiği saptanmıştır (18)(19)(20)(21).…”